What Is Plummer-Vinson Syndrome?

Plummer-Vinson syndrome is iron-deficiency dysphagia. Iron-deficient dysphagia is caused by a thin diaphragm in the esophagus cavity, which is divided into upper esophageal web, middle esophageal web, and lower esophageal web according to different parts of the esophagus. The main symptom is intermittent dysphagia. Most appear when eating hard food. The patient felt food staying on the upper chest. It is often thin and pale, sometimes red, tongue is red and smooth, tongue papillae disappears, most are missing or completely toothless, cleft palate, spoon-shaped nails, splenomegaly and even giant spleen.

Basic Information

nickname

Daterson syndrome Paterson-Kelly syndrome or iron deficiency dysphagia

Visiting department

Internal medicine

Multiple groups

Women

Common locations

Intraesophageal lumen

Common causes

Iron deficiency

Common symptoms

The skin and mucous membranes gradually become pale or yellow, which is prone to fatigue and weakness, irritability, crying or loss of energy, inactivity, loss of appetite, dizziness, dark eyes, tinnitus, etc.

Causes of Plummer-Vinson syndrome

The cause of this disease is unknown. Most people believe that iron deficiency is the most basic factor in this disease. This is because the lack of iron causes changes in the epithelial layer, which makes swallowing difficult. Clinical treatment with iron without dilating the esophagus can make dysphagia disappear. As for the high incidence of women, it may be due to difficulty in swallowing, reduced iron intake, and women's iron loss during menstruation. Infant sporadic disease is likely to be a congenital cause and may be related to iron deficiency anemia.

Clinical manifestations of Plummer-Vinson syndrome

It can occur at any age, and the onset is slow, and many children are only found to have this disease when they see a doctor for other diseases.

General performance

The skin and mucous membranes are gradually pale or yellow, and the most obvious are the lips, oral mucosa and nail bed. Susceptible to fatigue, weakness, irritability, crying or loss of energy, inactivity, and loss of appetite. Older children may complain of dizziness, dark eyes, and tinnitus.

2. Hematopoietic organ performance

The liver, spleen, and lymph nodes are often slightly enlarged due to extra-marrow hematopoietic reactions. The younger the age, the longer the disease course, and the heavier the anemia, the hepato-splenomegaly becomes more pronounced, but the degree of swelling is rarely more than moderate, and the degree of lymphadenopathy is lighter and tougher.

3. Other symptoms and signs

Due to epithelial damage, there may be inferior nails, inflammation of the oral mucosa and anus, and atrophy of the tongue and nipples. Digestive symptoms often include low appetite, pica, vomiting or diarrhea. Breathing, pulse rate is accelerated, and systolic murmurs are often heard in the precardiac area. Patients with severe anemia may have enlarged heart and even complicated heart failure.

Plummer-Vinson syndrome test

Laboratory inspection

Hemoglobin, red blood cells, MCH, MCV, and MCHC were all reduced, serum iron was reduced, and combined with iron was elevated, showing iron deficiency small cell anemia. In some cases, vitamin B ₁₂ and B ₆ concentrations in serum decreased, gastric acid deficiency, and severe anemia may occur.

2. Other auxiliary inspections

(1) X-ray examination If webbing is suspected, you need to rely on fluorescent film examination. It is often found on the front side of the upper esophagus as eccentric and less than 2mm in width. You can see it continuously. It is rare to have more than one webbed, and this type of patient is likely to have oral cancer.

(2) Endoscopic examination The webbed is a smooth, colored diaphragm-like hole with eccentric openings, located below the level of the cyclopharyngeal muscle. The film-like webbed is sometimes thin enough to be undetected by the examiner. Rare webs are thick and stiff, preventing food from passing through. Perform a cell brush or biopsy if necessary to exclude inflammatory stenosis and cancer.

(3) Patients with Plummer-Vinson syndrome of thyroid and gastric parietal cell antibodies may be complicated by atrophic gastritis, malignant anemia, and myxedema. In some patients, thyroid and gastric parietal cell antibodies can be detected.

Diagnosis of Plummer-Vinson syndrome

Diagnosis is generally made based on clinical manifestations, age of onset, feeding history, and haematological characteristics. The amount of hemoglobin is significantly lower than the number of red blood cells and the morphological changes of red blood cells are of great significance for diagnosis. Bone marrow examination is generally not required to diagnose this disease. If clinical manifestations are not typical, try iron treatment, if there is a treatment response, it can help diagnosis. If necessary, bone marrow examination can be done, as well as serum iron content, serum iron binding capacity and other items. After the diagnosis is clear, the cause of the disease should be further identified in order to treat the cause.

Differential diagnosis of Plummer-Vinson syndrome

Certain rare anemias, such as hemoglobin C disease, thalassemia, anemia caused by vitamin B deficiency, and hereditary small cell anemia, can be identified based on the characteristics of each disease. Iron granulocyte anemia is also hypopigmented and must be distinguished from iron deficiency anemia. The former serum iron is normal or increased, more iron granulocytes can be seen in the bone marrow, the iron granules are large and coarse, and they form a ring around the nucleus, which can be identified.

Plummer-Vinson syndrome treatment

First, anemia should be treated. Most iron supplementation can reverse anemia, splenomegaly, and esophageal epithelial changes, and swallowing difficulties also improve rapidly. A few large and thick esophageal webs cannot be eliminated simply by iron supplementation and swallowing. They can be treated with endoscopic electrocautery or endoscopic smashing or dilator expansion. It is rare to require surgery because the diaphragm is tough. The three effects of iron supplementation, blood production and nutrition can better prevent and improve anemia and enhance human immunity.

Prognosis of Plummer-Vinson syndrome

Most of these diseases have a good prognosis after the above treatments. Once the symptoms recur, oral, pharyngeal or esophageal cancer should be noted. Some authors believe that about 70% of oral cancer patients have a long history of Plummer-Vinson syndrome.

Plummer-Vinson syndrome prevention

Iron deficiency is the basic cause of the disease. Due to the lack of iron, the lack of iron-containing enzyme system affects the metabolism of the mucosa, causing changes in the epithelial layer, the formation of esophageal webs, and difficulty in swallowing. In the early days without esophageal dilatation, most cases can only be treated with iron to make swallowing difficulties disappear. Therefore, iron supplementation as early as possible to treat anemia can quickly improve dysphagia.