Danbury Hospital - Yale School of Medicine Danbury, CT
Mohammad A. Ahmed-Khan, MD1, Chun Yu Peng, MD2, Agamsharan Patel, BSc3, Mahnoor Hanif, MD4, Zakee Jiffry, MD2 1Danbury Hospital - Yale School of Medicine, Danbury, CT; 2Danbury Hospital, Danbury, CT; 3Ross School of Medicine, Danbury, CT; 4CMH Lahore Medical College, Lahore, Punjab, Pakistan
Introduction: The triad of anemia, dysphagia, and esophageal webs is classic to Plummer-Vinson Syndrome (PVS), named for the two Mayo clinic physicians, discovered in the early 1900s the combination of iron deficiency and dysphagia was combined with the presence of suspected spasm of the upper esophagus or abnormal angulation of the esophagus. Epidemiologically the triad is more common in middle aged caucasian women and has been described to have an increased association with esophageal cancer. This illness is more commonly reported in the pediatric and younger adult population, but rarely in geriatric patients.
Case Description/Methods: A 74-year-old female with a history of dysphagia, iron deficiency anemia, esophageal stenosis status post endoscopic dilation of esophageal webs presented to the hospital with failure to thrive and dysphagia incidentally found to have COVID-19, Physical exam showed a cachectic appearing elderly female. She was uneventfully treated for her COVID-19 infection, however she remained hospitalized due to her inability to meet her nutritional needs.
She was found to have a microcytic anemia (Hb 4 g/dL, Ferritin 6 ng/mL, and TIBC 3%), she received 3 units of packed RBCs and her hemoglobin stabilized. Her hospital course was also complicated by dysphagia evaluated by modified barium swallow showing cricopharyngeal stenosis (Image 1), upper endoscopy was performed revealing esophageal webs (Image 2) treated with balloon dilation and biopsy showing normal histology. Oncology consulted for her anemia and recommended sodium ferric gluconate infusion weekly until discharge and ferrous sulfate 324 mg. Ultimately the patient could not meet her nutritional needs orally and elected to have a percutaneous gastrostomy tube placed for nutritional support.
Discussion: Failure to thrive in the affects up to 35% of the current geriatric population, even higher rates have been noted in long-term care residence in veterans. Unfortunately this vague complaint is difficult to work-up and manage due to its multifactorial nature, as many patients present with dementia, neurologic disease, malignancy, and a variety of other disorders that can present similarly. In the geriatric population, dysphagia related to PVS is a relatively treatable cause of failure to thrive. Its management can improve quality of life of patients and decrease mortality. The mainstay of treatment remains iron supplementation, and if necessary endoscopic balloon dilation.
Figure: A - Video Fluoroscopic Barium Swallow shows Cricopharyngeal Narrowing. B - Upper Esophageal Web (at Cricopharyngeus) C - Presence of Balloon Dilator at B
Mohammad Ahmed-Khan indicated no relevant financial relationships.
Chun Yu Peng indicated no relevant financial relationships.
Agamsharan Patel indicated no relevant financial relationships.
Mahnoor Hanif indicated no relevant financial relationships.
Zakee Jiffry indicated no relevant financial relationships.
Mohammad A. Ahmed-Khan, MD1, Chun Yu Peng, MD2, Agamsharan Patel, BSc3, Mahnoor Hanif, MD4, Zakee Jiffry, MD2. P1900 - Silent Suffering: Unveiling Plummer Vinson Syndrome in Geriatric Failure to Thrive, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.