The esophagus is a fibromuscular tube that connects the mouth to the stomach and progresses food along the digestive tract via a series of peristaltic contractions. From the lumen outwards, the esophagus is composed of mucosa, submucosa, muscle, and fibrous tissue. Under normal circumstances, the esophagus is open and flexible and we can swallow food without thinking much about it. Sometimes, though, abnormal growth can cause obstructions that lead to numerous problems. One common example of this is esophageal rings.
What Are Esophageal Rings?
Esophageal rings are essentially anomalous folds of epithelium that form around the inside of the esophagus. Similar to esophageal strictures, the bands of tissue can grow inward far enough to eventually cause difficulty swallowing and other symptoms related to esophageal motility. Esophageal rings can be divided into two major types: A rings and B rings. A rings are found in the distal esophagus but above the squamocolumnar junction, a line of demarcation between the lower esophagus and the stomach. B rings, also known as Schatzki rings, are only found at this squamocolumnar junction.
What Are Esophageal Webs?
A closely related but different phenomenon is the esophageal web. Whereas esophageal rings are primarily found in the lower esophagus, esophageal webs are found in the upper (proximal) esophagus. Esophageal webs are also abnormal growths of epithelial tissue, but in this case they form thin membranes that partially block the esophagus, usually on its anterior side. Because the blockage is usually not as extreme, many people have an esophageal web without any symptoms present.
Symptoms of Esophageal Rings and Webs
For all types of esophageal rings and webs, many people will not experience any symptoms. The type and severity of the symptoms will be related to how much of a blockage the growth is causing. The most common symptom is dysphagia, the medical term for difficulty swallowing a bolus of solid food. In severe cases, the blockage can be so large that even liquids are difficult to swallow; it is also possible to have total blockage and not be able to swallow at all.
Many people with esophageal rings report a feeling akin to choking when attempting to swallow food normally. Sometimes bits of food can get temporarily stuck on a web or a ring and cause a feeling that something is stuck in the throat. This can also make it difficult to swallow pills that might be needed to treat other conditions. In general, dysphagia can be quite disruptive to quality of life; there is even a link between difficulty swallowing and weight loss because of ongoing discomfort when eating.
What Causes Esophageal Rings?
The underlying cause behind esophageal rings and webs is not currently known, but in some cases it does seem to be passed down from parents to children through genetics. Because of the likelihood of being asymptomatic, it is also unclear how prevalent this condition is. There are, however, a number of theories about factors that might be involved in the development of esophageal rings:
- Hiatal hernia: In a typical hiatal hernia, a little portion of the stomach slips through the diaphragm through the opening to the esophagus. When this happens, abnormalities in the folding of tissue can cause a lower esophageal mucosal ring to form in the area.
- Iron deficiency: Iron-deficiency anemia is characterized by having not enough blood cells available to carry oxygen in the bloodstream. In addition to causing symptoms like fatigue and shortness of breath, iron deficiency anemia can also contribute to the development of Plummer-Vinson syndrome, a disease that includes the formation of esophageal webs. There may also be a link to celiac disease.
- GERD: There is also significant evidence that points to inflammatory conditions like gastroesophageal reflux disease (GERD) may be a factor in the formation of esophageal rings. In a patient with GERD, dysfunction in the lower esophageal sphincter causes stomach acid and contents to back up into the esophagus. Over time, chronic acid reflux can cause permanent scarring. It is believed that this may lead to the formation of lower esophageal rings as well.
- Barrett’s esophagus: The scarring and lesions that can happen with GERD can also lead to Barrett’s esophagus, a condition where there is a change to the mucosa of the esophagus on a cellular level. This change in the makeup of cells in the esophagus is thought to be precancerous and is also potentially a cause of esophageal rings.
- Esophagitis: Esophagitis is the general medical term for inflammation of the esophagus. Examples included pill-induced esophagitis and eosinophilic esophagitis. Though more research needs to be done, studies have shown a strong connection between esophagitis and Schatzki’s rings.
How Are Esophageal Rings Diagnosed?
As noted above, dysphagia is the most common symptom associated with esophageal rings, but it’s also a common symptom associated with many other gastrointestinal conditions. To investigate the symptoms or confirm a diagnosis, a gastroenterologist will have to use an imaging test like an X-ray with a barium swallow or upper GI endoscopy. Because of the connection with Plummer-Vinson syndrome, a test for iron deficiency anemia may also be ordered.
How Are Esophageal Rings Treated?
As with many diseases, the treatment will depend on the severity of the condition or the types of symptoms that are present. Generally speaking, though, treatment involves dealing with the underlying problem and stretching out the esophagus to relieve any dysphagia. Below are some common treatments for esophageal rings and webs:
- Medication: For patients with GERD, proton pump inhibitors (ppis) are often prescribed to reduce the amount of stomach acid that gets produced. By treating the source of the esophageal damage, less abnormal tissue will form. For people with iron-deficiency anemia, iron supplements may also be used.
- Dilation: Esophageal dilation means that the gastroenterology doctor uses an endoscope to place a special balloon in the esophagus in order to stretch it out. This treatment also often includes acid-suppression medication.
- Hernia repair: If a hiatal hernia is the potential cause, the damage needs to be treated first. This can involve medication and in rare cases esophageal surgery.
- Dietary changes: Part of the management of symptomatic esophageal rings and webs involves making adjustments to your diet to help with swallowing. In addition to eating more slowly and in smaller bites, it’s helpful to avoid tough foods like some types of meat.
Contact a Gastroenterologist
Difficulty swallowing can be a symptom for a variety of different gastrointestinal conditions, but there are some other signs that it might be an esophageal ring. Regardless of the reason, though, difficulty swallowing should be taken seriously. To speak with a gastroenterologist, contact Cary Gastro today to request an appointment. Our doctors and staff are passionate about providing the very best digestive health care.