ABSTRACT
DISCUSSION
Esophageal webs are thin membranes located in the
middle or upper esophagus. They are mainly observed
in the Plummer Vinson syndrome which is associated
with iron deficiency anemia. Its main symptoms are
pain and difficulty in swallowing (odynophagia).
Esophageal webs are associated with bullous diseases
(such as epidermolysis bullosa, pemphigus and bullous
pemphigoid) with graft versus host diseases involving
the esophagus and with celiac diseases.
A case of esophageal web is hereby
manifesting as secondary candidial infection in 60
years old female with history of Dysphagia.
INTRODUCTION
Esophageal webs are thin 2-3mm membranes of
normal esophageal tissue consisting of mucosa and sub
mucosa. They can be congenital or
Congenital webs commonly appear in the middle and
inferior third of esophagus and they are more likely to
be circumferential with a central or eccentric orifice.
Acquired webs are much more common than congenital
webs and typically appear in the cervical area (post-
Cricoid).
Esophageal webs are more common in whites and in
women with a ratio of 2:1.
CASE REPORT
A 60 years old Female patient presented with six-
month history of progressive Dysphagia. It was more
for solids than liquids, episodic in nature with varying
interval of freedom from symptoms. She also reported
with weakness, fatigue, tachycardia and palpable
thyroid gland. She also had significant weight loss.
IMAGING STUDIES
Ultra sound thyroid revealed multiple nodules in both
the lobes. Findings were consistent of multi nodular
goiter. Barium swallow showed segment of irregular
narrowing at C7, D1 and D2 level. Mucosa appeared
eroded and ulceration was seen at this level. Shelf like
indentation seen at C6-7 level. After the barium study
patient underwent Endoscopy twice and
revealed diffuse infiltration by chronic inflammatory
cells. 2nd Biopsy confirmed that mucosal erosion and
ulceration was due to secondary candidial infection
Rings and webs are the most common structural
abnormalities in the esophagus. The terminology,
pathogenesis, and treatment of these esophageal
lesions remain controversial. Esophageal rings usually
exist as a single lesion but can be multiple several
names have been coined for when multiple rings are
found in the esophagus, including multiple esophageal
rings or webs, congenital esophageal stenosis, ringed
esophagus, corrugated esophagus, and feline
presented esophagus.
An esophageal web is a thin (2-3 mm), eccentric,
smooth extension of normal esophageal tissue
consisting of mucosa and sub mucosa that can occur
anywhere along the length of the esophagus but
typically is located in the anterior postcricoid area of
the proximal esophagus
acquired.
The pathophysiology of esophageal rings and webs is
controversial. Several theories have been proposed for
a) Barium swallow examination revealed esophageal web with
associated narrowing and mucosal irregularity in the lower the formation of esophageal webs and rings. These
cervical and upper thoracic esophagus resembling neoplastic include etiologies related to congenital origin, iron
lesion deficiency, development, inflammation, and
autoimmunity.
b) CT Scan showed circumferential narrowing of the proximal The true prevalence of esophageal rings and webs is
unknown. In patients with dysphagia, esophageal webs
esophagus
can be found in 5-15% by barium radiography. Rings
and webs have been identified in all age cohorts.
Patients do not typically become symptomatic until
after the age of 40
Alarming symptoms that are not consistent with
esophageal rings are progressive dysphagia, weight
loss, and anemia.
The association between iron deficiency and
esophageal webs is controversial. Chisholm and Jacobs
supported this association in 2 case series of 72 and
63 patients. However, a careful epidemiologic study by
Elwood failed to show a correlation between iron
deficiency and cervical esophageal webs. Less
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Barium swallow is the diagnostic test of choice and
should be the initial test in patients with dysphagia.