View source for Diffuse esophageal spasm differential diagnosis

__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diffuse_esophageal_spasm]]
{{CMG}}; {{AE}}{{MSI}}

==Overview==
Diffuse esophageal spasm must be differentiated from other [[diseases]] that cause [[dysphagia]], [[chest pain]] and [[weight loss]] such as [[Angina|angina,]] [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm|nutcracker esophagus]], [[hypertensive LES]], [[Esophageal web|esophageal web/stricture]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]] etc.

==Differential Diagnosis== 
Diffuse esophageal spasm must be differentiated from other diseases that cause  [[dysphagia]], [[chest pain]] and [[weight loss]] such as [[Angina|angina,]] [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm|nutcracker esophagus]], [[hypertensive LES]], [[Esophageal web|esophageal web/stricture]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]] etc.<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref>

<small>
{| class="wikitable"
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Signs and Symptoms
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Barium esophagogram
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Endoscopy
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Other imaging and laboratory findings
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold Standard
|-
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Onset
| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Dysphagia
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Heartburn
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other findings
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Mental status
|-
| style="background:#4479BA; color: #FFFFFF;" align="center" |Solids
| style="background:#4479BA; color: #FFFFFF;" align="center" |Liquids
| style="background:#4479BA; color: #FFFFFF;" align="center" |Type
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
|
* Gradual
| +
| -
|Non progressive
| +/-
| -
|
* [[Glossitis]]

* [[Koilonychia]]

|Normal
|
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]]
| 
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
<div style="width:350px">{{#ev:youtube|HFfsTgsB6Pg}}</div>
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings

|
Triad of 
* [[Iron deficiency anemia]]
* [[Esophageal webs]]
* [[Glossitis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]] 
|
* Gradual

* Sudden onset
| +
| -
|Progressive
| +/-
| +/-
|
* [[Odynophagia]]
* [[Cough]]

* [[Chest pain]]
|Normal
|
*Sacculations
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
[[Image:Benign-oesophageal-stricture.jpg|center|200px|thumb|Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008]]
|
* [[Mucosal]] edema
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
<div style="width:350px">{{#ev:youtube|vax5E-jMnQ}}</div>
|
* [[Manometry]] may show dysmotility
* [[CT scan]] for staging [[malignant]] [[strictures]]
|
* [[Esophagogram|Barium esophagogram]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Non progressive
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Chest pain]]

|Normal
|
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
[[Image:DES radio.png|center|200px|thumb|Barium swallow appearance of DES<br>Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]]
|
* Inconclusive
<div style="width:350px">{{#ev:youtube|2ipA34iMA3c}}</div>
|
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles
|
* [[Manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Non progressive
| +/-
| -
|
* [[Regurgitation]] of undigested food
* [[Chest pain]]
|Normal
|
* "Bird's beak" or "rat tail" appearance 
* Dilated esophageal body
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
[[Image:Achalasia-2.jpg|center|200px|thumb|Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071]]
|
* Dilated [[esophagus]]
* Residual food fragments 
* Normal [[mucosa]] 
<div style="width:350px">{{#ev:youtube|ydLcskQzEjM}}</div>
|
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* Aperistalsis
|
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Progressive
| +/-
| +
|
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]

* [[Raynaud's phenomenon]]

* [[Skin changes]] 
|Normal
|
* Dysmotility

* Patulous [[esophagus]]
|
* [[Mucosal]] damage

* [[Peptic]] stricture (advanced cases)
|Positive serology for
* [[Antinuclear antibodies]]

* [[Rheumatoid factor]]

* [[Creatine kinase]]

* [[ESR]]
|
* [[Skin biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
|
* Gradual
| +
|<nowiki>-</nowiki>
|
| +/-
| -
|
* Food [[regurgitation]]

* [[Halitosis]]

* [[Coughing|Cough]]

* [[Hoarseness]]
|Normal
|
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
[[Image:Zenker-4.jpg|center|200px|thumb| Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}<nowiki></ref></nowiki>]]
|
* Outpouching of posterior [[pharyngeal]] wall

* Exclude the presence of [[Squamous cell carcinoma|SCC]]
<div style="width:350px">{{#ev:youtube|FdEruFsNdVA}}</div> 
|
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
|
* Barium [[Esophagogram|esophagography]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
|
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
| +
|<nowiki>+/-</nowiki>
|
* [[Lymphadenopathy]]

* [[Cachexia]]
|Normal
|
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
|
* [[Esophageal]] obstruction
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
|
* [[Biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|
* [[Dysarthria]]

