Psoriasis, dysphagia, and esophageal webs or rings

Abstract

Abstract. Esophageal webs and rings may have a congenital origin and have been associated with iron-deficiency states and esophageal mucosal inflammation. Cutaneous diseases associated with esophageal webs and rings include benign mucosal pemphigoid and epidermolysis bullosa dystrophica. We report three cases of patients with psoriasis and associated single or multiple esophageal webs. Two of the three patients experienced a significant degree of dysphagia requiring periodic esophageal dilatation. Esophageal abnormalities did not seem to correlate directly with the extent or activity of psoriasis. The cause of esophageal webs or rings in these patients with psoriasis is not known. This report suggests, but does not prove, that there may be an association between these conditions. Key words: Dysphagia -Psoriasis-Webs -Rings.Cutaneous diseases that have been associated with esophageal webs or rings include benign mucosal pemphigoid and epidermolysis bullosa dystrophica [1][2][3]. The epidermis is the principal site of histopathology in these diseases. Psoriasis is also a disease of the epidermis that causes abnormalities in cell maturation and the rate of cellular proliferation [4]. Although psoriasis may rarely involve mucous membranes, there are no reports of associated esophageal pathology [4,5], We report three cases of patients with psoriasis and single or multiple esophageal webs.Address reprint requests to. Richard F. Harty, M.D., Section Digestive Diseases and Nutrition, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, NE 68105, USA Materials and Methods Case lA 21-year old white male with a 5-year history of psoriasis was evaluated for recurrent solid food dysphagia. Difficulty in swallowing began at age 14. During the course of the present illness, the patient had modified his eating patterns to include ingestion of softer foods and careful mastication. He would at times, however, experience esophageal impaction. Physical examination revealed a healthy-appearing young man with typical psoriatic lesions involving areas of the scalp, hairline, and trunk. There was no evidence of psoriatic nail changes or signs or symptoms of psoriatic arthritis. Mucous membranes of the oropharynx were normal. Complete blood count (CBC) and red blood cell indices were normal.Esophagram showed multiple webs and concentric ring-like structures in the proximal and middle thirds of the esophagus (Fig. 1). Videofluoroscopy of the esophagus demonstrated normal peristalsis. Upper gastrointestinal endoscopy was performed with the Olympus GIF Q-10 endoscope (diameter of 11 ram). Multiple concentric rings and webs were identified beginning at 18 cm from the incisors (Fig. 2). The endoscope could not be advanced beyond the proximal esophageal rings. Endoscopy was repeated with the Olympus XP-10 (diameter of 7.9 mm). This smaller-diameter endoscope could be passed through the areas of esophageal narrowing without difficulty. The concentric ring-like structures of the proximal and mide...

Dysphagia in systemic disease

“…A recent report raised the question of an association between psoriasis, a chronic skin rash with excess cell turnover in the dermis and scaling, and esophageal webs [10]. …”