Knowledge Check

True of false: patients rarely volunteer a history of pica; they must be asked specifically about the symptom.

A very rare presentation of iron deficiency is the Plummer-Vinson syndrome:

• Reported in < 0.1% of cases of iron deficiency.
• Associated with classic triad of:
  • Dysphagia
  • Iron deficiency anemia
  • Upper esophageal webs
• Pathogenesis of Plummer-Vinson syndrome remains speculative:
  • Depletion of iron-dependent oxidative enzymes may produce:
    • Myasthenic changes in muscles involved in the swallowing mechanism
    • Atrophy of the esophageal mucosa
    • Formation of webs as epithelial complications
  • Improvement in dysphagia after iron therapy provides evidence for an association between iron deficiency and postcricoid dysphagia.