Multiple esophageal rings

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 rings: an association with eosinophilic esophagitis: case report and review of the literature

Esophagitis may present endoscopically with erythema, edema, loss of vascular pattern, friability, and ulceration of the esophageal mucosa. Left untreated, chronic esophagitis may result in stricture formation. The presence of multiple concentric rings involving the entire esophagus has been cited as a chronic form of esophagitis. We present a case of an 8-yr-old boy with multiple concentric esophageal rings and histological evidence of eosinophilic esophagitis, who failed medical antireflux treatment and responded to an elimination diet.

Esophageal rings, webs, and diverticula

Rings, webs, and diverticula are among the most common anatomic anomalies of the esophagus. Although these structural lesions are often asymptomatic, patients can develop significant problems with dysphagia, regurgitation, and aspiration. This article discusses the epidemiology, pathogenesis, diagnosis, and therapy of esophageal rings, webs, and diverticula with emphasis on the clinical, diagnostic, and therapeutic strategies involved in caring for patients with these conditions.

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.

Felinization of the esophagus

Transient transverse folds of the esophageal mucosa as seen by barium esophagography and on endoscopic examination have been termed "felinization." This finding has been considered a normal variant or has been associated with reflux esophagitis. No symptoms have been associated with its presence. In 280 unselected patients undergoing upper gastrointestinal endoscopy in our clinic, felinization was identified in 24% by prospective visual examination. It was not correlated with sex, age, symptom complex, or common coexistent endoscopic findings. These transverse esophageal folds, although visually interesting, appear to have no clinical significance. The endoscopist should recognize and differentiate them from fixed or persistent folds that can be associated with mucosal disease.