Double congenital midesophageal webs in adults

The ringed esophagus: histological features of GERD

OBJECTIVE

The "ringed" or "corrugated" esophagus is a cause of chronic dysphagia and recurrent food impactions in young men. It was previously believed to be a congenital condition, but recent case series have documented histological esophagitis in these patients. We have treated 19 patients with a ringed esophagus and are impressed that this represents an acquired condition with gastroesophageal reflux disease (GERD) as its etiology. Our goals are to present the largest case series to date of ringed esophagus, discuss the evidence for GERD, and suggest a strategy for its diagnosis and management.

METHODS

The charts of 19 patients with a ringed esophagus were reviewed. A single pathologist interpreted all available esophageal biopsy specimens and graded them for the presence of GERD-related abnormalities. Phone interviews were conducted to assess response to therapy and confirm historical features obtained from medical records.

RESULTS

The typical patient is a young man (median age 35, M:F 17:2) with long-standing dysphagia and multiple food impactions. Endoscopy revealed multiple concentric rings that persisted despite air insufflation and caused significant stenosis. Of the 11 patients with available histology, all had basal cell hyperplasia, papillomatosis, and an increased number of intraepithelial eosinophils. Other clinical features of GERD such as heartburn, endoscopic esophagitis, and hiatal hernia were often absent. Response to dilation and acid suppression was good.

CONCLUSIONS

The uniform presence of histological esophagitis with intraepithelial eosinophils, basal cell hyperplasia, and papillary lengthening strongly implicates GERD in the pathogenesis of the adult ringed esophagus. In addition to a series of gradual esophageal dilations, we suggest using a proton pump inhibitor to provide acid suppression.

Multiple esophageal webs: treatment and follow-up of seven patients

We have treated seven patients with multiple esophageal webs without a predisposing disorder. The patients ranged in age from 34 to 61 years and had suffered from dysphagia for 4 to 26 years. None had skin disease, a history of ingestion of a potentially caustic substance, or evidence of gastroesophageal reflux disease by history or endoscopy. All patients responded to esophageal dilation, but dysphagia recurred in all during follow-up ranging from 6 months to 4 years, often requiring repeated dilation. Study of our patients and similar patients reported previously leads us to believe this unusual disorder is congenital.

Congenital esophageal stenosis presenting as noncardiac, esophageal chest pain

A case of a 31-year-old female with congenital esophageal stenosis presenting with symptoms of chest pain caused by esophageal dysmotility is described. The involved segment in congenital esophageal stenosis has a characteristic thickening of the muscularis propria layer, as seen by EUS examination. In these patients, symptoms of dysphagia can be managed with esophageal dilation and noncardiac esophageal chest pain responds to pharmacotherapy with diltiazem.