Plummer-Vinson syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Differential Diagnosis

Disease	Signs and Symptoms	Diagnostic test
Anemia of chronic disease		Peripheral smear: Normocytic and normochromic (initially) Microcytic, hypochromic (later in disease) Anisocytosis, and poikilocytosis CBC will show: Low hemoglobin Low MCV Low MCHC Increased ferritin Normal transferrin

Disease	Signs & Symptoms	Imaging test
Reflux esophagitis	Dysphagia (from peptic stricture) Heartburn Hoarseness	Barium swallow: show up strictures and hiatus hernias Endoscopy: with or without a peptic stricture. A hiatus hernia may be present below the stricture Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux
Esophageal carcinoma	Dysphagia (initially for solids, liquids develops with advanced disease.) Weight loss Lymphadenopathy Appetite changes Cachexia	Barium swallow : esophageal constriction Endoscopy: esophageal obstruction by the tumor. Biopsy: for definite diagnosis and tumor histology
Systemic sclerosis	Dysphagia Muscle and joint pain Raynaud's phenomenon skin changes (e.g., rash, skin swelling or thickening).	Serology for Antinuclear antibodies Rheumatoid factor creatine kinase ESR
Esophageal spasm	Chest pain (more prominent) Dysphagia (intermittent)	Barium swallow: Inconclusive Endoscopy: Inconclusive Manometry: high-amplitude esophageal contractions
Pseudoachalasia	Dysphagia Weight loss Lymphadenopathy Appetite changes Cachexia Older patients Underlying malignancy that mimics idiopathic achalasia. Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid.	Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy. Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia.
Chagas disease	Dysphagia myocarditis Blepharitis Toxic megacolon	Giemsa stain: Trypanosoma cruzi. PCR for trypanosome subtype