{"id":4558,"date":"2018-10-08T09:00:12","date_gmt":"2018-10-08T09:00:12","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/sindrome-de-plummer-vinson\/"},"modified":"2024-03-30T12:32:37","modified_gmt":"2024-03-30T12:32:37","slug":"sindrome-de-plummer-vinson","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/sindrome-de-plummer-vinson\/","title":{"rendered":"S\u00edndrome de Plummer-Vinson"},"content":{"rendered":"<p><span style=\"font-family: Arial, sans-serif;\">Dificuldade em engolir ou disfagia \u00e9 um sintoma comum. Membranas esof\u00e1gicas, apesar de infrequentes, podem ocorrer em associa\u00e7\u00e3o com anemia por defici\u00eancia de ferro e disfagia. Esta tr\u00edade cl\u00ednica foi denominada de diversas formas: \u201cS\u00edndrome de Plummer\u2013Vinson\u201d (SPV) e \u201cS\u00edndrome de Paterson\u2013Brown\u2013Kelly\u201d. O primeiro termo foi derivado dos nomes de dois m\u00e9dicos americanos da Mayo Clinic (Henry Stanley Plummer e Porter Paisley Vinson), e o segundo por dois otorrinolaringologistas ingleses (Donald Ross Paterson e Adam Brown-Kelly). <\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">A tr\u00edade t\u00edpica da SPV n\u00e3o \u00e9 vista em todos os pacientes com membrana esof\u00e1gica. Disfagia e anemia por defici\u00eancia de ferro s\u00e3o as caracter\u00edsticas mais comuns, embora alguns pacientes n\u00e3o apresentem uma membrana claramente demonstr\u00e1vel. Da mesma forma, nem todos os pacientes com anemia e membrana esof\u00e1gica apresentam disfagia.<\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">A S\u00edndrome de Plummer-Vinson (SPV) \u00e9 uma condi\u00e7\u00e3o rara e que continua a ser enigm\u00e1tica, apesar de transcorrido um s\u00e9culo desde a sua primeira descri\u00e7\u00e3o. A literatura dispon\u00edvel sobre sua patog\u00eanese, tratamento e hist\u00f3ria natural \u00e9 limitada a relatos de casos e s\u00e9rie de casos retrospectivas. Apesar de raros relatos em crian\u00e7as e adolescentes, a maioria dos pacientes acometidos \u00e9 de meia-idade (47 anos). A ra\u00e7a branca parece ser mais afetada que a negra, bem como as mulheres s\u00e3o muito mais afetadas que os homens (8:1), de tal forma que, em determinado momento, a SPV foi considerada uma doen\u00e7a exclusivamente feminina. Esta not\u00e1vel preponder\u00e2ncia feminina pode ser atribu\u00edda, pelo menos em parte, a uma maior preval\u00eancia de anemia ferropriva entre as mulheres, devido \u00e0 menor ingest\u00e3o diet\u00e9tica, perda de sangue menstrual e gravidez.<\/span><\/p>\n<h2><strong>Patog\u00eanese<\/strong><\/h2>\n<p><span style=\"font-family: Arial, sans-serif;\">A patog\u00eanese exata da SPV ou da forma\u00e7\u00e3o da membrana esof\u00e1gica n\u00e3o \u00e9 clara porque, pelo menos em parte, tais estudos s\u00e3o dif\u00edceis de conduzir devido \u00e0 natureza infrequente dessa condi\u00e7\u00e3o. V\u00e1rios mecanismos foram propostos, como fatores gen\u00e9ticos, nutricionais, autoimunes e infecciosos. No entanto, a <strong>anemia ferrop\u00eanica \u00e9 \u00fanico fator aceito por unanimidade para desempenhar um papel<\/strong>. Sabe-se que o trato gastrointestinal \u00e9 suscept\u00edvel \u00e0 ferropenia, dada sua elevada taxa de renova\u00e7\u00e3o celular com enzimas dependentes de ferro. Dessa forma, \u00e9 poss\u00edvel que tal altera\u00e7\u00e3o promova degrada\u00e7\u00e3o da mucosa e forma\u00e7\u00e3o de membranas, bem como altera\u00e7\u00e3o na contra\u00e7\u00e3o muscular por degrada\u00e7\u00e3o progressiva dos m\u00fasculos da faringe devido \u00e0 redu\u00e7\u00e3o de enzimas oxidativas ferro-dependentes.