ETIOLOGIC CONSIDERATIONS OF PLUMMER-VINSON (PATERSON-KELLY) SYNDROME

Abstract

The present study is based upon 150 patients with dysphagia believed to be on the basis of tissue abnormalities associated with Plummer-Vinson syndrome. Statistical comparison is made with suitable control groups. The distribution of Plummer-Vinson syndrome in Sweden has been reviewed and found to be most common in the northern rural areas. Plummer-Vinson syndrome occurs in men, though relatively rarely. The relative distribution of signs and symptoms is presented. Among these, early edentia has been relatively little stressed in previous reports. Among 133 female Plummer-Vinson cases, 20 had lost their teeth prior to the age of 30. Among the general medical disorders found to be more common are dry skin and hoarseness in the Plummer-Vinson group. Menstrual flow was found to be somewhat heavier in the Plummer-Vinson cases than in the control cases. No differences were found in the number of pregnancies and the number of siblings between the study and the control cases. The dietary pattern of the study and control cases is presented in some detail. The diet of the general population in which Plummer-Vinson disease occurs most commonly is deficient in fresh fruits, vegetables and meats. Normal serum iron and hemoglobin do not rule out the presence of Plummer-Vinson disease. Sixty-eight per cent of 109 female patients had normal serum iron levels. Cancer of the upper respiratory tract, and particularly cancer of the lower hypopharynx, are frequently closely related to the Plumme-Vinson syndrome. A schematic diagram is presented indicating known and theoretic steps believed to be precursors to the Plummer-Vinson syndrome. Though chronic iron deficiency is thought to be a primary cause of this syndrome, it is suggested that other nutritional factors may be involved, although these have not been identified. The apparent reduction in the present incidence of Plummer-Vinson disease suggests that nutritional supplements, perhaps of iron and vitamins B and C, are effective prophylactic agents both for the syndrome itself and for the types of cancer associated with it.