Plummer-Vinson Syndrome Treatment & Management

  • Author: Louis-Michel Wong Kee Song, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jun 21, 2011
 

Medical Care

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.[20]
  • 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.[21, 22]
  • ND:YAG laser therapy has also been reported as a successful means of disrupting an esophageal web.[23] This modality is rarely required.
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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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Consultations

Gastroenterologists - For management of dysphagia requiring dilation

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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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Activity

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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, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

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, 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.

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

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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

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