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Partial esophagectomy with gastric pull-through
8%
1/12
PET scan
0%
0/12
Colonoscopy
17%
2/12
Iron supplementation
67%
8/12
No treatment is necessary
Select Answer to see Preferred Response
This patient's clinical presentation is consistent with Plummer-Vinson syndrome, which is treated with iron supplementation. Plummer-Vinson Syndrome is characterized by iron-deficiency anemia that leads to formation of esophageal webs. Patients typically present with dysphagia, as well as characteristic symptoms of chronic anemia, including malaise and spooned nails. Iron supplementation can lead to resolution of existing webs, as well as decreased development of new webs. In patients with severe or refractory webs, esophageal dilation may be useful for symptom management. Layke and Lopez discuss esophageal cancer and note that patients with Plummer-Vinson Syndrome are at increased risk for esophageal cancer. Other risk factors for esophageal cancer include H. pylori infection, gastric reflux, smoking, and heavy alcohol use. Katsinelos et al. describe the use of mitomycin C injections for treatment of refractory webs in patients with Plummer-Vinson Syndrome, in addition to traditional esophageal dilation. Mitomycin C is a highly active, DNA crosslinker that leads to activation of the cell death pathway. They note that this approach may be a useful alternative in cases that are not controlled with esophageal dilation alone. Figure A shows an esophageal web. Incorrect Answers: Answers 1-3: These are not part of the work-up of Plummer-Vinson Syndrome. Answer 5: Treatment is available for Plummer-Vinson Syndrome and improves outcomes, so it should be implemented.
5.0
(2)
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