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Synonyms: Paterson-Brown Kelly syndrome, Paterson-Brown-Kelly syndrome, Waldenström-Kjellberg syndrome, sideropenic dysphagia, sideropenic nasopharyngopathy.
Plummer-Vinson syndrome (PVS) is a triad of microcytic hypochromic anaemia (iron deficiency), atrophic glossitis, and oesophageal webs or strictures. A description of this syndrome was published by Henry Plummer in Chicago in 1911 and also by Porter Vinson in Philadelphia in 1919. Donald Ross Paterson and Adam Brown Kelly published independently of each other in London in 1919.
PVS most often affects middle-aged women (this may be related to a propensity for iron deficiency), although it can occasionally present in a child. The web (containing mucosa and submucosa) occurs at the anterior post-cricoid area of the upper oesophagus.
It is an uncommon condition and much of the literature is case reports of one or a few individuals rather than large series. Figures for incidence and prevalence are not available but it is becoming rarer, probably because dietary inadequacy is becoming less common.
A high prevalence of PVS was reported in Sweden in the early 20th century. This reduced after the introduction of iron supplementation in food.
PVS appears to be more common in the Indian subcontinent than in Western countries. PVS is common in males as well as females in the Indian subcontinent.
Iron deficiency - this is related to poor diet or blood loss.
The presentation is usually with painless, intermittent dysphagia. It tends to be with solid foods but, if untreated, may progress to soft foods and even liquids. As with other causes of oesophageal strictures, webs and rings, the patient is able to give a good indication of the level of obstruction. In this condition the patient indicates the upper oesophagus. Dysphagia may lead to weight loss. This should be regarded as a sign of danger.
There may also be features of iron-deficiency anaemia like lethargy, tiredness and shortness of breath on exertion.
The features that appear on examination are those associated with iron deficiency. There may be pallor and even tachycardia if anaemia is marked. There may be koilonychia (spoon-shaped nails), angular cheilitis and glossitis.
- FBC will show a microcytic, hypochromic anaemia. Ferritin is low.
- Barium swallow may show the web. This may need to be enhanced with videofluoroscopy.
- Biopsy may be required if malignancy is suspected clinically.
Various disorders have been known to associate PVS, such as coeliac disease, inflammatory bowel disease, pernicious anaemia, thyroid disease, Sjögren's syndrome and rheumatoid arthritis.
- Iron replacement can almost invariably be achieved by oral means. Adding vitamin C does not improve absorption significantly. There is rarely any need for parenteral iron. Supplements may be needed long-term because after correction it is important to maintain a normal iron status. Causes of blood loss like menorrhagia may require attention.
- Endoscopic dilatation or argon plasma coagulation therapy of the oesophageal web is occasionally required in cases of persistent dysphagia.
Post-cricoid carcinoma or carcinoma of the oesophagus may develop.
Correction of iron deficiency will correct the condition if malignancy has not yet occurred. Prevention of iron deficiency prevents the disease.
- Henry Plummer (1874-1937) was an American internist. He was a professor at the Medical School of Minnesota. He published: Diffuse dilatation of the esophagus without anatomic stenosis (cardiospasm). A report of ninety-one cases. Journal of the American Medical Association, Chicago, 1912, 58: 2013-2015.
- Porter Paisley Vinson (1890-1959) was an American surgeon at the Mayo Clinic. He published: A case of cardiospasm with dilatation and angulation of the esophagus. Medical Clinics of North America, Philadelphia, PA., 1919, 3: 623-627.
- Born in Inverness, Donald Ross Paterson (1863-1939) was an otolaryngologist. He worked in Cardiff and published: A clinical type of dysphagia. The Journal of Laryngology, Rhinology and Otology, London, 1919, 24: 289-291.
- Adam Brown Kelly (1865-1941) graduated from Glasgow but worked as an ENT surgeon in London, Berlin and Vienna. He published: Spasm at the entrance of the esophagus. The Journal of Laryngology, Rhinology and Otology, London, 1919, 34: 285-289.
Further reading and references
Scott EC, Schuster S; Plummer-Vinson syndrome and reactive thrombocytosis mask a JAK2-V617F positive myeloproliferative neoplasm. Blood. 2011 Dec 1118(23):5988.
Samad A, Mohan N, Balaji RV, et al; Oral manifestations of plummer-vinson syndrome: a classic report with literature review. J Int Oral Health. 2015 Mar7(3):68-71.
Plummer-Vinson Syndrome; whonamedit.com
Novacek G; Plummer-Vinson syndrome. Orphanet J Rare Dis. 2006 Sep 151:36.
Gude D, Bansal D, Malu A; Revisiting Plummer Vinson syndrome. Ann Med Health Sci Res. 2013 Jan3(1):119-21. doi: 10.4103/2141-9248.109476.
Hefaiedh R, Boutreaa Y, Ouakaa-Kchaou A, et al; Plummer-Vinson syndrome. Tunis Med. 2010 Oct88(10):721-4.
Richie JP Jr, Kleinman W, Marina P, et al; Blood iron, glutathione, and micronutrient levels and the risk of oral cancer. Nutr Cancer. 200860(4):474-82. doi: 10.1080/01635580801956477.
Bakshi SS; Plummer Vinson syndrome - is it common in males? Arq Gastroenterol. 2015 Jul-Sep52(3):250-2. doi: 10.1590/S0004-28032015000300018.
Jones R, Latinovic R, Charlton J, et al; Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database. BMJ. 2007 May 19334(7602):1040. Epub 2007 May 10.
Letur T; Carcinoma of the esophagus and gastro-esophageal junction, 2001.
Phatak S, Redkar N, Patil MA, et al; Plummer-Vinson syndrome. BMJ Case Rep. 2012 Jul 252012. pii: bcr2012006403. doi: 10.1136/bcr-2012-006403.
Teucher B, Olivares M, Cori H; Enhancers of iron absorption: ascorbic acid and other organic acids. Int J Vitam Nutr Res. 2004 Nov74(6):403-19.
Popescu CR, Bertesteanu SV, Mirea D, et al; The epidemiology of hypopharynx and cervical esophagus cancer. J Med Life. 2010 Oct-Dec3(4):396-401.
I have had very low ferritin levels after bowel surgery, but i have symptoms of low b12 . My surgeon said b 12 was ok, but my gp said he would start b12 injections anyway because of my symptoms....Rhiannon_5000
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