[Dysphagia] Plummer-vinson syndrome/sideropenic dysphagia

[kgoertz at paphr.sk.ca (Clarke-Goertz, Kim (PAPHR))]

Hi All,
Just met a new client as an outpatient, requesting treatment for her
dysphagia of 20 years with recent worsening. 
Pt's medical hx is + for Plummer-Vinson Syndrome (aka sideropenic dysphagia
or Paterson-Kelly Syndrome).  
She had a laryngeal web dilated 20 years ago as well as a hiatus hernia at
that time.  
She has hx of a mild stroke in 2005 affecting the R optic nerve, GER
(accompanied by pain that radiates to jaw, teeth, ears), emphysema,
xerostomia, diverticuli (2005 Ba Swallow), laryngospasm (self-report, weekly
occurance), globus, hoarse voice quality and once-weekly vomiting/regurg of
solids or pills.  
She reports improvement in GER symptoms since spring 2005 when started on
ranitidine.  Pt. is also on amilzide, diltiazam, furosemide, pantaloc,
ativan, spiriva inhalor, salbutamol inhalor, flonase, nu cephalex, magnesium
and asa.
Pt had a gastroscopy in the spring of 06 which was normal with the exception
of narrowing near the LES.
When pt experiences globus and actual retention of food in
esophagus/pharynx, water will not wash, pt. must regurgitate material to
clear.

Just want to get the opinion of those reading, so far I am planning on
recommending her GP send her for laryngeal exam per ENT, repeat gastroscopy
per GI/surgeon and videofluoroscopy.
I plan to symptomatically treat/give recommendations for her GER, xerostomia
and globus by suggesting diet and positioning strategies, as well as
hydration tips.  I am assuming if she can get the GER under control by
identifying triggers that her laryngospasm my subside or lessen.  Perhaps
Gaviscon my be of some benefit in addition to the Ranitidine, I know Irene
has recommended that on the list over the years.
At first thought I feel it's likely she may have another web or perhaps the
narrowing near the LES has worsened since her last gastroscopy.  I am hoping
that the GP will suggest she have it re done.

Any other suggestions or pearls from those of you out there who may have
seen another outpatient like mine?
Thanks for any and all insights,
Kim