Esophageal Web: Causes, Symptoms, Treatment and Cost

Esophageal Web is a condition that occurs when the walls of the oesophagus thicken and narrow, resulting in less space for passing food or liquids. It is also known as a Schatzki ring.

There are two main types of Esophageal Webs:

• Plummer-Vinson Syndrome (PVS) Web: This type of Esophageal Web is typically associated with iron deficiency anaemia and occurs most commonly in middle-aged women. PVS webs are thin, membrane-like structures that form in the upper part of the oesophagus and can cause difficulty swallowing and other symptoms.
• Congenital Esophageal Web: This type of Esophageal Web is present at birth and is caused by incomplete development of the oesophagus. Congenital Esophageal Webs are usually located in the middle or lower part of the oesophagus and can cause difficulty swallowing and other symptoms. This type of web is much less common than PVS web.

Esophageal Web's precise causation is unknown, however there are a number of things that might have an impact on how it develops. The most common causes of Esophageal Web include:

• Nutritional deficiencies: Nutritional deficiencies, particularly iron deficiency, have been linked to the development of Esophageal Web, particularly in the case of Plummer-Vinson Syndrome.
• Genetics: While the precise genes responsible are yet unknown, genetic factors are likely to be the root cause of congenital esophageal web.
• Autoimmune disorders: Autoimmune disorders such as Sjogren's syndrome and systemic lupus erythematosus (SLE) have been linked to the development of the Esophageal Web.
• Gastroesophageal reflux disease (GERD): Chronic acid reflux can cause inflammation and scarring of the oesophagus, which may contribute to the development of the Esophageal Web.
• Infections: In rare cases, infections such as Candida or herpes simplex virus may lead to the development of an Esophageal Web.

The symptoms of Esophageal Web may vary depending on the severity and location of the web. Some typical signs include:

• Difficulty swallowing (dysphagia): The most typical sign of an esophageal web is this.Patients may feel as if food is getting stuck in their throat or chest when they swallow.
• Painful swallowing (odynophagia): During swallowing, some individuals may feel pain or discomfort.
• Regurgitation: Food or liquid may come back up into the mouth or throat, especially if the Esophageal Web is causing a blockage.
• Heartburn: Patients with Esophageal Web may experience frequent heartburn or acid reflux, especially if the web is caused by gastroesophageal reflux disease (GERD).
• Coughing: Patients with Esophageal Web may sometimes choke or cough when eating or drinking. Unintended weight loss: In severe cases, patients with Esophageal Web may experience unintended weight loss due to difficulty eating and swallowing.

Esophageal Web is not always preventable, but there are several steps you can take to reduce your risk of developing the condition. These include:

• Eating a healthy, balanced diet: A diet rich in iron, vitamin C, and other nutrients can help prevent nutritional deficiencies that may contribute to the development of the Esophageal Web.
• Managing acid reflux: If you have gastroesophageal reflux disease (GERD), taking steps to manage your symptoms, such as avoiding trigger foods and eating smaller, more frequent meals, can help prevent inflammation and scarring of the oesophagus.
• Stopping smoking: Smoking has been linked to an increased risk of Esophageal Web, as well as other esophageal conditions. Quitting smoking can help reduce your risk.
• Managing underlying medical conditions: Certain medical conditions, such as autoimmune disorders, may increase your risk of developing Esophageal Web. Managing these conditions through proper medical care can help reduce your risk.

Esophageal Web can be diagnosed through several tests and procedures, which may include:

• Upper endoscopy: This procedure involves inserting a thin, flexible tube with a camera on the end (an endoscope) through the mouth and into the oesophagus. The endoscope allows the doctor to visualise the oesophagus and identify any abnormalities, such as an Esophageal Web.
• Barium swallow: Swallowing a drink containing barium, which covers the oesophagus and makes it visible on X-rays, is required for this test.X-rays can then be taken to identify any abnormalities, such as an Esophageal Web.
• Esophageal manometry: In order to quantify the muscular contractions in the oesophagus while you swallow, a small, flexible tube is inserted through the nose and into the oesophagus.
• pH monitoring: In order to assess the quantity of acid reflux in the oesophagus over the course of 24 hours, a small, flexible tube must be inserted via the nose and into the oesophagus.
• Biopsy:A biopsy may be done to ascertain the underlying aetiology of an esophageal web if one is discovered during an endoscopy.

