FFinalistSouthampton · 2027
Gastroenterology
AKT · Gastroenterology/Oesophagus & stomachlow yield

Plummer-Vinson syndrome

Triad of dysphagia + iron-deficiency anaemia + oesophageal web

Overview

A classic triad: DYSPHAGIA + IRON-DEFICIENCY ANAEMIA + an upper OESOPHAGEAL WEB (post-cricoid). Typically a middle-aged woman; the web causes intermittent solid-food dysphagia. Important because it is a recognised PRE-MALIGNANT condition (post-cricoid/oesophageal squamous cell carcinoma). Treated by iron replacement and dilatation of the web.

Recognise

  • Intermittent DYSPHAGIA to solids, with IRON-DEFICIENCY ANAEMIA (fatigue, koilonychia, glossitis, angular cheilitis) and a post-cricoid oesophageal WEB
  • Middle-aged woman; the web is seen on barium swallow/endoscopy
  • Pre-malignant - raised risk of post-cricoid/oesophageal squamous cell carcinoma

Red flags

  • Progressive dysphagia/weight loss -> exclude oesophageal cancer (endoscopy)
  • Pre-malignant - surveillance/biopsy as indicated

Differentials & how to tell them apart

Oesophageal cancerprogressive dysphagia + weight loss - exclude (and PVS predisposes to it)
Other dysphagia causesachalasia (solids+liquids), stricture, eosinophilic oesophagitis

Investigations

FBC/ferritin (iron-deficiency anaemia); barium swallow/endoscopy (post-cricoid web); investigate the iron deficiency (GI source).

Management

Iron replacement + endoscopic dilatation of the web

  1. 1Confirm the triad; treat with iron replacement and dilate the web if dysphagia persists. Investigate the cause of iron deficiency.Gate: It is PRE-MALIGNANT (post-cricoid/oesophageal SCC) - keep oesophageal cancer in mind and investigate progressive dysphagia/weight loss
  2. 2Treat the underlying iron-deficiency cause; surveillance given the malignancy risk.
Iron replacement — corrects anaemia and often the dysphagia
Endoscopic dilatation of the web — for persistent dysphagia

Key points

Dysphagia + iron-deficiency anaemia + oesophageal web (middle-aged woman) = Plummer-Vinson - iron + dilatation, and remember it is pre-malignant.

Monitor & prognosis

Anaemia; dysphagia; malignancy vigilance.

Good with treatment; SCC risk.

Source: BSG; StatPearls