Plummer-Vinson Syndrome Workup

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

Laboratory Studies

In patients with suspected Plummer-Vinson syndrome (PVS), obtain complete blood cell (CBC) counts, 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.

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

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Imaging Studies

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

Barium esophagraphy

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.

Videofluroscopy

If the 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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Procedures

Esophagogastroduodenoscopy

Esophagogastroduodenoscopy may be used to evaluate patients with suspected Plummer-Vinson syndrome (PVS). 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.

The upper esophagus is carefully examined for the 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. [14] 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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