Esophageal Webs

by Carlo Raj, MD

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    00:01 We move away from rings and we go on to webs.

    00:04 Now, in terms of the presentation here, rings and webs, rings and webs are often times interchanged by clinicians.

    00:12 You cannot afford to do that.

    00:14 As a medical student or a resident.

    00:17 So ring would be down in, as we showed, with the lower esophagus.

    00:21 An esophageal web will be more so in the upper portion.

    00:25 Congenital anomalies characterized by one or more thin, thin horizontal membrane of squamous epithelium in the upper and mid-esophagus. I’m obviously emphasizing the location of the web versus the location of a ring.

    00:41 The web almost always will be in the upper and mid, as far as you’re concerned. Very rarely would it be in the lower.

    00:50 Ultimately though, you’re causing what? Compromise of the lumen.

    00:53 A fixed obstruction.

    00:55 So therefore the patient has dysphagia to both, both solids and liquids.

    00:59 Now the webs, because of the invagination of the squamous cells, do not worry so much about the upper and the lower aspect because all of it will be squamous, squamous, squamous.

    01:10 Webs.

    01:10 Last time we've heard of this is, what if I told you, well the patient comes in. The patient says, “Hey Doc, I’m having a hard time eating." “Tell me about your eating pattern.

    01:21 Are you having a hard time eating your dinner? Solid foods?" “ I am." “And what about your fluids?" “Yeah, I’m having a hard time drinking my shake." “Okay, do you find that there was a progression in terms of difficulty?" “No, it was at the same time." “Okay." Next you take a look at the nails and it looks like they’re depressed, spooning of the nails.

    01:48 And upon physical examination you check out the tongue and the tongue looks beefy, beefy red.

    01:55 Go on to find out that there’s iron deficiency.

    02:00 Obviously here we’re dealing with Plummer-Vinson syndrome.

    02:11 And because the web is made up of squamous cell, with persistent irritation may go on to develop dysplasia and squamous cell cancer of the esophagus.

    02:26 Worst case scenario.

    02:27 Do not forget it.

    02:30 Here with the web, once again, a little bit different, not in terms of the dilation.

    02:36 So the dilatation is going to be part of the management, but with Plummer-Vinson Syndrome which should be high on your differential with the web; Iron, patient’s iron deficient.

    02:47 Iron therapy.

    About the Lecture

    The lecture Esophageal Webs by Carlo Raj, MD is from the course Esophageal Disease.

    Included Quiz Questions

    1. Upper esophagus and mid-esophagus
    2. Lower esophagus
    3. Lower esophageal sphincter
    4. Peptic ulcer in the stomach
    5. Chronic inflammation throughout the esophagus which leads to blood loss
    1. Squamous cell carcinoma
    2. Adenocarcinoma
    3. Sarcoma
    4. Lymphoma
    5. None of the above
    1. Repeated dilatation and iron supplementation
    2. Dilatation only
    3. Anti-inflammatory drugs
    4. All of the above
    5. Surgical resection

    Author of lecture Esophageal Webs

     Carlo Raj, MD

    Carlo Raj, MD

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