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 the evaluation of the etiology of iron deficiency.

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.

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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.

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.

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Upper esophageal web.

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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.^[17]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.^[13]

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.

Treatment & Management

Atmatzidis K, Papaziogas B, Pavlidis T, Mirelis Ch, Papaziogas T. Plummer-Vinson syndrome. Dis Esophagus. 2003. 16(2):154-7. [QxMD MEDLINE Link].
Chisholm M. The association between webs, iron and post-cricoid carcinoma. Postgrad Med J. 1974 Apr. 50(582):215-9. [QxMD MEDLINE Link].
Hoffman RM, Jaffe PE. Plummer-Vinson syndrome. A case report and literature review. Arch Intern Med. 1995 Oct 9. 155(18):2008-11. [QxMD MEDLINE Link].
Jacobs A, Kilpatrick GS. The Paterson-Kelly syndrome. Br Med J. 1964 Jul 11. 2(5401):79-82. [QxMD MEDLINE Link].
Slater SD. The Brown Kelly-Paterson or Plummer-Vinson syndrome: an old score finally settled. J R Coll Physicians Lond. 1991 Jul. 25(3):257-8. [QxMD MEDLINE Link].
Waldenstrom J, Kjellberg SR. The roentgenological diagnosis of sideropenic dysphagia (Plummer-Vinson's syndrome). Acta Radiol. 1939. 20:618-38.
Elwood PC, Jacobs A, Pitman RG, Entwistle CC. Epidemiology of the Paterson-Kelly syndrome. Lancet. 1964 Oct 3. 2(7362):716-20. [QxMD MEDLINE Link].
Geerlings SE, Statius van Eps LW. Pathogenesis and consequences of Plummer-Vinson syndrome. Clin Investig. 1992 Aug. 70(8):629-30. [QxMD MEDLINE Link].
Chhabra P, Khurana H. Image diagnosis: Plummer-Vinson syndrome: an unusual cause of dysphagia. Perm J. 2018 Jun 18. 22:18-035. [QxMD MEDLINE Link]. [Full Text].
Changela K, Haeri NS, Krishnaiah M, Reddy M. Plummer-Vinson syndrome with proximal esophageal web. J Gastrointest Surg. 2016 May. 20(5):1074-5. [QxMD MEDLINE Link].
Dantas RO, Villanova MG. Esophageal motility impairment in Plummer-Vinson syndrome. Correction by iron treatment. Dig Dis Sci. 1993 May. 38(5):968-71. [QxMD MEDLINE Link].
Goel A, Bakshi SS, Soni N, Chhavi N. Iron deficiency anemia and Plummer-Vinson syndrome: current insights. J Blood Med. 2017. 8:175-84. [QxMD MEDLINE Link]. [Full Text].
Dickey W, McConnell B. Celiac disease presenting as the Paterson-Brown Kelly (Plummer-Vinson) syndrome. Am J Gastroenterol. 1999 Feb. 94(2):527-9. [QxMD MEDLINE Link].
Buse PE, Zuckerman GR, Balfe DM. Cervical esophageal web associated with a patch of heterotopic gastric mucosa. Abdom Imaging. 1993. 18(3):227-8. [QxMD MEDLINE Link].
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. 1994 Mar. 89(3):421-4. [QxMD MEDLINE Link].
Ekberg O, Nylander G. Webs and web-like formations in the pharynx and cervical esophagus. Diagn Imaging. 1983. 52(1):10-8. [QxMD MEDLINE Link].
Maleki D, Cameron AJ. Plummer-Vinson syndrome associated with chronic blood loss anemia and large diaphragmatic hernia. Am J Gastroenterol. 2002 Jan. 97(1):190-3. [QxMD MEDLINE Link].
Chen TS, Chen PS. Rise and fall of the Plummer-Vinson syndrome. J Gastroenterol Hepatol. 1994 Nov-Dec. 9(6):654-8. [QxMD MEDLINE Link].
