Plummer-Vinson Syndrome: A Rare Cause of Dysphagia in an Octogenarian

Abstract

Patient: Female, 88-year-old Final Diagnosis: Esophageal web • iron deficiency • Plummer-Vinson syndrome Symptoms: Dysphagia Medication:— Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Plummer-Vinson syndrome is a rare disease that presents with iron-deficiency anemia, dysphagia, and esophageal webs. It usually occurs in middle-aged White women, and it increases the risk for esophageal cancer. The prevalence of Plummer-Vinson syndrome has decreased due to early detection of iron deficiency and repletion of iron stores. Although Plummer-Vinson syndrome has also been commonly described in children and adolescents, it is seldom reported in the elderly population. Case Report: An 88-year-old women with a history of mild cognitive impairment, allergic rhinitis, and gastroesophageal re-flux disease presented with difficulty in swallowing solid foods. She had a decreased appetite, along with a 4.5-kg weight loss in the last 1 year. She was also found to have severe iron deficiency and mild anemia. Her dysphagia continued to progress even after starting iron supplementation for her iron deficiency. She eventually had a food bolus trapped in her cervical esophagus that required removal via esophagogastroduodenos-copy. A barium swallow revealed a narrowing in the upper esophagus. A repeat esophagogastroduodenoscopy revealed an esophageal web that was dilated, resulting in relief of symptoms. Conclusions: Dysphagia is reported in up to 10% of the elderly population. It commonly causes malnutrition and is associated with increased mortality. The usual etiologies include cognitive dysfunction, neurological disorders, and/or esophageal dysmotility or narrowing. Although the incidence of Plummer-Vinson syndrome has decreased over time, the possibility of its presence should not be overlooked. To our knowledge, the current case is the third case of dysphagia related to Plummer-Vinson syndrome reported in an octogenarian in the literature so far. Iron replacement can help resolve dysphagia in Plummer-Vinson syndrome but dilation of esophageal webs may sometimes be required.

Could Plummer–Vinson Syndrome Be Associated with Celiac Disease?

“…22 , 23 Chronic IDA can also be a direct cause of esophageal webs. 5 , 6 , 24 Webs can appear as thin protrusions or esophageal imprints in the upper esophagus or post-cricoid region in patients with CD. 3 , 4 , 11 Patients with webs typically present with oropharyngeal dysphagia for solids, but because of their proximal location, deglutitive aspiration may occur.…”

“…Studies report an association between cervical esophageal webs and CD. 1,7,12,13 The appearance of the web can be a direct consequence of IDA; 5,6 therefore, iron supplements can greatly improve swallowing difficulty. 12 Although CD has been discussed in detail in the literature, 12,14 few studies have described the dysphagia features associated with CD and the similarities and differences between CD and PVS (Table 1).…”

“…3 , 4 The pathogenesis of PVS syndrome is unknown, but several studies have suggested etiological factors between iron deficiency and web formation. 5 , 6 Treatment with iron supplementation can completely resolve dysphagia and esophageal webs; 5 , 6 however, dysphagia can still persist in some patients due to severe narrowing of the esophageal lumen. As a solution, rupture, and dilation of the web cannot be avoided.…”

“…Studies report an association between cervical esophageal webs and CD. 1 , 7 , 12 , 13 The appearance of the web can be a direct consequence of IDA; 5 , 6 therefore, iron supplements can greatly improve swallowing difficulty. 12 …”

Endoscopic Submucosal Dissection for Esophageal Squamous Cell High-grade Dysplasia in a Patient with Plummer Vinson Syndrome

“…3 4 It is commonly seen among middle-aged women and rarely in children and adolescents. 5 6 Patients with esophageal rings or webs are usually asymptomatic. Symptomatic patients typically present with intermittent dysphagia to solids.…”