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Updated: Dec 11 2021

Plummer-Vinson Syndrome

  • 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
    • 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
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