Plummer-Vinson Syndrome

Snapshot

A 50-year-old woman presents to her primary care physician with problems with eating. She reports that over the past few months, she has experienced some difficulty swallowing food. She drinks liquids and soups normally, but reports difficulty swallowing particularly solid foods. On exam, she is noted to have atrophic glossitis and fissures in the bilateral oral commissure. An upper gastrointestinal barium swallow study reveals narrowing, and esophagogastroduodenoscopy shows thin web-like tissue growths 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

Imaging

Upper gastrointestinal barium swallow radiography
- may show a thin projection post-cricoid
- may show multiple esophageal webs
Video fluoroscopic swallowing exam
can help differentiate a true web from false webs such as mucosal folding

Studies

Serum labs
- complete blood count
  - hypochromic and microcytic anemia
- peripheral blood smear
  - hypochromic and microcytic anemia
- iron studies
  - iron deficiency
invasive 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
Surgical
- esophageal dilatation, most commonly via balloon method
  - can be performed concurrently with esophagogastroduodenoscopy
not required if iron supplementation improves dysphagia

Complications