An esophageal web, described as a thin membranous extension of the esophageal mucosa and submucosa, is assumed to be present in about 10% of the population and is asymptomatic in virtually all cases [1] [2]. Its potential protrusion into the lumen of the esophagus (most commonly in the proximal portion) and compromise of food passage, however, can occur in certain disorders, such as Plummer-Vinson syndrome, where iron deficiency, the principal pathophysiological event, is assumed to promote esophageal web development [1] [3] [4] [5]. Moreover, various studies have associated esophageal webs with bullous pemphigoid, pemphigus vulgaris, epidermolysis bullosa, gastroesophageal reflux disease (GERD), glossitis, and desquamative esophagitis in graft-versus-host disease (GVHD) [2]. Regardless of the etiology, the principal symptom that could be triggered by an esophageal web is dysphagia, which may be initially painless and intermittent [2] [3]. More severe symptoms, on the other hand, include nasopharyngeal reflux, aspiration (and consequent pneumonia) and even spontaneous perforation in the setting of significant obstruction [2]. Among adults, a minor but notable predilection toward women has been observed [2] [6]. If Plummer-Vinson syndrome is the underlying cause of esophageal webs, accompanying signs are brittle hair, thinning of nails, glossodynia, angular cheilitis, and koilonychia, as well as constitutional symptoms due to anemia - fatigue, pallor, tachycardia and weakness [3] [4].

• Constitutional Symptom

  Patients should be asked about the onset and progression of symptoms, whereas additional signs may be of critical importance to suspect Plummer-Vinson syndrome or other known associated diseases in which esophageal webs are a constitutive feature. [symptoma.com]

  He denied nausea, vomiting, abdominal pain, gastrointestinal bleeding, weight loss, or constitutional symptoms. He had intermittent heartburn and reflux. [acgcasereports.gi.org]

• Intermittent Fever

  fever and anaemia • Great weakness felt in the morning • Coldness, heartburn, palpitations • Great disturbance in alimentary tract Picricum acidum – • Muscular debility, with tired feeling • Prostration and weakness • Progressive and pernicious anaemia [drthindhomeopathy.com]

• Dysphagia

  Iron deficiency clearly can precede dysphagia. [emedicine.com]

  The pathogenesis of the esophageal web and the cause of dysphagia in this syndrome were investigated radiographically, endoscopically, manometrically, and histologically. [ncbi.nlm.nih.gov]

• Cheilitis

  Physical examination revealed conjunctival pallor, koilonychia, angular cheilitis and smooth tongue with loss of the normal tongue papillae (fig. 1 ). Fig. 1 Angular cheilitis and smooth tongue with loss of the normal tongue papillae. [karger.com]

  If Plummer-Vinson syndrome is the underlying cause of esophageal webs, accompanying signs are brittle hair, thinning of nails, glossodynia, angular cheilitis, and koilonychia, as well as constitutional symptoms due to anemia - fatigue, pallor, tachycardia [symptoma.com]

  This syndrome usually has: dysphagia esophageal web atrophic glossitis (inflammation of tongue) and/or cheilitis (inflammation around the lips/mouth) iron deficiency anemia This patient presents with koilonychia (spoon-shaped nail) and platynychia (flat [stanfordmedicine25.stanford.edu]

  […] the upper part of the esophagus Along-with the presence of esophageal webs causing partial obstruction of the food-pipe, Plummer-Vinson Syndrome consists of iron-deficiency anemia, inflammation of the tongue (glossitis), and inflammation of the lip (cheilitis [dovemed.com]

• Conjunctival Pallor

  Physical examination revealed conjunctival pallor, koilonychia, angular cheilitis and smooth tongue, and laboratory findings were consistent with microcytic hypochromic anemia with iron deficiency. [karger.com]

• Arthritis

  Medrano M: Dysphagia in a patient with rheumatoid arthritis and iron deficiency anemia. MedGenMed 2002;4:10. [karger.com]

  Associated diseases Thyroid disease, rheumatoid arthritis, graft-versus-host disease, Stevens-Johnson syndrome, psoriasis, blistering skin diseases, and pernicious anaemia. [patient.info]

  Autoimmune theory Autoimmune diseases have been associated with esophageal webs and include thyroid disease, rheumatoid arthritis, graft versus host disease, Stevens-Johnson syndrome, psoriasis, blistering skin diseases, and pernicious anemia. [emedicine.com]

• Koilonychia

  Links: dysphagia iron deficiency anaemia (IDA) glossitis koilonychia angular stomatitis barium swallow [gpnotebook.com]

