The ringed esophagus: Histological features of GERD

OBJECTIVE: The "ringed" or "corrugated" esophagus is a cause of chronic dys phagia and recurrent food impactions in young men. It was previously believ ed to be a congenital condition, but recent case series have documented his tological esophagitis in these patients. We have treated 19 patients with a ringed esophagus and are impressed that this represents an acquired condit ion with gastroesophageal reflux disease (GERD) as its etiology. Our goals are to present the largest case series to date of ringed esophagus, discuss the evidence for GERD, and suggest a strategy for its diagnosis and manage ment. METHODS: The charts of 19 patients with a ringed esophagus were reviewed. A single pathologist interpreted all available esophageal biopsy specimens a nd graded them for the presence of GERD-related abnormalities. Phone inter views were conducted to assess response to therapy and confirm historical f eatures obtained from medical records. RESULTS: The typical patient is a young man (median age 35, M:F 17:2) with long-standing dysphagia and multiple food impactions. Endoscopy revealed mu ltiple concentric rings that persisted despite air insufflation and caused significant stenosis. Of the 11 patients with available histology, all had basal cell hyperplasia, papillomatosis, and an increased number of intraepi thelial eosinophils. Other clinical features of GERD such as heartburn, end oscopic esophagitis, and hiatal hernia were often absent. Response to dilat ion and acid suppression was good. CONCLUSIONS: The uniform presence of histological esophagitis with intraepi thelial eosinophils, basal cell hyperplasia, and papillary lengthening stro ngly implicates GERD in the pathogenesis of the adult ringed esophagus. In addition to a series of gradual esophageal dilations, we suggest using a pr oton pump inhibitor to provide acid suppression. (Am J Gastroenterol 2001;9 6:984-989. (C) 2001 by Am. Coll. of Gastroenterology).