Mansell NJ, Jani P, Bailey CM. Plummer-Vinson syndrome--a rare presentation in a child. J Laryngol Otol. 1999 May. 113(5):475-6. [QxMD MEDLINE Link].
Jessner W, Vogelsang H, Puspok A, et al. Plummer-Vinson syndrome associated with celiac disease and complicated by postcricoid carcinoma and carcinoma of the tongue. Am J Gastroenterol. 2003 May. 98(5):1208-9. [QxMD MEDLINE Link].
Nosher JL, Campbel WL, Seaman WB. The clinical significance of cervical esophageal and hypopharyngeal webs. Radiology. 1975 Oct. 117(1):45-7. [QxMD MEDLINE Link].
Liu CC, Lin YS. Plummer-Vinson syndrome. Ear Nose Throat J. 2019 Jun. 98(5):259-60. [QxMD MEDLINE Link]. [Full Text].
Lo KB, Albano J, Sandhu N, Candelario N. Plummer-Vinson syndrome: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc. 2019. 12:471-7. [QxMD MEDLINE Link]. [Full Text].
Larsson LG, Sandstrom A, Westling P. Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. Cancer Res. 1975 Nov. 35(11 pt 2):3308-16. [QxMD MEDLINE Link].
Aday U, Gundes E, Ali Cetin D, Ciyiltepe H, Basak K, Duman M. Long-term evolution of squamous-cell cancer in Plummer-Vinson syndrome. Prz Gastroenterol. 2017. 12(3):226-8. [QxMD MEDLINE Link]. [Full Text].
Rashid Z, Kumar A, Komar M. Plummer-Vinson syndrome and postcricoid carcinoma: late complications of unrecognized celiac disease. Am J Gastroenterol. 1999 Jul. 94(7):1991. [QxMD MEDLINE Link].
Paterson DR. A clinical type of dysphagia. Proc R Soc Med. 1919. 12 (Laryngol Sect):235-9. [QxMD MEDLINE Link]. [Full Text].
Hoover WB. The syndrome of anemia, glossitis, and dysphagia. New Engl J Med. 1935. 213(9):394-8.
Bredenkamp JK, Castro DJ, Mickel RA. Importance of iron repletion in the management of Plummer-Vinson syndrome. Ann Otol Rhinol Laryngol. 1990 Jan. 99(1):51-4. [QxMD MEDLINE Link].
Hirose T, Funasaka K, Furukawa K, et al. Plummer-Vinson syndrome with esophageal web formation in which detailed endoscopic images were obtained. Intern Med. 2019 Mar 15. 58(6):785-9. [QxMD MEDLINE Link]. [Full Text].
Goel A, Lakshmi CP, Bakshi SS, Soni N, Koshy S. Single-center prospective study of Plummer-Vinson syndrome. Dis Esophagus. 2016 Oct. 29(7):837-41. [QxMD MEDLINE Link].
Huynh PT, de Lange EE, Shaffer HA Jr. Symptomatic webs of the upper esophagus: treatment with fluoroscopically guided balloon dilation. Radiology. 1995 Sep. 196(3):789-92. [QxMD MEDLINE Link].
Lindgren S. Endoscopic dilatation and surgical myectomy of symptomatic cervical esophageal webs. Dysphagia. 1991. 6(4):235-8. [QxMD MEDLINE Link].
Krevsky B, Pusateri JP Jr. Laser lysis of an esophageal web. Gastrointest Endosc. 1989 Sep-Oct. 35(5):451-3. [QxMD MEDLINE Link].
Seo MH, Chun HJ, Jeen YT, et al. Esophageal web resolved by endoscopic incision in a patient with Plummer-Vinson syndrome. Gastrointest Endosc. 2011 Nov. 74(5):1142-3. [QxMD MEDLINE Link].
Kelly AB. Spasm at the entrance of the oesophagus. Proc R Soc Med. 1919. 12 (Laryngol Sect):235. [QxMD MEDLINE Link]. [Full Text].
Okamura H, Tsutsumi S, Inaki S, Mori T. Esophageal web in Plummer-Vinson syndrome. Laryngoscope. 1988 Sep. 98(9):994-8. [QxMD MEDLINE Link].
Vinson PP. Hysterical dysphagia. Minn Med. 1922. 5:107-8.
Jain A, Agrawal P, Malhotra P, Nada R, Varma S. An unusual etiology of Plummer-Vinson syndrome. Blood Res. 2018 Mar. 53(1):79-81. [QxMD MEDLINE Link]. [Full Text].