A 24yr old female with history of easy fatigabality,dysphagia. Oral ulcers and oesophageal webs are shown on endoscopy. What is most common site for the oesophageal webs?
## **Core Concept**
The patient's symptoms of easy fatigability, dysphagia, oral ulcers, and esophageal webs on endoscopy are suggestive of **Plummer-Vinson syndrome**, also known as Paterson-Kelly syndrome or sideropenic dysphagia. This condition is characterized by esophageal webs, iron-deficiency anemia, and mucosal changes in the mouth and esophagus.
## **Why the Correct Answer is Right**
The correct answer, **C. Upper third of esophagus**, is the most common site for esophageal webs in Plummer-Vinson syndrome. These webs are thin, membranous structures that partially obstruct the lumen of the esophagus, leading to dysphagia. They are typically found in the upper third of the esophagus, which is consistent with the clinical presentation of this syndrome.
## **Why Each Wrong Option is Incorrect**
* **Option A:** The lower third of the esophagus is not the typical location for esophageal webs in Plummer-Vinson syndrome. While webs can occur anywhere, the upper esophagus is more characteristic.
* **Option B:** The middle third of the esophagus can occasionally be involved but is not the most common site for esophageal webs in this condition.
* **Option D:** The gastroesophageal junction is not typically associated with the formation of esophageal webs in Plummer-Vinson syndrome.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that Plummer-Vinson syndrome is strongly associated with an increased risk of **esophageal squamous cell carcinoma**. Therefore, patients with this syndrome require careful follow-up and surveillance. Another important point is that the syndrome often responds well to **iron supplementation**, which can help alleviate symptoms and may lead to the regression of esophageal webs.
## **Correct Answer:** C. Upper third of esophagus.