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Rings And Webs

  1. Oesophageal webs are thin membranes of connective tissue covered by normal squamous epithelium, usually situated in the upper third and are frequently asymmetrical.
  2. The association of a cervical oesophageal web and iron deficiency anaemia is known as the Paterson-Brown-Kelly (or Plummer-     Vinson) syndromeQ and occurs most often in middle-aged women.These webs regress spontaneously with treatment of the anaemia and, the syndrome is associated with an increased incidence of post-cricoid carcinoma of esophagus and oral cavity.
  3. Types of oesophageal ring:
    Schatzki ring –  
    1. It is a complication of GERD.
    2. Symmetrical, Submucosal, fibrous thickening, measuring 1-3mm in thickness and occurs at the squamo-columnar junction at the lower end of the oesophagus.
    3. The ring can be seen endoscopically above the diaphragmatic indentation.
    4. The other type of ring occurs just cephalad to the site of the Schatzki ring, at the junction of the distal oesophagus and the uppermost part of the lower oesophageal sphincter and is thought to be muscular. Manometrically, this corresponds to a high pressure zone and is frequently associated with oesophageal motor disorders and diffuse oesophageal spasm.
    5. Most have a luminal diameter of at least 2 cm and are asymptomatic.
    6. When the diameter is less than 2 cm, patients may have dysphagia.
    7. The classic esophageal web occurs in the cervical esophagus, just below the cricopharyngeal muscle.
    8. In contradistinction to Schatzki's rings and lower esophageal mucosal rings, cervical esophageal webs are    not usually circumferential; rather, they are U shaped and indenting the anterior and lateral walls but sparing the posterior wall
    9. Luminal diameter                
      <2 cm – asymptomatic
      >2 cm - dysphagia

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