Iron deficiency and autoimmunity in post-cricoid webs.

The incidence of post-cricoid webs in patients with iron-deficiency anaemia and a variety of other conditions including thyroid disease, pernicious anaemia, ulcerative colitis, and Sjogren's syndrome has been examined by cinefluorography of swallowing. A total of 32 subjects were found to have a post-cricoid web; 17 of these were patients in whom the index diagnosis was iron deficiency. One or more subjects in each of the other groups studied were found to have a post-cricoid web, but webs were not seen in a healthy control group. Definite evidence of iron deficiency either at the time of diagnosis of the web or in the past was obtained in all but five of the 32 patients with a post-cricoid web. Clinical and laboratory findings in these 32 patients were combined with results in our 72 patients with webs described previously and compared with the findings in two control groups. There was a significant increase in the incidence of angular stomatitis, glossitis, edentia, thyroid disease, and thyroid antibodies in patients with a post-cricoid web when compared with an iron-deficient control group without a web. A high incidence of malignant disease of the upper gastrointestinal tract was also found in patients with webs. The incidence of gastric parietal cell antibodies was significantly higher in patients with iron deficiency, irrespective of the presence of a web, than in the healthy controls. The role of iron deficiency and autoimmunity in the pathogenesis of post-cricoid webs and the other tissue changes associated with iron deficiency is discussed.