What are the other Names for this Condition? (Also known as/Synonyms)

• Esophagogastric Ring
• LER (Lower Esophageal Ring)

What is Lower Esophageal Ring? (Definition/Background Information)

• Lower Esophageal Ring (LER) is a condition that is characterized by a narrowing of the esophagus (food-pipe), due to the formation of abnormal rings in the GI tract, near the mouth of the stomach
• Lower Esophageal Ring may be observed in children and adults. Depending on the degree of constriction, the symptoms may be mild or severe and may include obstruction of food in the gastrointestinal (GI) tract
• Currently, the specific cause of Lower Esophageal Ring is unknown. It may be congenital in nature, or acquired. The condition may be diagnosed by a healthcare professional through physical exam, imaging tests of the esophagus, and barium swallow
• Upon diagnosis, treatment options for Lower Esophageal Ring, such as modifying one’s eating habits, may be suggested. In case of severe obstruction, the esophagus may be mechanically dilated (expanded)
• The prognosis of Lower Esophageal Ring is generally good with treatment, but complications, such as trauma within the GI tract during treatment, may worsen the prognosis. Also, following dilation of the constricted tract, the condition may recur

Who gets Lower Esophageal Ring? (Age and Sex Distribution)

• Lower Esophageal Ring may be a congenital or acquired condition. Hence, the symptoms may present itself at birth, or anytime during one’s childhood or adulthood
• Both males and females are affected
• Individuals of different racial and ethnic backgrounds can be affected and no preference is observed

What are the Risk Factors for Lower Esophageal Ring? (Predisposing Factors)

Presently, the following risk factors for Lower Esophageal Ring have been identified:

• Any growth abnormality involving the esophagus that takes place during fetal development
• Acid-reflux disease
• Injury to the esophagus
• Presence of tumors in the region

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lower Esophageal Ring? (Etiology)

The cause of Lower Esophageal Ring is generally unknown. However, it may be due to the following factors:

• Congenital: Presence of abnormal tissue in the esophagus at birth
• Acquired: Factors include esophageal trauma, tumors affecting the GI tract, and gastroesophageal reflux disease (GERD)

What are the Signs and Symptoms of Lower Esophageal Ring?

The signs and symptoms of Lower Esophageal Ring may vary between individuals. Some may have mid symptoms, while others, severe symptoms, depending on the degree of esophageal constriction. In some individuals, the condition may be asymptomatic and discovered only incidentally, while the healthcare provider examines the individual for other medical conditions. 

The signs and symptoms of Lower Esophageal Ring may include the following:

• The ring causes periodic obstruction of food within the gastrointestinal tract; individuals may feel that food is getting stuck within the GI tract
• The esophageal ring forms where the esophagus meets the stomach
• Solid foods are more difficult to completely swallow than liquid foods
• Pain after swallowing the food
• Impaction of food: Obstruction of food pieces (such as meat) in the esophageal ring
• The symptoms are not known to progress with time

How is Lower Esophageal Ring Diagnosed?

A healthcare professional can diagnose Lower Esophageal Ring through:

• A physical examination and analysis of previous medical history
• Upper GI series: X-rays are used to view the esophagus, stomach, and small intestine, to look for deformities or growths
• Barium swallow
• Esophagogastroduodenoscopy (EGD): Examination of the lining of the esophagus, stomach, and beginning parts of the small intestine, with a small camera that is guided to the area of interest
• Videofluoroscopy: A video swallowing study using a small camera that is guided to the area of interest
• Blood tests to rule-out anemia or iron deficiency, if necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lower Esophageal Ring?

The complications of Lower Esophageal Ring may include:

• Extremely rarely, esophageal perforation may occur
• Injury to the esophagus (tears) from medical devices used to stretch the esophagus during diagnosis and/or treatment
• Recurrence of the condition following treatment

How is Lower Esophageal Ring Treated?

The treatment of Lower Esophageal Ring is determined by a healthcare professional and the following may be considered:

• Widening and stretching of the web tissue in the esophagus, which is contracting the lumen of the esophagus, during esophagogastroduodenoscopy (the constricted web is dilated)
• Eating foods slowly, chewing thoroughly, and eating meals in small bites; taking liquids or semi-solid foods
• In some cases of no symptoms or mild symptoms, no treatment may be undertaken and the healthcare provider may choose to regularly monitor the condition
• Undertaking treatment of gastroesophageal reflux disease (GERD), if any
• Surgery to correct any congenital abnormalities

How can Lower Esophageal Ring be Prevented?

Currently, Lower Esophageal Ring is not a preventable condition, as the cause of the condition is still unknown.

What is the Prognosis of Lower Esophageal Ring? (Outcomes/Resolutions)

• The prognosis of Lower Esophageal Ring is generally good with appropriate treatment
• In case dilation of the esophageal stricture is performed, a repeat procedure may have to be undertaken, sometimes after a few years, if further narrowing of the esophagus occurs (presenting swallowing difficulties)

Additional and Relevant Useful Information for Lower Esophageal Ring:

Plummer-Vinson syndrome (PVS) is a rare condition that involves swallowing difficulties due to esophageal webs causing partial obstruction of the food-pipe. The condition also consists of iron-deficiency anemia, inflammation of the tongue (glossitis), and inflammation of the lip (cheilitis).