eMedicine Specialties > Gastroenterology > Esophagus

Plummer-Vinson Syndrome: Follow-up

Author: Louis-Michel Wong Kee Song, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic
Contributor Information and Disclosures

Updated: Apr 16, 2008

Follow-up

Further Inpatient Care

  • PVS is usually managed on an outpatient basis.

Further Outpatient Care

  • Perform follow-up CBCs and iron studies in 3 months, after initiation of iron replacement, to document resolution of sideropenia and anemia.
  • Provide follow-up care for patients whose treatment has been initiated for the specific cause, if any, of the iron deficiency anemia.
  • Repeat esophageal dilations may be required in patients with recurrent dysphagia.

Inpatient & Outpatient Medications

  • Ferrous preparations are administered to correct the deficiency in iron (with or without anemia).

Complications

  • Although reports are inconsistent, patients with PVS seem to be at an increased risk for hypopharyngeal and esophageal cancers.
    • A high prevalence of hypopharyngeal cancers in Swedish women in the 1930s and 1940s was attributed to PVS.
    • The reported frequency of postcricoid carcinoma associated with PVS varies (4-16% in older studies) and remains a matter of debate.

Prognosis

  • Prognosis is generally good, unless PVS is complicated by hypopharyngeal or esophageal carcinoma. Patients with PVS usually respond well to iron therapy, diet modification, and, if necessary, esophageal dilation.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Consider endoscopy to exclude alternative and/or serious diagnoses, such as upper esophageal carcinoma.
  • No guidelines are established for cancer surveillance in patients with PVS. Some authors endorse regular (annual or biennial) endoscopic surveillance to exclude malignancy in patients with bona fide PVS. This is a reasonable precaution.

Special Concerns

  • The major concern in patients with PVS is the potential increased risk for upper gastrointestinal tract cancer, as described above.
 


More on Plummer-Vinson Syndrome

Overview: Plummer-Vinson Syndrome
Differential Diagnoses & Workup: Plummer-Vinson Syndrome
Treatment & Medication: Plummer-Vinson Syndrome
Follow-up: Plummer-Vinson Syndrome
Multimedia: Plummer-Vinson Syndrome
References
[ CLOSE WINDOW ]

References

  1. Atmatzidis K, Papaziogas B, Pavlidis T, Mirelis Ch, Papaziogas T. Plummer-Vinson syndrome. Dis Esophagus. 2003;16(2):154-7. [Medline].

  2. Bredenkamp JK, Castro DJ, Mickel RA. Importance of iron repletion in the management of Plummer-Vinson syndrome. Ann Otol Rhinol Laryngol. Jan 1990;99(1):51-4. [Medline].

  3. Brown Kelly A. Spasm at the entrance of the oesophagus. J Laryngol Rhinol Otol. 1919;34:285-9.

  4. Buse PE, Zuckerman GR, Balfe DM. Cervical esophageal web associated with a patch of heterotopic gastric mucosa. Abdom Imaging. 1993;18(3):227-8. [Medline].

  5. Chen TS, Chen PS. Rise and fall of the Plummer-Vinson syndrome. J Gastroenterol Hepatol. Nov-Dec 1994;9(6):654-8. [Medline].

  6. Chisholm M. The association between webs, iron and post-cricoid carcinoma. Postgrad Med J. Apr 1974;50(582):215-9. [Medline].

  7. Dantas RO, Villanova MG. Esophageal motility impairment in Plummer-Vinson syndrome. Correction by iron treatment. Dig Dis Sci. May 1993;38(5):968-71. [Medline].

  8. Dickey W, McConnell B. Celiac disease presenting as the Paterson-Brown Kelly (Plummer-Vinson) syndrome. Am J Gastroenterol. Feb 1999;94(2):527-9. [Medline].

  9. Ekberg O, Nylander G. Webs and web-like formations in the pharynx and cervical esophagus. Diagn Imaging. 1983;52(1):10-8. [Medline].

  10. Elwood PC, Jacobs A, Pitman RG. Epidemiology of the Paterson-Kelly syndrome. Lancet. 1964;2:716-20.

  11. Geerlings SE, Statius van Eps LW. Pathogenesis and consequences of Plummer-Vinson syndrome. Clin Investig. Aug 1992;70(8):629-30. [Medline].

