MISCELLANEOUS CONDITIONS

MISCELLANEOUS CONDITIONS

Plummer–Vinson (in the USA) or Paterson–Brown-Kelly syndrome (UK) refers to the findings of a cervical oesophageal web, iron deficiency anaemia and dysphagia. It is also known as sideropenic dysphagia. The pathophysiology remains elusive, and the association of iron deficiency is also controversial. Possible mechanisms include iron and nutritional deficiencies, genetic predisposition and autoimmunity . It is a rare disease, mainly a ff ecting middle-aged women. There is a predispo sition to postcricoid, cervical oesophageal cancer. A web is distinguished from a Schatzki’s ring in that both the proximal and distal surfaces of the web are lined by squamous mucosa; in a Schatzki’s ring, the pro ximal side is lined with squamous mucosa and the distal side by columnar mucosa, coinciding with its location at the squamocolumnar junction. Treatment is with iron therapy , diet modification and, if necessary , endo scopic dilatation of the cervical web. A ring is located a few centimetres proximal to the B ring, if found) is a mucosal band found at the squamocolumnar junction and is not an uncommon cause of food impaction in adults ( Figure 66.58 ). Radiological studies using barium contrast by Scha tzki demonstrated that, in individuals with a ring size of less than 13 /uni00A0 mm, the symptom of dysphagia may occur. The exact aetiology of Schatzki’s ring is uncertain but is believed to be related to GORD; hiatus hernia is more common. Treatment is by endoscopic dilatation if symptomatic with dysphagia.

Figure 66.58 Schatzki’s ring found on endoscopy. Note there is also oesophagitis.