In the lining of the oesophagus, the tube that links the neck to the stomach, tiny membranes called esophageal webs may develop. Possible complications of Esophageal Webs include:

• Dysphagia: The most common complication of Esophageal Webs is difficulty swallowing, which is known as dysphagia. As a result, food may get lodged in the oesophagus and cause aspiration, regurgitation, and even chest discomfort.
• Esophageal stricture: Repeated episodes of food impaction in the oesophagus can lead to inflammation and scarring, which can cause the oesophagus to narrow and form strictures. This can further aggravate dysphagia and increase the risk of food impaction.
• Esophageal perforation: In rare cases, Esophageal Webs can lead to perforation, which is a tear or hole in the esophageal wall. This can cause severe chest pain, fever, and difficulty breathing, and requires emergency medical attention.
• Malnutrition: Difficulty swallowing and frequent food impaction can lead to malnutrition, as patients may avoid eating certain foods or reduce their overall food intake.
• Weight loss: The combination of dysphagia and malnutrition can cause significant weight loss, which can further exacerbate the symptoms of Esophageal Webs and lead to other complications.

Here are a few home remedies that may be helpful in treating esophageal web:

• Triphala: Triphala is a traditional Ayurvedic remedy made from a blend of three fruits, namely Amla, Haritaki, and Bibhitaki. It is known to help regulate digestion and promote the overall health of the digestive system, which may help relieve some of the symptoms associated with the esophageal web.
• Guggulu: In Ayurvedic medicine, guggulu, a resin, is often used to treat a variety of ailments, including digestive problems. Because of its well-known anti-inflammatory and antispasmodic characteristics, it may be able to aid with esophageal web symptoms.
• Licorice root: Another age-old Ayurveda treatment for digestive issues is licorice root. It has been used for ages.It is known to have anti-inflammatory and anti-ulcer properties that may help reduce the inflammation and irritation associated with the esophageal web.
• Ashwagandha: Ashwagandha is an Ayurvedic herb that is known for its adaptogenic properties, which can help reduce stress and anxiety. This may be particularly helpful for individuals with an esophageal web, as stress can exacerbate the symptoms of this condition.
• Ayurvedic diet: Following an Ayurvedic diet that is tailored to your specific dosha (constitution) may also be helpful in managing the symptoms of esophageal web. This may involve avoiding certain foods that are known to aggravate the condition, such as spicy or acidic foods, and consuming more soothing, nourishing foods like warm soups and stews.

Here are some examples of foods that are recommended for people with Esophageal Webs:

• Cooked vegetables: Soft-cooked vegetables such as carrots, squash, and green beans can be easily chewed and swallowed.
• Oatmeal: Soft, moist oatmeal can be a good source of fibre and provide a filling meal that is easy to swallow.
• Mashed potatoes: The texture of mashed potatoes makes them simple to consume.You can add some milk or butter to make them even smoother.
• Soups: Pureed soups or broth-based soups with soft vegetables or noodles can be a good source of nutrients and hydration.
• Soft fruits: Soft fruits such as bananas, berries, and ripe peaches can be easily mashed or pureed and are high in nutrients.
• Scrambled eggs: The addition of milk or butter may make scrambled eggs soft and moist, making them a wonderful source of protein.
• Ground or minced meat: Ground or minced meat can be a good source of protein if cooked until it is soft and moist.

When dealing with an Esophageal Web, the following food should be avoided:

• Foods high in fat or oil: Eating high-fat foods can make it difficult for food and liquids to pass the Esophageal Web, increasing the risk of choking.
• Tough or chewy meat: A band of fibrous tissue that builds up in your oesophagus due to food such as steak, sausage, bacon, etc. can be difficult for swallowing and cause blockages on the web.
• Pitted fruits and vegetables: Foods like cherries, olives, apple seeds, apricot kernels, etc., when swallowed whole create a risk of getting stuck in your throat.
• Popcorn seeds and nuts: Nuts have a tendency to get lodged into the web causing problems with digestion.
• Seeds from berries or other fruits: Like apple seeds apricot pips etc., some berries and their seeds contain hard pits which could not only get caught in the Esophageal Web but also harm you on their way down your throat if swallowed without chewing properly.

