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Plummer-Vinson Syndrome Treatment & Management

  • Author: Louis-Michel Wong Kee Song, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Aug 20, 2015
 

Medical Care

Plummer-Vinson syndrome (PVS) is usually managed on an outpatient basis. Consult with gastroenterologists for the management of dysphagia requiring dilation.

Treat iron deficiency and its underlying cause

Iron replacement is necessary to correct the anemia, if present, and to resolve most of the physical signs of iron deficiency. The necessity for continued iron treatment is doubtful other than for anemia correction.[23]

Dysphagia may improve with iron replacement alone, particularly in patients whose webs are not substantially obstructive. Dysphagia caused by more advanced webs is unlikely to respond to iron replacement alone and, thus, is managed with mechanical dilation.

Address the cause of the iron deficiency (eg, celiac sprue, bleeding angiectasias).

Treat dysphagia and the web

Aside from iron replacement, diet modification may be sufficient in mildly symptomatic patients (see Diet). Those with significant and long-standing dysphagia usually require mechanical dilation. The web can often be disrupted during simple passage of the endoscope into the esophagus. Otherwise, passage of a bougie (eg, Savary dilator) is quite effective. In most cases, passage of a single large dilator is adequate and is thought to be more effective than serial progressive dilations.

Fluoroscopic guidance is usually not required unless a tight web precludes further passage of the endoscope. The proximal location of the webs in PVS makes endoscopic balloon dilation difficult, but it has been performed successfully by radiology under fluoroscopic guidance.[24, 25]

ND:YAG laser therapy has also been reported as a successful means of disrupting an esophageal web.[26] This modality is rarely required.

Needle-knife electroincision has been described as a therapeutic alternative to dilation.[27]

Diet

Advise patients to eat slowly and chew thoroughly. Solid foods should be prepared and cut in small pieces, especially meats.

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Surgical Care

Surgery is rarely needed and is reserved for patients whose webs are recalcitrant to dilation or associated with Zenker diverticulum.

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Long-Term Monitoring

Perform follow-up complete blood cell counts (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.

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Contributor Information and Disclosures
Author

Louis-Michel Wong Kee Song, MD Associate 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 Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Noel Williams, MD, FRCPC FACP, MACG, 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, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

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 Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical 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, Western Surgical Association

Disclosure: Nothing to disclose.

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Postcricoid web. Courtesy of Alan Cameron, MD.
Upper esophageal web.
Upper esophageal web.
 
 
 
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