Other
non-neoplastic conditions
Schatzki’s
ring
Schatzki’s ring is a circular ring in the distal oesophagus (Fig.
50.74),
usually at the squamocolumnar junction. The cause is obscure. The core of
the ring consists of variable amounts of fibrous tissue and cellular infiltrate.
Most rings are incidental findings on barium examination. Some are associated
with dysphagia and a single dilatation is curative.
Monilial
oesophagitis
Oesophagitis due to Candida albicans is relatively common in
patients taking steroids, including steroid inhalers for asthma. It may present
with dysphagia or odynophagia. There may be visible thrush in the throat.
Endoscopy shows numerous white plaques that cannot be moved, unlike food
residues (Fig. 50.75). Biopsies are diagnostic. In severe cases a barium
swallow may show dramatic mucosal ulceration and
Acquired
immunodeficiency syndrome (AIDS) and the oesophagus
Dysphagia and odynophagia may occur in immune deficiency due to
infection with a variety of agents including Candida, herpes simplex virus
and cytomegalovirus. Similar infections may arise in immune suppression
due to any other cause.
The oesophagus is not commonly affected by Crohn’s disease. Rarely,
it may be the only site of Crohn’s disease. When it occurs symptoms are
severe and may be mistaken for unusually severe reflux oesophagitis with
retrosternal pain and dysphagia. Endoscopy shows extensive oesophagitis that
extends much further proximally than is the case with reflux oesophagitis.
Biopsies may be diagnostic, but may show only nonspecific inflammation. In
severe cases a barium swallow may show deep sinuses in the oesophagus. Crohn’s
oesophagitis responds poorly to medical treatment and resection may be
required. Reconstruction can be a challenging problem in a patient with
widespread Crohn’s disease at other sites.
Plummer—Vinson
syndrome
Also called the Brown Kelly—Paterson syndrome or sideropenic
dysphagia, this may be a pathological relic. The original descriptions are
vague and poorly supported by evidence of a coherent syndrome. They describe
young women with iron deficiency anaemia and dysphagia referred high in the
neck. The dysphagia was said to be caused by spasm or a web in the postcricoid
area. The patients were said to have an increased tendency to postcricoid
cancer.
Webs
certainly occur in the upper oesophagus (Fig. 50.78), but their connection with
any particular syndrome is questionable. The pathology is uncertain. More
recently it has been noted that there is often a patch of heterotopic gastric
mucosa in the upper oesophagus. It is probably congenital and may be seen in up
to 4 per cent of endoscopic examinations. Most are small, less than 1 cm2,
and are easily missed. Occasional complications have been reported, such as
ulceration, stricture and adenocarcinoma. Perhaps the Plummer—Vinson syndrome
is a case of mistaken identity.