Updated: 5/31/2019

Plummer-Vinson Syndrome

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https://upload.medbullets.com/topic/120144/images/esophageal_web.jpg
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
  • Epidemiology
    • most commonly observed in postmenopausal women
    • rare
  • Pathogenesis
    • unknown
  • Associated conditions
    • autoimmune disease
Presentation
  • Symptoms
    • dysphagia to solid foods
    • cough
    • choking
    • fatigue
    • nail changes
    • dizziness
  • Physical exam
    • atrophic glossitis
    • angular cheilitis
    • pallor
    • koilonychia
Studies
  • Diagnostic testing
    • 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
    • laboratory studies
      • complete blood count
        • hypochromic and microcytic anemia
      • peripheral blood smear
        • hypochromic and microcytic anemia
      • iron studies
        • iron deficiency
    • 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
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
 

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