Rare cause of dysphagia in a young woman

A 27-year-old woman presented to our department for evaluation and treatment of dysphagia with recently diagnosed oesophageal stenosis. The patient had progressive difficulty in swallowing during the previous 2 years, first with solids then with liquids. The medical history showed that the patient was admitted to our clinic 5 months earlier for fatigue and she was diagnosed with severe iron deficiency anaemia. 2 months before presenting to our department, the patient underwent an oesophagogastroduodenoscopy (EGD), which revealed a 3-mm marked narrowing due to an eccentric oesophageal web 14 cm from the incisors preventing passage of either an adult or a paediatric endoscope (figure A). Biopsies taken from the oesophageal web showed that the mucosa had no substantial alterations. Physical examination showed that the patient was emaciated (BMI 16·9 kg/m2) and had bilateral angular cheilitis and koilonychia (ie, spoon-shaped nails). We completed the evaluation with a barium swallow (figure B) and a CT of the neck to assess the extent of the stenosis and to exclude extraluminal process. The examinations showed a focal stenosis in the upper oesophagus at the C6 level, without signs of malignancy. The EGD and the barium swallow findings with the history of severe iron deficiency anaemia led to a final diagnosis of an oesophageal web associated with Plummer-Vinson syndrome. The oesophageal web was managed by oesophageal dilation, which was done gradually multiple times over 6 weeks with a through-the-scope balloon to 18 mm in diameter (figure C). The patient reported complete resolution of dysphagia symptoms and is planned for regular surveillance of malignant transformation of the hypopharynx or the upper oesophagus with upper endoscopy.