A Severe But Easily Treatable Dysphagia

Abstract

Question: A 31-year-old woman, born in Pakistan, presented with dysphagia and severe anemia. She had a 10-year history of iron deficiency anemia secondary to chronic menorrhagia. She initially received a red blood cell transfusion, but had no gynecologic explorations or follow-up. The patient complained of dysphagia for solids that had been worsening for the last 5 years associated with a weight loss of 10 kg, but not with odynophagia or dysphonia. At admission, her hemoglobin level was 55 g/L, with a low mean corpuscular volume ( 70fL) and ferritin level (<10 mg/L). Oral clinical examination, nasopharyngeal endoscopy and cervical computed tomography scan were normal. A barium swallow (Figure A, B) and gastroscopy (Figure C) were performed.What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.