Snap Shot A 63-year-old woman with chronic anemia presents to her primary care physician complaining of difficulty swallowing. An upper endoscopy is ordered. Introduction Small, thin web-like tissue growth partially obstruct the upper esophagus Characterized by atrophic glossitis, esophageal webs, and anemia Etiology unknown Epidemiology most commonly observed in elderly woman associated with chronic iron-deficiency anemia Patients at increased risk of developing squamous cell carcinoma of the esophagus Presentation Symptoms difficulty swallowing chronic cough weakness/malaise nail changes Physical exam atrophic glossitis esophageal webs anemia spoon nail deformities Evaluation Diagnosis can be aided by clinical observations, including skin and nail changes Upper endoscopy may identify esophageal webs CBC may indicated chronic anemia Fe studies show Fe deficiency Differential Achalasia, esophageal spasm, Zenker's diverticulum Treatment Medical management Fe supplementation indicated to treat chronic anemia state esophageal dilation can be performed concurrently with upper GI endoscopy or manometry most commonly done with radial expansion balloon method Prognosis, Prevention, and Complications Prognosis most patients respond to treatment Prevention Fe supplementation in patients with known anemia may prevent web development Complications bleeding may occur secondary to esophageal tear during dilation esophageal carcinoma