DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review

Q4 Medicine

Acta Medica Bulgarica Pub Date : 2021-10-01 DOI:10.2478/amb-2021-0032

H. Valkov, M. Kovacheva-Slavova, I. Lyutakov, T. Angelov, P. Getsov, B. Vladimirov, P. Penchev

{"title":"DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review","authors":"H. Valkov, M. Kovacheva-Slavova, I. Lyutakov, T. Angelov, P. Getsov, B. Vladimirov, P. Penchev","doi":"10.2478/amb-2021-0032","DOIUrl":null,"url":null,"abstract":"Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea. Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed. Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"30 - 33"},"PeriodicalIF":0.0000,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Medica Bulgarica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2478/amb-2021-0032","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea. Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed. Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.

查看原文本刊更多论文

一个疑难杂症的临床案例，并附文献复习

摘要弥漫性特发性骨骼增生症（DISH）是一种常见但诊断不足的系统性骨骼疾病。其特征是钙化主要影响脊柱前纵韧带。在大多数情况下，患者没有症状，但颈部骨赘有时会导致声音嘶哑、吞咽困难（DISHphagia），甚至呼吸困难。病例描述：一名61岁的男子因吞咽困难和体重减轻而住进我们的科室。吞咽困难在九个月内逐渐增加。钡咽食管造影显示吞咽不对称，食管上括约肌上方扩张，无其他异常。食管胃十二指肠镜检查（EGD）证实了扩张。此外，胸部的CT扫描清楚地显示了颈部和胸部的退行性变化、前纵韧带的广泛骨化以及C2-C7的骨赘，食道向前移位了14毫米。还观察到了所谓的“蜡滴蜡烛”现象。结论：DISH是一种系统性的老年人肌肉骨骼疾病，病因不明。吞咽困难是该病最常见的症状，可能由颈部骨赘引起。我们报告了一例DISH，罕见的颈部C2-C7区域骨赘定位。由于Forestier综合征及其相关的“DISHphagia”的发病率不断增加，胃肠病学家应该提高对这种被低估的疾病的认识，并改进诊断方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Medica Bulgarica Medicine-Medicine (all)

CiteScore

0.30

自引率

0.00%

发文量

审稿时长

25 weeks

期刊介绍： About 30 years ago - in 1973, on the initiative of the Publishing House „Medicine and Physical Culture", namely its former director Mr. Traian Ivanov, the Ministry of Health set up and accepted to subsidize a new medical magazine that was to be published only in the English language and had to reflect the status and the achievements of the Bulgarian medical science. Thus the language barrier was overcome and stable relations were established with the international medical society, large libraries, and university centers. The famous internationally known scientist professor Assen A. Hadjiolov was elected edition-in-chief by the first editorial staff and the magazine was named Acta Medica Bulgarica.