Sandbox: esophageal web

Pathogenesis

Inflammation Esophageal webs are thought to be due to the chronic damage of 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). Most of the esophageal webs lie anteriorly in the upper part of the esophagus.

Microscopic picture Esophageal webs are covered by esophageal squamous epithelium.