  If Plummer-Vinson syndrome is the underlying cause of esophageal webs, accompanying signs are brittle hair, thinning of nails, glossodynia, angular cheilitis, and koilonychia, as well as constitutional symptoms due to anemia - fatigue, pallor, tachycardia [symptoma.com]

  Source/References: This case was obtained from Clinical Case Reports article Spooning of the nails and webbing of the esophagus: koilonychia and Plummer–Vinson Syndrome Samad, Mohan, Balaji, Augustine, Patil SG. [stanfordmedicine25.stanford.edu]

  The physical signs of tissue iron deficiency include smooth tongue, angular cheilitis and koilonychia, which were also observed in our patient. [karger.com]

  There may be koilonychia (spoon nails), cheilosis and glossitis. Webs are more frequent in women and this may be related to propensity for iron deficiency. Most upper oesophageal webs are not associated with Plummer-Vinson syndrome. [patient.info]

• Skin Disease

  Autoimmune theory Autoimmune diseases have been associated with esophageal webs and include thyroid disease, rheumatoid arthritis, graft versus host disease, Stevens-Johnson syndrome, psoriasis, blistering skin diseases, and pernicious anemia. [emedicine.com]

  Associated diseases Thyroid disease, rheumatoid arthritis, graft-versus-host disease, Stevens-Johnson syndrome, psoriasis, blistering skin diseases, and pernicious anaemia. [patient.info]

• Brittle Hair

  If Plummer-Vinson syndrome is the underlying cause of esophageal webs, accompanying signs are brittle hair, thinning of nails, glossodynia, angular cheilitis, and koilonychia, as well as constitutional symptoms due to anemia - fatigue, pallor, tachycardia [symptoma.com]

The differential diagnosis of dysphagia is rather broad, making a detailed patient history and a complete physical examination necessary to narrow the list of possible diseases. Patients should be asked about the onset and progression of symptoms, whereas additional signs may be of critical importance to suspect Plummer-Vinson syndrome or other known associated diseases in which esophageal webs are a constitutive feature. Nevertheless, the cornerstone of diagnosing esophageal webs is the implementation of one of the three imaging studies - the barium swallow test, videofluoroscopy, or upper endoscopy [4]. Barium swallow test is somewhat safer, as the web may be mechanically injured and ruptured during insertion of the endoscope, thus the diagnosis can be missed [4]. For this reason, certain authors suggest that videofluoroscopy (also known as the modified barium swallow test) is the optimal method to detect esophageal webs [2] [4]. Smooth and thin protrusions of the central lumen, often originating from the anterior wall and spreading to the lateral aspects of the esophagus, are typical findings [4]. Whenever esophageal webs are detected, a complete blood count (CBC) and further tests to confirm iron-deficiency anemia (serum iron levels, ferritin, and total iron binding capacity, or TIBC) should be performed, in order to obtain valid clinical suspicion toward Plummer-Vinson syndrome [6].

To present a technique for the treatment of complete esophageal stenosis in the post-radiation patient that may be applied to selected patients with obstructing stenoses. A case report of the treatment of a post-radiation esophageal web. [ncbi.nlm.nih.gov]

In case of severe obstruction, the esophagus may be mechanically dilated (expanded) The prognosis of Plummer-Vinson Syndrome is generally good with treatment, but complications, such as trauma/tears in the throat during treatment, may worsen the prognosis [dovemed.com]

Treatments Treatment usually consists of opening up the throat so the web no longer blocks it. This can be done with a balloon introduced during upper GI endoscopy or with a long, flexible, tubular instrument called a dilator. [cedars-sinai.edu]

Homeopathic treatment for Plummer-Vinson Syndrome/Paterson-Kelly Syndrome/Sideropenic Dysphagia/Esophageal Web. [drthindhomeopathy.com]

In case of severe obstruction, the esophagus may be mechanically dilated (expanded) The prognosis of Plummer-Vinson Syndrome is generally good with treatment, but complications, such as trauma/tears in the throat during treatment, may worsen the prognosis [dovemed.com]

Prognosis of Plummer-Vinson Syndrome/Paterson-Kelly Syndrome/Sideropenic Dysphagia/Esophageal Web. Prognosis is good after prompt treatment. [drthindhomeopathy.com]

[…] distal esophagus web) 7 external beam radiation Fluoroscopy: barium swallow may be demonstrated on high-volume barium oesophagrams when the esophagus is fully distended 4 a "jet effect" of contrast passing distal to the web may be seen 6 Treatment and prognosis [radiopaedia.org]

Prognosis The prognosis of esophageal webs is generally good especially with treatment of the underlying cause. [wikidoc.org]