* Limb [[weakness]]

* [[Fatigue]]
|Impaired
|
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
|
* Reduced opening of [[upper esophageal sphincter]]
* Reduced [[larynx]] elevation
|
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
|
* [[CT]] without [[Contrast medium|contrast]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
([[Myasthenia gravis]])
|
* Gradual
| +
| +
|Progressive
|<nowiki>+/-</nowiki>
|
|
* [[Ptosis]]
* [[Diplopia]]
* [[Fatigue]]
|Normal
|
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
|
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
|
* CT may show anterior [[mediastinal]] mass ([[thymoma]]) 
* Positive tensilon test 
|
* Anti–acetylcholine receptor antibody test
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
|
* Gradual

* Sudden onset
| +
| -
|Progressive
| +/-
| +
|
* [[Cough]]

* [[Hoarseness]]
|Normal
|
* Free acid reflux
* [[Esophagitis]] with scarring
* [[Strictures]]
* [[Barrett's oesophagus]]
|
* [[Erythema]], erosions and [[ulceration]]
* [[Barrett's esophagus]]
|
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
* 24 hour [[esophageal]] pH monitoring
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
|
* Gradual
| +
| +/-
|Progressive
| -
| +/-
|
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]]
|Normal
|
* Symmetrical narrowing of the [[esophagus]]
|
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
|
* Barium [[esophagogram]]
|}
<small>

{| class="wikitable"
!
!
!
!Manifestations
!
!Diagnostic tools
|-
|
|[[Achalasia]]
|
|
* [[Dyspnea]]<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref>

*[[Dysphagia]] for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref>
*[[Regurgitation]] of undigested food occurs in 76-91% of patients<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
*[[Cough]] mainly when lying down in 30%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
|
|
* [[Esophagogastroduodenoscopy]] findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis).
* Barium swallow shows the characteristic bird's beak appearance.
[[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]]
|-
|
|[[GERD]]
|
|
* Retrosternal burning chest pain.
* [[Cough]] and [[hoarseness]] of voice.
* May present with complications such as [[strictures]] and [[dysphagia]].<ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref>
|
|
* Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
* Esophageal manometry may show decreased tone of the lower esophageal sphincter.
* 24-hour esophageal pH monitoring may be done to confirm the diagnosis.
[[Image:Barretts esophagus.jpg|center|300px|thumb|Barret's esophagus - By Samir धर्म - taken from patient with permission to place in public domain, Copyrighted free use, https://commons.wikimedia.org/w/index.php?curid=1595945]]
|-
|
|[[Esophageal cancer|Esophageal carcinoma]]
|
|
*[[Dysphagia]]
*[[Odynophagia]]- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty<ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref>
*[[Weight loss]]
*[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
*[[Nausea]] and [[vomiting]]<ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref>
|
|
* Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
[[Image:Esophageal adenoca.jpg|center|300px|thumb|CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715]]
|-
|
|
|
|
|
|
|-
|
|[[Esophageal stricture]]
|
|
*Patient may present with the symptoms of the underlying [[Gastroesophageal reflux disease|GERD]].
*[[Dysphagia]] and [[odynophagia]].<ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref>
|
|
* Barium esophagography provides information about the site and the diameter of the [[stricture]] before the endoscopic intervention.<ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref>
[[Image:Peptic stricture.png|center|300px|thumb|Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423]]
|-
|
|[[Plummer-Vinson syndrome]]
|
|Common symptoms of  Plummer-Vinson syndrome include:<ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref>
*Difficulty swallowing (more for solids)
*[[Weakness]]
*[[Pain]]
*Burning sensation in mouth
*Dry tongue
*Painful cracks in the angles of a dry mouth
*Pale color of the skin
===Less common symptoms===
*Cold intolerance
*Reduced resistance to infection
*Altered behavior
*Craving for for unusual items (such as ice or cold vegetables)
|
|Lab tests are consistent with the diagnosis of [[iron deficiency anemia]].

Findings on an [[x-ray]] ([[barium]] [[esophagogram]]) suggestive of [[esophageal web]]/[[strictures]] associated with [[Plummer-Vinson syndrome]] appear as either:
* Thin projections on the anterior [[esophageal]] wall.
* Multiple upper ([[cervical]]) [[Esophageal stricture|esophageal constrictions]] consistent with [[esophageal webs]].

[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Plummer-Vinson syndrome (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]]
|}

==References==
{{Reflist|2}}

[[Category:Gastroenterology]]
[[Category:Hematology]]
<references />