What is the most common cause of dysphagia in young females ??
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"Deglutition Disorders"[MeSH Terms] AND "young adult"[MeSH Terms]
Exam answer: Plummer-Vinson syndrome (also called Paterson-Brown-Kelly or sideropenic dysphagia). It is the classic cause of dysphagia in a young or middle-aged woman.
Features
- The triad is dysphagia, iron deficiency anaemia and an upper oesophageal (postcricoid) web.
- It occurs almost exclusively in women. Rosen's Emergency Medicine says most patients are women aged 30 to 50. S Das's Manual on Clinical Surgery says it occurs in women nearing menopause, over 40 years of age.
- The dysphagia is intermittent at first and worse with solids. It is usually high, at the cricoid level.
- Associated signs are koilonychia, angular stomatitis, cheilosis, glossitis and fatigue. (Bailey and Love's Short Practice of Surgery, 28th Edition, "Sideropenic dysphagia")
- A barium swallow shows the web. Treatment is iron replacement, with dilation of the web if symptoms persist.
- It carries a risk of post-cricoid squamous cell carcinoma, so these patients need follow-up.
Caveat
Plummer-Vinson syndrome is rare. In real-world practice, the more common causes of dysphagia in a young woman are:
- GERD or reflux oesophagitis
- Functional dysphagia or globus
- Achalasia, which affects both sexes
- Eosinophilic oesophagitis, which is more common in young men
If the question comes from an exam, choose Plummer-Vinson syndrome. My quick PubMed check for recent meta-analyses and systematic reviews found nothing relevant that changes this.
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