The Paterson-kelly Syndrome.

Dysphagia localized to the post-cricoid region occurring mainly in middle-aged women was first fully described in the papers of Paterson (1919) and Kelly (1919). Kelly noted an association with anaemia, superficial glossitis, and angular stomatitis, while Paterson remarked on " the not infrequent supervention of malignant disease at the mouth of the gullet." Vinson (1922) observed the development of hypothyroidism in some patients. Moersch and Conner (1926) studied 65 patients with the syndrome and found the majority to have a hypochromic anaemia: achlorhydria was demonstrated in 8 of the 10 patients tested. Witts (1931) confirmed these findings in a smaller group of patients, and found that although the anaemia responded to iron there was a tendency for it to relapse. Waldenstr6m and Hallen (1938) showed that the syndrome could occur with iron deficiency unaccompanied by anaemia, and the term " sideropenic dysphagia " was coined. Although it is commonly held that iron deficiency is the basic cause of post-cricoid dysphagia in middle-aged women (Ahlbom, 1936; Smiley, McDowell, and Costello, 1963) proof of a cause-and-effect relationship has not been obtained. Such a relationship has been doubted by several authors (Kirchenberger and Flett, 1946; Wynder and Fryer, 1958 ; Jacobs, 1963), and we prefer to use the name Paterson-Kelly syndrome until such time as the aetiology and pathology of the condition have been clarified. The occurrence of this syndrome, together with its malignant sequelae in cases of pernicious anaemia (Jacobs, 1962), stimulated the present investigation.