Multiple rings of the esophagus: A consequence of chronic esophagitis?

A condition of multiple esophageal rings involving long segments of the esophagus is a rare cause of dysphagia in adults. The condition easily may be overlooked by endoscopists unfamiliar with the disorder, especially if the esophagus is not well distended during the endoscopic examination. An association with GERD has been proposed, although it is not clear how GERD contributes to the pathogenesis of the multiple rings Conceivably, the rings might represent short fibrotic strictures that form as a consequence of esophagitis. We have evaluated 6 patients with multiple esophageal rings whose clinical features were as follows: Heartburn Duration of Endoscopic Histologic Pt Age Sex (≥1x/mo) Dysphagia Esophagitis Esoohaptis 1 31 M Yes 20 yrs No Yes 2 35 M No 15 yrs No Yes 3 38 M No 15 yrs No Yes 4 47 M Yes >10 yrs No Yes 5 67 F Yes 12 yrs No Yes 6 73 F No 1 yr No Yes No patient in our series had endoscopic evidence of reflux esophagitis (i.e. erosions or ulcerations), and only 3 of the 6 had a history of heartburn. All patients had histologic signs of esophagitis, but the cause of the inflammation is not clear. Although the multiple esophageal rings resembled the cartilaginous rings of the trachea, high resolution (20MHz) endosonography performed in one patient (#2) did not identify cartilage. Indeed, endosonography revealed only expansion of the submucosa consistent with submucosal fibrosis. CONCLUSIONS: The condition of multiple esophageal rings is strongly associated with histologic evidence of esophagitis, but not with endoscopic signs of GERD. Endosonography suggests that the rings are not comprised primarily of mucosa, cartilage, or muscle. We speculate that the rings represent short fibrotic strictures that form as a consequence of esophagitis, but the contribution of GERD to the esophagitis remains unknown.