eMedicine Specialties > Gastroenterology > Esophagus

Plummer-Vinson Syndrome: Treatment & Medication

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

Treatment

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

Surgical Care

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

Consultations

  • Gastroenterologists - For management of dysphagia requiring dilation

Diet

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

Activity

Unrestricted

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Iron preparations

Iron replacement is an important component of the treatment of PVS.


Ferrous sulfate (Feosol)

A nutritionally essential inorganic substance used to treat iron deficiency anemia associated with PVS.

Adult

325 mg PO qd or divided bid/tid

Pediatric

<15 kg: 5 mg/kg/d PO
15-30 kg: 1/2 adult dose PO
>30 kg: Administer as in adults

Absorption enhanced by ascorbic acid; interferes with tetracycline absorption; food and antacids impair absorption

Documented hypersensitivity; hemochromatosis; hemolytic anemia

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Gastrointestinal upset; dark stools; iron toxicity occurs with ingestion of large amount and can be fatal, especially in children; IV administration may cause adverse reactions, including headaches, malaise, fever, generalized lymphadenopathy, arthralgia, and urticaria; can cause severe anaphylaxis; may cause phlebitis at infusion site

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.