Snapshot A 58-year-old woman with iron deficiency anemia presents to her primary care physician complaining of difficulty swallowing. She reports no difficulties with liquids. On exam, she is pale and has spoon-shaped fingernails. Dysphagia is evaluated by upper endoscopy which reveals a thin web-like tissue in the upper esophagus. Introduction Clinical definition characterized by atrophic glossitis, upper esophageal webs (eccentric and often anterior), and iron deficiency anemia Associated conditions autoimmune disease Epidemiology Most commonly observed in postmenopausal women Rare ETIOLOGY Pathogenesis unknown Presentation Symptoms dysphagia to solid foods cough choking fatigue nail changes dizziness Physical exam atrophic glossitis angular cheilitis pallor koilonychia imaging Upper gastrointestinal barium swallow radiography may show a thin projection post-cricoid Video fluoroscopic swallowing exam can help differentiate a true web from false webs such as mucosal folding Other studies esophagogastroduodenoscopy thin web-like tissue growth in the upper esophagus normal squamous mucosa and submucosa, possible atrophy and chronic inflammation on histopathological exam Studies Laboratory studies complete blood count hypochromic and microcytic anemia peripheral blood smear hypochromic and microcytic anemia iron studies iron deficiency Differential Schatzki ring distinguishing factor distal esophageal web Post-cricoid cancer distinguishing factor malignancy on histopathological exam Achalasia distinguishing factor dysphagia at the lower esophageal sphincter Treatment Medical iron supplementation treat the underlying cause of iron deficiency Interventional esophageal dilatation, most commonly via balloon method can be performed concurrently with esophagogastroduodenoscopy not required if iron supplementation improves dysphagia Complications Squamous cell carcinoma of the esophagus, oral cavity, or hypopharynx Aspiration