What causes dysphagia in Plummer Vinson syndrome?

Dysphagia occurs due to the formation of a post-cricoid oesophageal web that narrows the oesophageal lumen.

Who is most commonly affected by Plummer Vinson syndrome?

The condition most commonly affects middle-aged and elderly women with iron deficiency anaemia.

What type of anaemia is associated with Plummer Vinson syndrome?

Microcytic hypochromic iron deficiency anaemia is the typical haematological finding.

Koilonychia refers to spoon-shaped nails and is a classic sign of chronic iron deficiency.

Which investigation can identify an oesophageal web?

A barium swallow study or upper gastrointestinal endoscopy can identify an oesophageal web.

What are the typical iron study findings in Plummer Vinson syndrome?

Low serum ferritin, low serum iron, high total iron-binding capacity, and low transferrin saturation are typical findings.

Is Plummer Vinson syndrome considered a premalignant condition?

Yes. Patients have an increased risk of developing squamous cell carcinoma of the pharynx and upper oesophagus.

What malignancy is associated with Plummer Vinson syndrome?

Squamous cell carcinoma of the pharynx and upper oesophagus is the most important associated malignancy.

What is the first-line treatment for Plummer Vinson syndrome?

Iron replacement therapy is the cornerstone of treatment and may improve both anaemia and dysphagia.

When is oesophageal dilation required?

Mechanical or endoscopic dilation is indicated when dysphagia persists despite iron replacement therapy.

Can dysphagia improve with iron therapy alone?

Yes. Many patients experience improvement in dysphagia after correction of iron deficiency.

Why is long-term follow-up important in Plummer Vinson syndrome?

Long-term follow-up is important because of the increased risk of upper gastrointestinal squamous cell carcinoma.

What are common differential diagnoses of dysphagia in this condition?

Differential diagnoses include achalasia cardia, oesophageal carcinoma, benign oesophageal stricture, Schatzki ring, and diffuse oesophageal spasm.

What is the prognosis of Plummer Vinson syndrome?

The prognosis is generally excellent with iron supplementation, treatment of the underlying cause, and oesophageal dilation when required.

Iron Deficiency, Dysphagia & Oesophageal Web

Plummer‑Vinson Syndrome · Case Quiz for Internal Medicine Quiz

Plummer Vinson Syndrome Quiz | Internal Medicine Quiz < /head>

Plummer Vinson Syndrome Quiz

History

60-year-old woman
Weakness and lethargy
Palpitations
Exertional dyspnoea
Dysphagia to solid food for 1 month

Examination

Anaemia
Koilonychia

Investigations

CBC with ESR
Serum ferritin
Plasma iron
Total Iron Binding Capacity (TIBC)
Transferrin saturation
Barium swallow
X-ray showing post-cricoid oesophageal web

MCQ Questions

Q1. What is the most likely diagnosis?

A. Achalasia cardia
B. Carcinoma oesophagus
C. Plummer Vinson syndrome
D. Diffuse oesophageal spasm

Q2. Which is NOT a differential diagnosis for dysphagia in this case?

A. Benign oesophageal stricture
B. Achalasia cardia
C. Diffuse oesophageal spasm
D. Myasthenia gravis

Q3. Which serious complication is this patient at risk of developing?

A. Oesophageal varices
B. Squamous cell carcinoma of oesophagus or pharynx
C. Barrett's oesophagus
D. Peptic ulcer disease

Q4. What is the specific treatment for the oesophageal lesion?

A. Proton pump inhibitor therapy
B. Surgical oesophagectomy
C. Mechanical dilation of oesophageal web
D. High-dose corticosteroids

Brief Case Summary

An elderly woman presents with iron deficiency anaemia manifestations, koilonychia, fatigue, exertional dyspnoea and progressive dysphagia to solids. Imaging demonstrates a post-cricoid oesophageal web.

Answers

Show Answers

Q1: C. Plummer Vinson syndrome

Q2: D. Myasthenia gravis

Q3: B. Squamous cell carcinoma of oesophagus or pharynx

Q4: C. Mechanical dilation of oesophageal web

Answer Explanation

Plummer Vinson syndrome is characterized by the triad of iron deficiency anaemia, dysphagia and upper oesophageal web formation. The presence of koilonychia, iron deficiency markers and post-cricoid web strongly supports the diagnosis.

