Plummer-Vinson syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; zAssociate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
The mainstay of treatment for Plummer-Vinson syndrome is aimed at correcting iron deficiency anemia. Patients with Plummer-Vinson syndrome should receive oral iron salts (ferrous sulphate) and iron supplementation in their diet. Parenteral iron is used in patients who are unable to tolerate oral iron or with malabsorption syndromes. Another important aspect in treating Plummer-Vinson syndrome is to identify the cause of iron deficiency in order to exclude active hemorrhage, malignancy or celiac disease.
Medical Therapy
The treatment of Plummer-Vinson syndrome is primarily aimed at correcting iron deficiency anemia.[1][2][3][4][5][6]
- Patients with Plummer-Vinson syndrome should receive oral iron salts (ferrous sulphate) and iron supplementation in their diet.
- Another important aspect in treating Plummer-Vinson syndrome is to identify the cause of iron deficiency in order to exclude active hemorrhage, malignancy or celiac disease.
- Patients with mild dysphagia may improve with iron replacement alone, if esophageal webs are not significantly obstructive.
- Patients with persistent and significant dysphagia (for solids) require mechanical dilation for esophageal web(s).
- Mechanical dilatation with an endoscope can be used to disrupt esophageal web/stricture.
- In addition, needle-knife electro incision may be used as an alternative to endoscopic dilation.
Iron deficiency anemia
- 1.1 Ferrous sulphate[7][8]
- Preferred regimen (1): Ferrous sulphate 325 mg PO three times a day; may administer extended release form once daily.
- Note(1): To increase absorption, patients are advised to take vitamin C (500 units) PO once daily with the iron pill.
- Note(2): An indicator of successful iron therapy includes a 2-g/dL rise in hemoglobin (Hb) levels in 3 weeks.
- Alternate regimen (1): Iron sucrose or iron dextran three times weekly by slow intravenous injection.
- Dosage: Body weight x (14 - Hb) x (2.145) ÷ concentration of elemental iron
- Note(1): Parenteral iron is used in patients who are unable to tolerate oral iron or with malabsorption syndromes.
- Preferred regimen (1): Ferrous sulphate 325 mg PO three times a day; may administer extended release form once daily.
Food Sources of Iron
- Iron deficiency can have serious health consequences that regular diet may not be able to quickly correct. Hence, iron supplementation is necessary in patients with Plummer-Vinson syndrome.
- Iron supplementation is often necessary if iron deficiency is symptomatic. However, mild iron deficiency can be corrected and prevented, by eating iron-rich foods.
- Iron rich foods from plants and animals are absorbed and processed differently by the body.
- Iron from meat (heme iron source) is more easily broken down and absorbed than iron in grains (nonheme iron source).
- Minerals and chemicals in one type of food may inhibit absorption of iron from another type of food eaten at the same time.[3]
- Heme-bound iron from animal source is readily absorbed as compared to iron from plant sources.
- Thus, vegetarians and vegans should have a higher total daily iron intake than those who consume meat, fish or poultry.[4]
- Legumes and dark-green leafy vegetables like broccoli, kale and oriental greens are especially good sources of iron for vegetarians and vegans. However, spinach and swiss chard contain oxalates which bind iron making it largely unavailable for absorption.
- Iron from non-heme sources (foodgrains) is more readily absorbed if consumed with foods that contain either heme-bound iron or vitamin C.
