A web of dysphagia

A 45-year-old woman presented with a 6-month history of dysphagia. Pallor and koilonychia were present on examination. Laboratory tests revealed microcytic hypochromic anaemia (haemoglobin, 59 g/L; mean cell volume, 65 fL), with decreased iron stores (on serum iron studies and bone marrow examination). Barium swallow (Figure A) and oesophagoscopy (Figure B) revealed an upper oesophageal web, which was fractured using Savary–Gilliard dilators. A diagnosis of Plummer–Vinson syndrome (oesophageal web, dysphagia and sideropenic anaemia) was made. As further investigations gave negative results (oesophagoduodenoscopy, colonoscopy, duodenal biopsy, measurement of anti-tissue transglutaminase antibodies, and stool examination for occult blood, ova and cysts), we attributed the iron deficiency to inadequate iron intake. This syndrome is associated with upper alimentary tract cancer, and surveillance endoscopy is recommended.

A: Barium swallow showing oesophageal web (arrow).

B: Oesophageal web seen on upper gastrointestinal endoscopy (arrows).