<\/span><\/p>\n<h2><strong>Tratamento<\/strong><\/h2>\n<p><span style=\"font-family: Arial, sans-serif;\">O tratamento dos pacientes com S\u00edndrome de Plummer-Vinson tem por objetivo a corre\u00e7\u00e3o da anemia, bem como da disfagia.<\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">A reposi\u00e7\u00e3o com ferro por via oral \u00e9 eficaz no tratamento da maioria dos pacientes com anemia ferropriva, entretanto, em algumas situa\u00e7\u00f5es espec\u00edficas, nas quais a terapia por via oral \u00e9 insuficiente, a administra\u00e7\u00e3o de ferro por via parenteral \u00e9 uma alternativa eficaz. <\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">A dilata\u00e7\u00e3o endosc\u00f3pica atrav\u00e9s dos dilatadores de Savary-Gilliard ou de bal\u00e3o \u00e9 bastante eficaz e segura. \u00c9 recomendada utiliza\u00e7\u00e3o da \u201cregra dos 3\u201d, que consiste em tr\u00eas di\u00e2metros consecutivos de dilatadores em cada sess\u00e3o, tendo como alvo um di\u00e2metro final de 15mm. Normalmente s\u00e3o necess\u00e1rias poucas sess\u00f5es, eventualmente apenas uma, para alcan\u00e7ar resolu\u00e7\u00e3o da disfagia, com eventos adversos em torno 1-3%. <\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">O desfecho em curto prazo \u00e9 geralmente favor\u00e1vel porque a disfagia e a anemia podem ser tratadas de forma eficaz. Alguns pacientes podem recidivar, principalmente por causa da descontinua\u00e7\u00e3o<br \/>\nde tratamento e menos comumente ap\u00f3s uma melhora cl\u00ednica que parecia est\u00e1vel. As taxas de recorr\u00eancia variaram entre 14% e 30% e ocorrem geralmente no seguimento a longo prazo. <\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">Outras op\u00e7\u00f5es terap\u00eauticas descritas s\u00e3o coagula\u00e7\u00e3o com plasma de arg\u00f4nio ou YAG laser, especialmente em casos de m\u00faltiplas recorr\u00eancias.<\/span><\/p>\n<p>A <span style=\"font-family: Arial, sans-serif;\">S\u00edndrome de Plummer-Vinson <\/span>est\u00e1 associada a um alto <strong>risco de transforma\u00e7\u00e3o maligna<\/strong> (3% -30%) e por isso \u00e9 considerada uma <strong>les\u00e3o pr\u00e9-cancerosa<\/strong>, principalmente para carcinoma de c\u00e9lulas escamosas da hipofaringe ou do es\u00f4fago superior. Portanto, o acompanhamento a longo prazo desses pacientes \u00e9 necess\u00e1rio. A vigil\u00e2ncia atrav\u00e9s de endoscopia digestiva alta anual para detec\u00e7\u00e3o precoce de neoplasia \u00e9 recomendada por muitos autores, contudo a efic\u00e1cia desta recomenda\u00e7\u00e3o n\u00e3o est\u00e1 confirmada definitivamente.<\/p>\n<h2><strong>Caso cl\u00ednico de exemplo:<\/strong><\/h2>\n<p>Mulher, 45 anos, com queixas de disfagia alta (cervical) progressiva, predominantemente para s\u00f3lidos, h\u00e1 cerca de um ano e meio.<\/p>\n<p>Nega DM, HAS ou perda de peso neste intervalo de tempo.\u00a0N\u00e3o \u00e9 tabagista ou etilista, tampouco possui hist\u00f3rico de neoplasias nos antecedentes cl\u00ednicos. Como \u00fanica interven\u00e7\u00e3o cir\u00fargica, submeteu-se \u00e0 gastroplastia redutora \u00e0 Capella h\u00e1 7 anos para tratamento de obesidade, sem relato de reganho de peso.<\/p>\n<p>Exames laboratoriais revelaram Hb 9,1g\/dL (12-16g\/dL), Ht 28,5%, \u00a0Ferro s\u00e9rico 20\u00b5g\/dL (37-145\u00a0\u00b5g\/dL), Transferrina 80\u00a0\u00b5g\/dL (250-380\u00a0\u00b5g\/dL), Sat. Ferro 19% (20-40%).<\/p>\n<p>No caso em quest\u00e3o, a EDA revelou curto segmento de estenose no es\u00f4fago proximal, imediatamente abaixo do cricofar\u00edngeo, composto por finas membranas esbranqui\u00e7adas, que ocupavam metade da circunfer\u00eancia local cada e conferiam leve\/moderada resist\u00eancia \u00e0 passagem do gastrosc\u00f3pio (9,8mm).