Why Not Others?

Achalasia: Causes dysphagia to both solids and liquids.
Carcinoma oesophagus: Usually associated with weight loss and malignant lesion.
Diffuse oesophageal spasm: Intermittent dysphagia with chest pain.
Myasthenia gravis: Neuromuscular disease causing fatigable weakness rather than structural obstruction.

5 Brief Case Scenarios

Middle-aged woman with iron deficiency anaemia and dysphagia.
Patient with koilonychia and post-cricoid web on barium swallow.
Chronic iron deficiency with progressive solid food dysphagia.
Woman with fatigue, glossitis and oesophageal web.
Iron deficiency anaemia presenting with swallowing difficulty.

Pathophysiology Simplified

Iron deficiency causes epithelial atrophy of the upper gastrointestinal tract. Mucosal degeneration leads to formation of thin oesophageal webs that narrow the lumen and produce dysphagia.

Physical Examination Pearls

Pallor
Koilonychia
Glossitis
Angular cheilitis
Signs of iron deficiency anaemia

Investigation Findings

Low haemoglobin
Microcytic hypochromic anaemia
Low ferritin
Low serum iron
High TIBC
Low transferrin saturation
Post-cricoid oesophageal web on barium swallow

Complications

Persistent dysphagia
Nutritional deficiency
Squamous cell carcinoma of pharynx
Squamous cell carcinoma of oesophagus

Management

Iron replacement therapy
Treat underlying cause of iron deficiency
Endoscopic mechanical dilation
Nutritional support
Long-term surveillance for malignancy

Differential Diagnosis

Achalasia cardia
Benign oesophageal stricture
Diffuse oesophageal spasm
Oesophageal carcinoma
Schatzki ring

Clinical Pitfalls

Ignoring iron deficiency as the primary cause
Missing upper GI malignancy risk
Assuming all dysphagia is due to cancer
Failure to investigate iron studies
Not performing barium swallow or endoscopy

Clinical Pearls

Classic triad: iron deficiency anaemia + dysphagia + oesophageal web.
Most patients are middle-aged or elderly women.
Usually causes dysphagia for solids first.
Iron therapy may improve symptoms.
Premalignant condition requiring follow-up.

Monitoring & Follow-Up

Repeat CBC
Monitor ferritin levels
Assess dysphagia improvement
Endoscopic surveillance if indicated
Screen for malignancy symptoms

Prognosis

Prognosis is excellent with iron replacement and dilation of oesophageal web. Most patients experience significant improvement in swallowing symptoms. Long-term monitoring is important because of the increased cancer risk.

Frequently Asked Questions (FAQ)

1. What is Plummer Vinson syndrome?
A syndrome characterized by iron deficiency anaemia, dysphagia and oesophageal web.

2. What causes dysphagia?
Post-cricoid oesophageal web formation.

3. Who is commonly affected?
Middle-aged and elderly women.

4. What type of anaemia occurs?
Microcytic hypochromic anaemia.

5. What is koilonychia?
Spoon-shaped nails due to iron deficiency.

6. What investigation confirms the web?
Barium swallow or endoscopy.

7. Is the condition premalignant?
Yes.

8. Which cancer is associated?
Squamous cell carcinoma.

9. What is the first-line treatment?
Iron supplementation.

10. When is dilation required?
Persistent dysphagia due to web.

11. Can symptoms improve with iron therapy?
Yes.

12. What ferritin level is expected?
Low ferritin.

13. What happens to TIBC?
It increases.

14. Why is follow-up important?
To monitor malignancy risk.

15. What is the prognosis?
Generally excellent with treatment.

References

Davidson's Principles and Practice of Medicine
Harrison's Principles of Internal Medicine
Oxford Handbook of Clinical Medicine
Kumar & Clark Clinical Medicine
British Society of Gastroenterology Guidelines

Keywords

Plummer Vinson Syndrome Quiz Iron Deficiency Anaemia Oesophageal Web Dysphagia MCQ Medical Quiz Internal Medicine Quiz Koilonychia Post Cricoid Web Ferritin Low Iron Studies Gastroenterology Quiz FCPS Medicine MRCP Quiz Clinical Case Challenge Squamous Cell Carcinoma Risk

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