  12. Hoffman RM, Jaffe PE. Plummer-Vinson syndrome. A case report and literature review. Arch Intern Med. Oct 9 1995;155(18):2008-11. [Medline].

  13. Hoover WB. The syndrome of anemia, glossitis, and dysphagia. New Engl J Med. 1935;213(9):394-8.

  14. Huynh PT, de Lange EE, Shaffer HA Jr. Symptomatic webs of the upper esophagus: treatment with fluoroscopically guided balloon dilation. Radiology. Sep 1995;196(3):789-92. [Medline].

  15. Jacobs A, Kilpatrick GS. The Paterson-Kelly syndrome. BMJ. 1964;2:79-82.

  16. Jerome-Zapadka KM, Clarke MR, Sekas G. Recurrent upper esophageal webs in association with heterotopic gastric mucosa: case report and literature review. Am J Gastroenterol. Mar 1994;89(3):421-4. [Medline].

  17. Jessner W, Vogelsang H, Püspok A, Ferenci P, Gangl A, Novacek G, et al. Plummer-Vinson syndrome associated with celiac disease and complicated by postcricoid carcinoma and carcinoma of the tongue. Am J Gastroenterol. May 2003;98(5):1208-9. [Medline].

  18. Krevsky B, Pusateri JP Jr. Laser lysis of an esophageal web. Gastrointest Endosc. Sep-Oct 1989;35(5):451-3. [Medline].

  19. Larsson LG, Sandström A, Westling P. Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. Cancer Res. Nov 1975;35(11 Pt. 2):3308-16. [Medline].

  20. Lindgren S. Endoscopic dilatation and surgical myectomy of symptomatic cervical esophageal webs. Dysphagia. 1991;6(4):235-8. [Medline].

  21. Maleki D, Cameron AJ. Plummer-Vinson syndrome associated with chronic blood loss anemia and large diaphragmatic hernia. Am J Gastroenterol. Jan 2002;97(1):190-3. [Medline].

  22. Mansell NJ, Jani P, Bailey CM. Plummer-Vinson syndrome--a rare presentation in a child. J Laryngol Otol. May 1999;113(5):475-6. [Medline].

  23. Nosher JL, Campbel WL, Seaman WB. The clinical significance of cervical esophageal and hypopharyngeal webs. Radiology. Oct 1975;117(1):45-7. [Medline].

  24. Okamura H, Tsutsumi S, Inaki S, Mori T. Esophageal web in Plummer-Vinson syndrome. Laryngoscope. Sep 1988;98(9):994-8. [Medline].

  25. Paterson DR. A clinical type of dysphagia. J Laryngol Rhinol Otol. 1919;34:289-91.

  26. Rashid Z, Kumar A, Komar M. Plummer-Vinson syndrome and postcricoid carcinoma: late complications of unrecognized celiac disease. Am J Gastroenterol. Jul 1999;94(7):1991. [Medline].

  27. Slater SD. The Brown Kelly-Paterson or Plummer-Vinson syndrome: an old score finally settled. J R Coll Physicians Lond. Jul 1991;25(3):257-8. [Medline].

  28. Vinson PP. Hysterical dysphagia. Minn Med. 1922;5:107-8.

  29. Waldenstrom J, Kjellberg SR. The roentgenological diagnosis of sideropenic dysphagia (Plummer-Vinson's syndrome). Acta Radiol. 1939;20:618-38.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

PVS, Plummer-Vinson’s syndrome, Paterson-Brown Kelly syndrome, Paterson-Kelly syndrome, sideropenic dysphagia, iron deficiency anemia, esophageal stenosis, atrophic glossitis, postcricoid dysphagia, upper esophageal webs, rheumatoid arthritis, pernicious anemia, celiac disease, thyroiditis, thyroid cytoplasmic autoimmune antibodies, heterotopic gastric mucosa, ulcerated inlet patch, Zenker diverticulum, iron replacement, esophageal dilation, postcricoid carcinoma, hypopharyngeal carcinoma, esophageal carcinoma, squamous esophageal cancer

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Louis-Michel Wong Kee Song, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic
Louis-Michel Wong Kee Song, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.