Plummer-Vinson Syndrome Workup

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

Laboratory Studies

Perform CBCs, peripheral blood smears, and iron studies (eg, serum iron, total iron-binding capacity [TIBC], ferritin, saturation percentage) to confirm iron deficiency, with or without hypochromic microcytic anemia.

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Imaging Studies

Barium esophagram and videofluoroscopy are the most sensitive methods and diagnostic tests of choice to detect esophageal webs.

Conventional barium swallow may detect the web, which characteristically appears as a thin projection off the postcricoid, anterior esophageal wall. The web is best visualized on lateral view (see following image). On occasion, multiple webs can be observed.

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

If conventional barium swallow findings are negative or equivocal and a high index of suspicion remains, a video swallow study can be performed. The latter can distinguish subtle true webs from weblike formations (false webs) due to insignificant mucosal foldings and submucosal phenomena.

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Other Tests

Order specific tests, as necessary, for evaluation of the etiology of iron deficiency.

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Procedures

Esophagogastroduodenoscopy may be used. A thin web can be easily ruptured and can go unnoticed during passage of the endoscope into the upper esophagus. If webbing is suspected, the endoscope should be advanced carefully under direct vision through the upper esophageal sphincter. The web typically appears as a thin mucosal membrane covered by normal squamous epithelium. Most webs are located along the anterior esophageal wall in the shape of a crescent (see following images), but a few are concentric.

Upper esophageal web. Upper esophageal web. Upper esophageal web. Upper esophageal web.

Carefully examine the upper esophagus for presence of an inlet patch. The differential diagnosis at endoscopy should also include inflammatory or infectious stricture, postcricoid cancer, or extrinsic compression from a submucosal venous plexus.

Potential causes of iron deficiency anemia may be found, including Cameron erosions within a large diaphragmatic hernia or angioectasias.[18] It is also prudent to obtain small bowel biopsies at the time of endoscopy to exclude villous atrophy from celiac sprue as the cause of iron deficiency anemia.[10]

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Histologic Findings

The web is composed of a thin layer of normal squamous mucosa and submucosa. Sometimes, chronic inflammatory cells may be observed in the submucosa.

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