Dysphagia resulting from an upper esophageal web--a case report.

A circumferential web was located in the proximal portion of the esophagus in a 69 year old female who was admitted to the Iwate Medical University Hospital with severe chronic dysphagia. She had a long history of difficulty in swallowing, intermittently and primarily associated with the ingestion of solid foods. The web was easily ruptured upon endoscopy with subsequent bouginage being performed twice leading to the complete relief of dysphagia. However, dysphagia recurred 6 months postbouginage and the circumferential web, which had regenerated, had less distensibility, making re-dilation impossible. Surgery was elected which revealed esophageal obstruction by a firm circumferential structure. Microscopic examination of the excised web revealed it to consist of a transverse fold of the esophageal mucosa with chronic inflammatory changes and submucosa with marked fibrous tissue proliferation. The patient has remained asymptomatic for the 4 years following her operation.