Plummer-Vinson Syndrome and Oesophageal Webs
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Direct answer
Plummer-Vinson syndrome is a triad of dysphagia, iron deficiency anaemia and glossitis, associated with thin mucosal webs in the upper oesophagus. The webs narrow the postcricoid region, and iron replacement followed by mechanical dilatation is the standard treatment. The syndrome matters for exams because it carries a recognised association with postcricoid carcinoma, so the pharynx and upper oesophagus must be examined before the web is dilated.
What you must remember
- Triad: dysphagia for solids, iron deficiency anaemia and glossitis, with angular stomatitis and koilonychia as common additions.
- Web location: a thin mucosal membrane in the upper oesophagus, usually in the postcricoid region.
- Demographics: described mainly in middle-aged women, and the syndrome is also known as Paterson-Brown Kelly syndrome.
- Carcinoma link: postcricoid carcinoma, arising in the hypopharynx or upper oesophagus, is a recognised association.
- Diagnosis: a barium swallow shows the web, and endoscopy with biopsy excludes malignancy.
- Iron first: oral iron corrects the anaemia, and dysphagia can improve with it.
- Dilatation: a web that persists is stretched with bougies such as Plummer or Savary dilators, or with endoscopic balloon dilatation.
- Schatzki ring: a lower oesophageal ring at the squamocolumnar junction, linked with hiatus hernia rather than iron deficiency.
Two rings, two causes
Oesophageal webs look similar on a barium study, but the Plummer-Vinson web carries an iron and mucosal story that the lower ring lacks. Comparing the two keeps the diagnosis and the treatment tied to the right cause. Each row of the table points to a different step in the workup.
| Feature | Plummer-Vinson web | Schatzki ring |
|---|---|---|
| Site | Upper oesophagus, postcricoid region | Lower oesophagus at the squamocolumnar junction |
| Typical association | Iron deficiency, glossitis | Hiatus hernia |
| Main symptom | Progressive dysphagia to solids | Intermittent solid food impaction |
| Carcinoma concern | Postcricoid carcinoma | Not a recognised association |
| Standard treatment | Iron, then dilatation | Dilatation |
A solid-food dysphagia with anaemia in a middle-aged woman points to the upper web, and the work-up looks for carcinoma before any dilatation. A lower ring with a hiatus hernia is the more likely answer when the anaemia is absent. Either way, the dilatation technique is similar, but the cause, the screening and the follow-up differ.
Where the exam tries to catch you
Examiners test whether you can separate the triad from a bare web and from a lower ring.
- Trap: calling every upper web Plummer-Vinson Correct: the syndrome rests on the triad, so an isolated web without anaemia is simply an upper oesophageal web.
- Trap: dilating the web without excluding carcinoma Correct: postcricoid carcinoma is associated, so endoscopy and biopsy of the pharynx and upper oesophagus come first.
- Trap: using the Schatzki ring label for upper webs Correct: a Schatzki ring is a lower oesophageal ring linked with hiatus hernia, not with iron deficiency.
Frequently asked questions
Which investigation shows an upper oesophageal web in Plummer-Vinson syndrome?
A barium swallow, usually with views of the pharynx and upper oesophagus, shows the web as a thin filling defect in the postcricoid region. Endoscopy then confirms it and allows biopsy to exclude carcinoma.
Why must patients with Plummer-Vinson syndrome be examined for carcinoma?
Postcricoid carcinoma is a recognised association of Plummer-Vinson syndrome, so the hypopharynx and upper oesophagus need careful endoscopic examination. Any suspicious mucosa is biopsied at the time of dilatation so that a tumour is not missed.
What is the first step in treating the anaemia of Plummer-Vinson syndrome?
Oral iron replacement is the first step, aimed at correcting the iron deficiency anaemia. Dysphagia can improve with iron alone, but a web that persists is usually dilated mechanically.
How does Plummer-Vinson syndrome differ from a Schatzki ring?
Plummer-Vinson syndrome involves an upper oesophageal web with iron deficiency and glossitis, while a Schatzki ring is a lower oesophageal ring at the squamocolumnar junction, often linked with hiatus hernia. Both can cause solid-food dysphagia, but the associated anaemia and the site mark the difference.
Which tongue and nail changes accompany Plummer-Vinson syndrome?
Glossitis with atrophic papillae is the classic tongue change, and angular stomatitis often coexists with it. Koilonychia, or spoon-shaped nails, is the nail change that accompanies iron deficiency in this syndrome.