The treatment for Esophageal Web depends on the severity of the condition and the symptoms experienced by the patient. Here are some possible treatments for Esophageal Web:

• Dilation: Esophageal dilation is a minimally invasive procedure that involves using an endoscope to stretch the oesophagus and widen the area affected by the web. This may be done using a balloon or other devices.
• Endoscopic incision: In some cases, an endoscopic incision may be made to cut through the web and relieve the blockage. This procedure is typically done using a laser or other cutting tool.
• Diverticulectomy: In cases where the esophageal web is accompanied by a diverticulum (a small pouch or sac that protrudes from the oesophagus), a diverticulectomy may be recommended. This procedure involves removing the diverticulum and repairing any damage to the oesophagus.
• Esophagectomy: In rare cases where the esophageal web is causing severe complications or cannot be treated by other means, an esophagectomy may be necessary. This entails disconnecting the remaining sections of the digestive system and removing the whole oesophagus.

If you suspect you have an Esophageal Web or experience difficulty swallowing, you should consult with a gastroenterologist or an otolaryngologist (also known as an ear, nose, and throat (ENT) doctor). These professionals are skilled in identifying and managing diseases that affect the gastrointestinal tract, especially the oesophagus.
If required, your primary care doctor might also suggest that you see a specialist. It is crucial to visit a doctor since an early diagnosis and course of treatment might lessen the likelihood of problems from esophageal webs.

There are no specific medications that are recommended for the treatment of Esophageal Web. Nevertheless, based on the underlying reason for the disease, your doctor could advise drugs like:

• Proton pump inhibitors: These drugs aid in lowering stomach acid production, which may aid in lowering acid reflux and esophageal inflammation.Examples include omeprazole (Prilosec) and pantoprazole (Protonix).
• H2 blockers: These medications also help reduce acid production in the stomach and may be used in conjunction with proton pump inhibitors. Examples include ranitidine (Zantac) and famotidine (Pepcid).
• Antacids: These medications neutralise stomach acid and can provide quick relief for symptoms of acid reflux, such as heartburn. Examples include Tums and Rolaids.
• Pain relievers: Over-the-counter pain medicines like acetaminophen (Tylenol) or ibuprofen (Advil) may be suggested if dysphagia is causing discomfort.

In certain instances, a minimally invasive surgical technique like dilatation or an endoscopic incision may provide individuals with instant relief, whereas recovery from a more invasive surgical operation like an esophagectomy may take several weeks or even months.

Although the symptoms may return or need continuous therapy in other situations, in certain circumstances the outcomes may be permanent.It is important to follow your doctor's instructions for treatment, attend follow-up appointments, and adopt lifestyle changes to reduce the risk of symptoms recurring.

There are no specific medications that are recommended for the treatment of Esophageal Web. Nevertheless, based on the underlying reason for the disease, your doctor could advise drugs like:

• Proton pump inhibitors: These drugs aid in lowering stomach acid production, which may aid in lowering acid reflux and esophageal inflammation.Examples include omeprazole (Prilosec) and pantoprazole (Protonix).
• H2 blockers: These medications also help reduce acid production in the stomach and may be used in conjunction with proton pump inhibitors. Examples include ranitidine (Zantac) and famotidine (Pepcid).
• Antacids: These medications neutralise stomach acid and can provide quick relief for symptoms of acid reflux, such as heartburn. Examples include Tums and Rolaids.
• Pain relievers: Over-the-counter pain medicines like acetaminophen (Tylenol) or ibuprofen (Advil) may be suggested if dysphagia is causing discomfort.

The cost of Esophageal Web treatment in India can vary depending on several factors, including the type of treatment needed, the hospital or clinic where the treatment is performed, and the individual patient's needs. It typically ranges from ₹1,50,000 to ₹2,00,000.

Here are some potential side effects of different treatments for esophageal web:

• Dilation: The potential side effects of esophageal dilation include mild discomfort or soreness in the throat, temporary difficulty swallowing, and a small risk of bleeding or perforation (tearing) of the oesophagus.Dilation may sometimes result in infection or aspiration (inhaling food or liquid into the lungs).
• Endoscopic incision: Side effects of endoscopic incision may include sore throat, temporary difficulty swallowing, bleeding, and perforation of the oesophagus. In rare cases, there may be a risk of infection or aspiration.
• Surgery: Potential side effects of surgery for esophageal web can include pain, swelling, infection, bleeding, and scarring.