<\/p>\n<h6><img fetchpriority=\"high\" decoding=\"async\" class=\" wp-image-8188 aligncenter\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem1-300x87.png\" alt=\"\" width=\"514\" height=\"149\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem1-300x87.png 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem1-585x170.png 585w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem1.png 680w\" sizes=\"(max-width: 514px) 100vw, 514px\" \/><\/h6>\n<p>As bi\u00f3psias da \u00e1rea de estenose evideciaram esofagite cr\u00f4nica leve, sem sinais de especificidade. Concomitante \u00e0 reposi\u00e7\u00e3o de ferro procedeu-se dilata\u00e7\u00e3o endosc\u00f3pica atrav\u00e9s de sondas termopl\u00e1sticas (Savary-Gilliard) at\u00e9 17mm, obtendo-se excelentes resultados em sess\u00e3o \u00fanica:<\/p>\n<h6>\u00a0<img decoding=\"async\" class=\" wp-image-8189 aligncenter\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem3-300x176.png\" alt=\"\" width=\"564\" height=\"331\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem3-300x176.png 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem3-585x342.png 585w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2018\/10\/Imagem3.png 680w\" sizes=\"(max-width: 564px) 100vw, 564px\" \/><\/h6>\n<h6><\/h6>\n<h2><strong><span style=\"font-family: Arial, sans-serif;\">Refer\u00eancias Bibliogr\u00e1ficas<\/span><\/strong><\/h2>\n<p><span style=\"font-family: Arial, sans-serif;\">1. Goel A, Bakshi S, Soni N, Chhavi N. Iron deficiency anemia and Plummer\u2013Vinson syndrome: current insights. Journal of Blood Medicine. 2017:8 175-184.<\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">2. Goel A, Lakshmi CP, Bakshi SS, Soni N, Koshy S. Single-center prospective study of Plummer-vinson syndrome. Dis Esophagus. 2016;29(7):837\u2013841<\/span><\/p>\n<p><span style=\"font-family: Arial, sans-serif;\">3. Bakari G, Benelbarhdadi I, Bahije L, Essaid A. Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience. Gastrointest Endosc. 2014; 80(4):738-741.<\/span><\/p>\n<h6><\/h6>\n<h6>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<\/h6>\n<h6><strong>Como citar esse artigo:<\/strong><\/h6>\n<h6><em>Brasil G. S\u00edndrome de Plumer-Vinson. Endoscopia Terap\u00eautica; 2018. Dispon\u00edvel em:\u00a0<span id=\"sample-permalink\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/sindrome-de-plummer-vinson\/\">https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/<span id=\"editable-post-name\">sindrome-de-plummer-vinson<\/span>\/<\/a><\/span>\u00a0<\/em><\/h6>\n","protected":false},"excerpt":{"rendered":"<p>Dificuldade em engolir ou disfagia \u00e9 um sintoma comum. Membranas esof\u00e1gicas, apesar de infrequentes,&hellip;<\/p>\n","protected":false},"author":2079,"featured_media":5261,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[270],"tipo":[153],"volume":[147],"class_list":["post-4558","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-270","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>S\u00edndrome de Plummer-Vinson &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"A S\u00edndrome de Plummer-Vinson (SPV) \u00e9 uma condi\u00e7\u00e3o rara caracterizada pela triade: membrana esof\u00e1gica, disfagia e anemia ferropriva,\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/sindrome-de-plummer-vinson\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"S\u00edndrome de Plummer-Vinson\" \/>\n<meta property=\"og:description\" content=\"Dificuldade em engolir ou disfagia \u00e9 um sintoma comum. 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