Plummer-Vinson syndrome (PVS) is a classical triad of postcricoid
dysphagia, upper esophageal webs, and iron deficiency anemia.
Identification and follow-up is relevant due to increased risk of
squamous cell carcinomas of the esophagus and pharynx.
Also known as
• Plummer-Vinson syndrome (USA): Named after Henry Stanley
Plummer and Porter Paisley Vinson who were physicians on the staff
of the Mayo Clinic.
• Paterson-Kelly/Paterson-Brown Kelly syndrome (UK): Named after
Donald Ross Paterson and Adam Brown-Kelly, both British
laryngologists, who published their findings independently in 1919.
• Sideropenic dysphagia: Because the syndrome can occur with iron
RACE: Whites & Scandinavians (Norway, Sweden, Finland)
AGE: 40-70 years
Women are at higher risk than men.
Menstrual blood loss (as much as 200-500 cc per month) might explain
the sex ratio (higher rate of sideropenic anemia among women), but
Plummer-Vinson syndrome is more likley to occour postmenopausal
So there might be also a different role of female hormones.
• Basically unclear.
Proposed mechanisms include:
iron deficiencies, causes may include GI blood loss, celiac sprue
nutritional deficiency - vitamin B complex
autoimmunity, causes may include rheumatoid arthritis, pernicious
• Dysphagia, is typically intermittent and limited to solids.
• Odynophagia (painful swallowing, also called algiaphagia)
• Choking spells and aspiration may occur because of the proximal location of the web.
• Weakness, fatigue and dyspnea are secondary to iron deficiency anemia.
• Weight loss is uncommon.
Manifestations of iron deficiency (with or without anemia) include:
• Angular stomatitis
• Koilonychia (spoon nails)
• Edentia (loss of teeth) - due to esophagial relux
• Enlarged nodular thyroid glands
• Gastritis with Acholorhydia
• Post cricoid webs
• Causes of dysphagia especially malignant tumors, benign strictures,
esophageal rings or Zenkers diverticula
• Motility disorders such as achalasia, spastic motility disorders,
scleroderma, diabetes mellitus, gastroesophageal reflux disease
• Heterotopic gastric mucosa (inlet patch) with stricture
• Hypopharyngeal bar (to differentiate from a web)
• Inflammatory conditions associated with web formation (blistering
skin diseases, chronic graft versus host disease)
Complete blood cell (CBC) counts: decreased values of hemoglobin,
hematocrit, mean corpuscular volume
Peripheral blood smears: hypochromic microcytic anemia
Iron studies: decreased values of serum iron and ferritin, and increased
total iron binding capacity
• esophageal webs appear smooth, thin, and gray with eccentric or
• characterized by one or more thin horizontal membranes consisting
of squamous epithelium and submucosa
• occur in the proximal part of the esophagus
• protrude from the anterior wall, extending laterally but not to the
Conventional barium swallow may detect the web, which
characteristically appears as a thin projection off the postcricoid,
anterior esophageal wall. On occasion, multiple webs can be observed.
If the conventional barium swallow findings are negative or equivocal
and a high index of suspicion remains, a video swallow study is
performed. The latter can distinguish subtle true webs from weblike
formations (false webs) due to insignificant mucosal foldings and
Upper GI Endoscopy
Treat iron deficiency and its underlying cause
• Iron replacement (Ferrous Sulphate)
• Address the cause of iron deficiency (celiac sprue, bleeding, malignancy)
Treat dysphagia and the web
• Mechanical dilation by upper endoscopy
• Bougie (eg, Savary dilator)
• ND:YAG laser therapy
• Needle-knife electroincision
• Eat slowly and chew thoroughly.
• Solid foods cut in small pieces, especially meats.
• Due to increased risk of squamous cell carcinoma of the pharynx and the esophagus,
the patients should be followed closely. A surveillance upper gastrointestinal endoscopy
is recommended every year.
• Follow-up complete blood cell counts (CBCs) and iron studies in 3 months, after
initiation of iron replacement, to document resolution of sideropenia and anemia.
• Provide follow-up care for patients whose treatment has been initiated for the specific
• Repeat esophageal dilations those who have recurrent dysphagia.
• Prognosis of the Plummer-Vinson syndrome is excellent.
• Dysphagia and anemia can be treated effectively.
• Complications: In case of an associated squamous cell
carcinoma of the hypopharynx or upper esophagus the prognosis