Symptoms Diagnosis Expected Duration Prevention Treatment When To Call a Professional Prognosis Additional Info What Is It? Esophageal rings and webs are folds that block your esophagus either partially or completely. [pernicious-anaemia-society.org]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

This patient's unique findings may provide further insight into the etiology of upper esophageal webs or rings (Paterson-Kelly syndrome). [ncbi.nlm.nih.gov]

Regardless of the etiology, the principal symptom that could be triggered by an esophageal web is dysphagia, which may be initially painless and intermittent. [symptoma.com]

Final diagnosis may require tissue examination in most cases as CES secondary to tracheobronchial remnants is the commonest etiology [ 5 ]. About one-third cases of CES may be associated with esophageal atresia [ 6, 7 ]. [omicsonline.org]

Its etiology remains unknown, but an embryologic origin has been suggested. [ojrd.biomedcentral.com]

This review attempts to provide a practical update on esophageal rings and webs and to discuss their definition, epidemiology, pathophysiology, clinical presentation, differential diagnosis, diagnosis, treatment, and follow-up care. [emedicine.com]

Molecular Epidemiology of Hereditary Epidermolysis Bullosa in a Middle Eastern Population. Journal of Investigative Dermatology (2006) 126, 777–781. Stewart MI,Woodley DT, Briggaman RA. [journalijar.com]

Epidemiology Prevalence Webs are diagnosed in 5-15% of patients doing barium esophagogram for diagnosing the cause of dysphagia. Congenital esophageal webs are estimated to be 1 in 25,000 to 1 in 50,000 live births. [wikidoc.org]

Eslick GD, Talley NJ (2008) Dysphagia: epidemiology, risk factors and impact on quality of life--a population-based study. Aliment Pharmacol Ther 27: 971-979. [archivesofmedicine.com]

Esophageal Web & Zenker's Diverticulum Pathophysiology A web is mucosal structure occur anywhere along the esophagus; reflux esophagitis may predispose A hypopharyngeal diverticulum, associated w/ dysfunctioning upper esophageal sphincter Diagnosis Esophageal [fprmed.com]

Its potential protrusion into the lumen of the esophagus (most commonly in the proximal portion) and compromise of food passage, however, can occur in certain disorders, such as Plummer-Vinson syndrome, where iron deficiency, the principal pathophysiological [symptoma.com]

Pathophysiology The pathophysiology of esophageal rings and webs is controversial. Several theories have been proposed for the formation of esophageal webs and rings. [emedicine.com]

Pathophysiology Lower Esophageal Sphincter (LES) constriction Associated with Hiatal Hernia in nearly all cases III. Symptoms Dysphagia for solids only IV. Diagnosis Barium swallow Endoscopy (EGD) V. [fpnotebook.com]

Stretching of strictures usually is combined with maximum treatment for acid reflux in order to prevent further scarring and narrowing of the esophagus. Permanent treatment of strictures requires surgery. Medical Author: Jay Marks, M.D. [medicinenet.com]

Symptoms Diagnosis Expected Duration Prevention Treatment When To Call a Professional Prognosis Additional Info What Is It? Esophageal rings and webs are folds that block your esophagus either partially or completely. [pernicious-anaemia-society.org]

[…] individuals with PVS have shown a higher incidence of esophageal cancer Please find comprehensive information on Plummer-Vinson Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention [dovemed.com]

Centers for Disease Control and Prevention Intersex (Medical Encyclopedia) [ Read More ] Esophagus Disorders The esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. [icdlist.com]

Gastrointestinal endoscopy and barium-swallow esophagography detected a web that prevented passage of the endoscope into the upper portion of the esophagus. [karger.com]

1. Tahara T, Shibata T, Okubo M, et al. A Case of Plummer-Vinson Syndrome Showing Rapid Improvement of Dysphagia and Esophageal Web after Two Weeks of Iron Therapy Case Rep Gastroenterol. 2014;8(2):211-215.
2. Liu JJ, Kahrilas PJ. Pharyngeal and esophageal diverticula, rings, and webs. GI Motility online; 2006.
3. Gude D, Bansal D, Malu A. Revisiting Plummer Vinson Syndrome. Annals of Medical and Health Sciences Research. 2013;3(1):119-121.
4. Novacek G. Plummer-Vinson syndrome. Orphanet Journal of Rare Diseases. 2006;1:36.
5. Terui K, Saito T, Mitsunaga T, Nakata M, Yoshida H. Endoscopic management for congenital esophageal stenosis: A systematic review. World J Gastrointest Endosc. 2015;7(3):183-191.
6. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.