SINGLE RINGS OR WEBS OF THE proximal or distal esophagus are a well recognized cause of dysphagia. Multiple rings or webs of the esophagus are very rare; only about 21 cases where dysphagia was due to more than one web or ring are reported in the English literature. This paper reports a Saudi patient with dysphagia due to multiple esophageal rings. The literature on the topic is also reviewed.
A 27-year-old Saudi man presented with a one-month history of dysphagia for solids. He denied heartburn or acid regurgitation. He had ingested no caustic substances and had not taken any medications known to cause esophagitis. He had no history of oral or skin lesions. Nine months previously he had been involved in a motor vehicle accident and sustained chest injuries. He remembered having a nasogastric tube inserted and left in place for one week. Past health and family history were unremarkable. Physical examination was normal. Your drugs could cost you less – buy birth control online here to start the treatment soon.
The patient was endoscoped using an Olympus PQ20 panendoscope. Multiple rings were identified, beginning at 28 cm from the teeth. The endoscope could not be passed through the upper rings so a guidewire was passed under endoscopic control, and a 9 and 11 mm Savary Guillard bougie passed with little resistance. The patient was immediately rescoped and several disrupted rings with slight bleeding and many intact rings were seen extending down to 35 cm just above the gastroesophageal junction. There was a small hiatal hernia and the lower esophageal sphincter appeared incompetent, but there were no esophageal ulcers or erosions. The rest of the endoscopy was normal. Biopsy of one of the proximal rings was reported as showing unremarkable squamous epithelium. Three weeks later the patient attended for follow-up endoscopy. Although his dysphagia was much improved, the rings were still very evident. He was again dilated, this time up to 14 mm, with no pain experienced.