Snapshot A 50-year-old woman presents to her primary care physician with problems with eating. She reports that over the past few months, she has experienced some difficulty swallowing food. She drinks liquids and soups normally, but reports difficulty swallowing particularly solid foods. On exam, she is noted to have atrophic glossitis and fissures in the bilateral oral commissure. An upper gastrointestinal barium swallow study reveals narrowing, and esophagogastroduodenoscopy shows thin web-like tissue growths in the upper esophagus. Introduction Clinical definition characterized by atrophic glossitis, upper esophageal webs (eccentric and often anterior), and iron deficiency anemia Epidemiology most commonly observed in postmenopausal women rare Pathogenesis unknown Associated conditions autoimmune disease Presentation Symptoms dysphagia to solid foods cough choking fatigue nail changes dizziness Physical exam atrophic glossitis angular cheilitis pallor koilonychia Imaging Upper gastrointestinal barium swallow radiography may show a thin projection post-cricoid may show multiple esophageal webs Video fluoroscopic swallowing exam can help differentiate a true web from false webs such as mucosal folding Studies Serum labs complete blood count hypochromic and microcytic anemia peripheral blood smear hypochromic and microcytic anemia iron studies iron deficiency invasive studies esophagogastroduodenoscopy thin web-like tissue growth in the upper esophagus normal squamous mucosa and submucosa, possible atrophy and chronic inflammation on histopathological exam Differential Schatzki ring distinguishing factor distal esophageal web Post-cricoid cancer distinguishing factor malignancy on histopathological exam Achalasia distinguishing factor dysphagia at the lower esophageal sphincter Treatment Medical iron supplementation treat the underlying cause of iron deficiency Surgical esophageal dilatation, most commonly via balloon method can be performed concurrently with esophagogastroduodenoscopy not required if iron supplementation improves dysphagia Complications Squamous cell carcinoma of the esophagus, oral cavity, or hypopharynx Aspiration