| Food | Serving size |
Miligrams per serving |
% DV* |
|---|---|---|---|
| Chicken liver (cooked) | 3˝ ounces | 12.8 | 70 |
| Oysters(breaded and fried) | 6 pieces | 4.5 | 25 |
| Beef, chuck (lean, braised) | 3 ounces | 3.2 | 20 |
| Clams (breaded, fried) | 1 cup | 3.0 | 15 |
| Beef tenderloin (roasted) | 3 ounces | 3.0 | 15 |
| Turkey ( dark meat, roasted) | 3˝ ounces | 2.3 | 10 |
| Beef, eye of round (roasted) | 3 ounces | 2.2 | 10 |
| Turkey, light meat (roasted) | 3˝ ounces | 1.6 | 8 |
| Chicken, leg, meat only (roasted) | 3˝ ounces | 1.3 | 6 |
| Tuna, fresh bluefin (cooked) | 3 ounces | 1.1 | 6 |
| Chicken breast (roasted) | 3 ounces | 1.1 | 6 |
| Halibut (cooked) | 3 ounces | 0.9 | 6 |
| Blue crab (cooked) | 3 ounces | 0.8 | 4 |
| Pork loin (broiled) | 3 ounces | 0.8 | 4 |
| Tuna white (canned in water) | 3 ounces | 0.8 | 4 |
| Shrimp (mixed species, cooked) | 4 large | 0.7 | 4 |
| Food | Serving size |
Miligrams per serving |
% DV* |
|---|---|---|---|
| Ready-to-eat cereal (100% iron fortified | cup | 18.0 | 100 |
| Oatmeal, instant, fortified (prepared with water | 1 cup | 10.0 | 60 |
| Soybeans, mature (boiled) | 1 cup | 8.8 | 50 |
| Lentils (boiled) | 1 cup | 6.6 | 35 |
| Kidney beans mature (boiled) | 1 cup | 5.2 | 25 |
| Lima beans large, mature (boiled) | 1 cup | 4.5 | 25 |
| Navy beans mature (boiled) | 1 cup | 4.5 | 25 |
| Ready-to-eat cereal (25% iron fortified) | 1 cup | 4.5 | 25 |
| Black beans mature (boiled) | 1 cup | 3.6 | 20 |
| Pinto beans mature (boiled) | 1 cup | 3.6 | 20 |
| Molasses (blackstrap) | 1 tablespoon | 3.5 | 20 |
| Tofu (raw, firm) | ˝ cup | 3.4 | 20 |
| Spinach (boiled, drained) | ˝ cup | 3.2 | 20 |
| Spinach (canned, drained solids) | ˝ cup | 2.5 | 10 |
| Black-eyed peas (cowpeas) (boiled) | ˝ cup | 1.8 | 10 |
| Spinach (frozen, chopped, boiled) | ˝ cup | 1.9 | 10 |
| Grits (white, enriched | 1 cup | 1.5 | 8 |
| Raisins (seedless, packed) | ˝ cup | 1.5 | 8 |
| Whole wheat bread | 1 slice | 0.9 | 6 |
| White bread (enriched) | 1 slice | 0.9 | 6 |
References
- ↑ Auerbach M, Deloughery T (2016). "Single-dose intravenous iron for iron deficiency: a new paradigm". Hematology Am Soc Hematol Educ Program. 2016 (1): 57–66. doi:10.1182/asheducation-2016.1.57. PMID 27913463.
- ↑ Auerbach M, Adamson JW (2016). "How we diagnose and treat iron deficiency anemia". Am. J. Hematol. 91 (1): 31–8. doi:10.1002/ajh.24201. PMID 26408108.
- ↑ Macdougall IC, Geisser P (2013). "Use of intravenous iron supplementation in chronic kidney disease: an update". Iran J Kidney Dis. 7 (1): 9–22. PMID 23314137.
- ↑ Onken JE, Bregman DB, Harrington RA, Morris D, Buerkert J, Hamerski D, Iftikhar H, Mangoo-Karim R, Martin ER, Martinez CO, Newman GE, Qunibi WY, Ross DL, Singh B, Smith MT, Butcher A, Koch TA, Goodnough LT (2014). "Ferric carboxymaltose in patients with iron-deficiency anemia and impaired renal function: the REPAIR-IDA trial". Nephrol. Dial. Transplant. 29 (4): 833–42. doi:10.1093/ndt/gft251. PMID 23963731.
- ↑ Dantas RO, Villanova MG (1993). "Esophageal motility impairment in Plummer-Vinson syndrome. Correction by iron treatment". Dig. Dis. Sci. 38 (5): 968–71. PMID 8482199.
- ↑ Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
- ↑ DeLoughery TG (2014). "Microcytic anemia". N. Engl. J. Med. 371 (14): 1324–31. doi:10.1056/NEJMra1215361. PMID 25271605.
- ↑ Brittenham GM (1994). "New advances in iron metabolism, iron deficiency, and iron overload". Curr. Opin. Hematol. 1 (2): 101–6. PMID 9371267.