Esophageal web: Difference between revisions
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{{CMG}} | __NOTOC__ | ||
{{Graves' disease}} | |||
{{CMG}};{{AE}}{{AY}} | |||
==Overview== | ==Overview== | ||
{{Infobox_Disease | | {{Infobox_Disease | | ||
Name = {{ | Name = {{Esophageal web}} | | ||
Image = | | Image = | | ||
Caption = | | Caption = | | ||
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Esophageal webs are associated with | ==Overview== | ||
==Historical perspective== | |||
*In 1944, esophageal webs were first described by Templeton and it was thought to be a congenital disease because most of the patients were children. | |||
*In 1953, a series of case reports of patients having dysphagia and radiological signs denoting esophageal narrowing made the diagnosis of esophageal rings not confined to the pediatric population. | |||
*In 1968, histological examination of specimens from the esophageal rings proved that none of them had muscle involvement. | |||
==Classification== | |||
Esophageal webs can be classified according to their site and their extent in three categories | |||
===Type A=== | |||
*Type A esophageal rings describe webs that involve the muscle layer of the esophageal wall and lies in close proximity to the squamocolumnar junction. | |||
*It is less common than type B esophageal webs. | |||
===Type B=== | |||
*Type B esophageal rings describe the webs that involve only the mucosa and submucosa of the esophagus. | |||
*It is often named “Schatzki ring”. | |||
*It is located exactly at the squamocolumnar junction. | |||
===Type C=== | |||
*Type C esophageal rings refer to wall invaginations due to pressure from the diaphragm. | |||
*It is rare with no clinical significance. | |||
==Pathophysiology== | |||
===Pathogenesis=== | |||
There are multiple theories explaining the origin of esophageal webs | |||
====Inflammation==== | |||
*Esophageal webs are thought to be due to the chronic damage to the esophageal mucosa. | |||
*This is supported by the presence of inflammatory cells in the wall of the web. | |||
*In allergic esophagitis, eosinophils were found while in cases of chronic inflammation as GERD, lymphocytes prevailed. | |||
====Congenital theory==== | |||
*Esophageal webs are thought to be due to failure of the esophagus to recanalize. | |||
*Specimens showed that the esophageal webs contained respiratory epithelium supporting this theory. | |||
*The webs mostly remain asymptomatic for long times and that is why it is not correlated with being congenital. | |||
====Iron deficiency==== | |||
*The esophageal webs of Plummer-Vinson syndrome have been associated with iron deficiency anemia in many studies. | |||
*The exact mechanism by which iron deficiency causes esophageal webs is not known, but it was hypothesized that iron deficiency starts a sequence of events in the esophageal epithelium that ends in its damage and formation of a web. | |||
*Moreover, treatment of iron deficiency in Plummer-Vinson syndrome patients leads to resolution of dysphagia even before the laboratory results become normal. | |||
===Gross picture=== | |||
*Esophageal webs appear as an eccentric narrowing of the esophageal lumen (while rings cause circumferential narrowing). | |||
===Microscopic picture=== | |||
*Esophageal webs are covered normally by mucosa and submucosa. | |||
*It is characterized by the presence of basal cell hyperplasia. | |||
*The tissue is often heavily infiltrated with chronic inflammatory cells. | |||
*Eosinophilic esophagitis is characterized by the presence of eosinophils infiltration. | |||
==Causes== | |||
===More common causes=== | |||
*Iron deficiency anemia | |||
*Plummer-Vinson syndrome | |||
*Celiac sprue | |||
*Zenker’s diverticulum | |||
===Less common causes=== | |||
*Epidermolysis bullosa | |||
*Bullous pemphigoid | |||
*Graft versus host disease | |||
*Pemphigus Vulgaris | |||
==Differentiating esophageal webs from other diseases== | |||
==Risk factors== | |||
==Screening== | |||
Acorrding to USPSTF, there are no screening measures recommended for esophageal webs. | |||
==Natural history, complications and prognosis== | |||
==History and symptoms== | |||
==Physical examination== | |||
==Lab findings== | |||
==Radiological tests== | |||
==Treatment== | |||
Revision as of 14:16, 16 November 2017
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Graves' disease Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Case Studies |
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Esophageal web On the Web |
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American Roentgen Ray Society Images of Esophageal web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
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Overview
Historical perspective
- In 1944, esophageal webs were first described by Templeton and it was thought to be a congenital disease because most of the patients were children.
- In 1953, a series of case reports of patients having dysphagia and radiological signs denoting esophageal narrowing made the diagnosis of esophageal rings not confined to the pediatric population.
- In 1968, histological examination of specimens from the esophageal rings proved that none of them had muscle involvement.
Classification
Esophageal webs can be classified according to their site and their extent in three categories
Type A
- Type A esophageal rings describe webs that involve the muscle layer of the esophageal wall and lies in close proximity to the squamocolumnar junction.
- It is less common than type B esophageal webs.
Type B
- Type B esophageal rings describe the webs that involve only the mucosa and submucosa of the esophagus.
- It is often named “Schatzki ring”.
- It is located exactly at the squamocolumnar junction.
Type C
- Type C esophageal rings refer to wall invaginations due to pressure from the diaphragm.
- It is rare with no clinical significance.
Pathophysiology
Pathogenesis
There are multiple theories explaining the origin of esophageal webs
Inflammation
- Esophageal webs are thought to be due to the chronic damage to the esophageal mucosa.
- This is supported by the presence of inflammatory cells in the wall of the web.
- In allergic esophagitis, eosinophils were found while in cases of chronic inflammation as GERD, lymphocytes prevailed.
Congenital theory
- Esophageal webs are thought to be due to failure of the esophagus to recanalize.
- Specimens showed that the esophageal webs contained respiratory epithelium supporting this theory.
- The webs mostly remain asymptomatic for long times and that is why it is not correlated with being congenital.
Iron deficiency
- The esophageal webs of Plummer-Vinson syndrome have been associated with iron deficiency anemia in many studies.
- The exact mechanism by which iron deficiency causes esophageal webs is not known, but it was hypothesized that iron deficiency starts a sequence of events in the esophageal epithelium that ends in its damage and formation of a web.
- Moreover, treatment of iron deficiency in Plummer-Vinson syndrome patients leads to resolution of dysphagia even before the laboratory results become normal.
Gross picture
- Esophageal webs appear as an eccentric narrowing of the esophageal lumen (while rings cause circumferential narrowing).
Microscopic picture
- Esophageal webs are covered normally by mucosa and submucosa.
- It is characterized by the presence of basal cell hyperplasia.
- The tissue is often heavily infiltrated with chronic inflammatory cells.
- Eosinophilic esophagitis is characterized by the presence of eosinophils infiltration.
Causes
More common causes
- Iron deficiency anemia
- Plummer-Vinson syndrome
- Celiac sprue
- Zenker’s diverticulum
Less common causes
- Epidermolysis bullosa
- Bullous pemphigoid
- Graft versus host disease
- Pemphigus Vulgaris
Differentiating esophageal webs from other diseases
Risk factors
Screening
Acorrding to USPSTF, there are no screening measures recommended for esophageal webs.