scholarly journals DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review

2021 ◽  
Vol 48 (3) ◽  
pp. 30-33
Author(s):  
H. Valkov ◽  
M. Kovacheva-Slavova ◽  
I. Lyutakov ◽  
T. Angelov ◽  
P. Getsov ◽  
...  
Keyword(s):  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Upper Esophageal Sphincter ◽  
Cervical Region ◽  
Barium Swallow ◽  
Unknown Etiology ◽  
Common Symptom ◽  
Anterior Longitudinal Ligament ◽  
Forward Displacement ◽  
Skeletal Disease ◽  
Cervical Osteophytes

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.

Ossification of the anterior longitudinal ligament and Forestier's disease: an analysis of seven cases

1995 ◽  
Vol 83 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Randall R. McCafferty ◽  
Michael J. Harrison ◽  
Laszlo B. Tamas ◽  
Mark V. Larkins
Keyword(s):  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Scar Tissue ◽  
Cord Compression ◽  
The Body ◽  
Anterior Longitudinal Ligament ◽  
Content Type ◽  
Forestier’S Disease ◽  
Cervical Osteophytes ◽  
Occult Malignancy ◽  
Forestier's Disease

✓ A retrospective review was conducted on the records and radiographs of six symptomatic patients and one asymptomatic patient with Forestier's disease. No other series of patients with this disease is found in the neurosurgical literature. Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is an idiopathic rheumatological abnormality in which exuberant ossification occurs along ligaments throughout the body, but most notably the anterior longitudinal ligament of the spine. It affects older men predominantly; all of our patients were men older than 60 years of age. The disease is usually asymptomatic; however, dyspnea, dysphagia, spinal cord compression, and peripheral nerve entrapment have all been documented in association with the disorder. Five of the six symptomatic patients presented with dysphagia due to esophageal compression by calcified anterior longitudinal ligaments, and one patient developed recurrent spinal stenosis when scar tissue from a previous decompressive laminectomy became calcified. All patients responded well to surgery. Two of the four patients who underwent removal of cervical osteophytes required several months following surgery for the dysphagia to resolve. This would support the hypothesis that not all cases of dysphagia in Forestier's disease are due to mechanical compression. Dysphagia may result from inflammatory changes that accompany fibrosis in the wall of the esophagus or from esophageal denervation. Evaluation of dysphagia even in the presence of Forestier's disease must rule out occult malignancy. The authors' experience suggests that dysphagia in the setting of Forestier's disease is an underrecognized entity amenable to surgical intervention.

scholarly journals Progressive dysphagia and dysphonia secondary to DISH-related anterior cervical osteophytes: A case report

2020 ◽  
Vol 11 ◽  
pp. 69
Author(s):  
Manoj Kumar ◽  
Prem Bahadur Shahi ◽  
Nitin Adsul ◽  
Shankar Acharya ◽  
K. L. Kalra ◽  
...  
Keyword(s):  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Barium Swallow ◽  
X Ray ◽  
Cervical Osteophytes ◽  
Computed Tomography Scans ◽  
Life Threatening ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Progressive Dysphagia ◽  
Emergency Tracheotomy

Background: Dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH)-related anterior cervical osteophytes is not uncommon. However, this rarely leads to dysphonia and/or dysphagia along with life- threatening airway obstruction requiring emergency tracheotomy. Case Description: A 56-year-old male presented with progressive dysphagia and dysphonia secondary to DISH-related anterior osteophytes at the C3–C4 and C4–C5 levels. The barium swallow, X-ray, magnetic resonance imaging, and computed tomography scans confirmed the presence of DISH. Utilizing an anterior cervical approach, a large beak-like osteophyte was successfully removed, while preserving the anterior annulus. After clinic-radiological improvement, the patient was discharged with a soft cervical collar and nonsteroidal anti-inflammatory drug (NSAID). Conclusion: Large anterior osteophytes in Forestier disease/DISH may cause dysphagia and dysphonia. Direct anterior resection of these lesions yields excellent results as long as other etiologies for such symptoms have been ruled out.

Diffuse idiopathic skeletal hyperostosis masquerading as asthma: case report

2019 ◽  
Vol 31 (2) ◽  
pp. 261-264
Author(s):  
Karim Mithani ◽  
Ying Meng ◽  
David Pinilla ◽  
Nova Thani ◽  
Kayee Tung ◽  
...  
Keyword(s):  
Pulmonary Function Tests ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Inhaled Corticosteroid ◽  
Treatment Resistant ◽  
Methacholine Challenge ◽  
Airway Reactivity ◽  
Cervical Osteophytes ◽  
History Of ◽  
Anterior Discectomy And Fusion ◽  
Asthma Case

A 52-year-old man with a 10-year history of treatment-resistant asthma presented with repeated exacerbations over the course of 10 months. His symptoms were not responsive to salbutamol or inhaled corticosteroid agents, and he developed avascular necrosis of his left hip as a result of prolonged steroid therapy. Physical examination and radiography revealed signs consistent with diffuse idiopathic skeletal hyperostosis (DISH), including a C7–T1 osteophyte causing severe tracheal compression. The patient underwent C6–T1 anterior discectomy and fusion, and the compressive osteophyte was removed, which completely resolved his “asthma.” Postoperative pulmonary function tests showed normalization of his FEV1/FVC ratio, and there was no airway reactivity on methacholine challenge. DISH is a systemic, noninflammatory condition characterized by ossification of spinal entheses, and it can present with respiratory disturbances due to airway compression by anterior cervical osteophytes. The authors present, to the best of their knowledge, the first documented case of asthma as a presentation of DISH.

scholarly journals An unusual cause of dysphagia in elderly, dysphagia caused by cervical osteophytes: a case report and review of literature

2019 ◽  
Vol 5 (2) ◽  
pp. 520
Author(s):  
Uday Kiran Katari
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Cervical Spondylosis ◽  
Inflammatory Diseases ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Review Of Literature ◽  
Neck Stiffness ◽  
Cervical Osteophytes ◽  
Common Causes ◽  
Spine Diseases

<p class="abstract">Dysphagia may occur in various pathological, inflammatory diseases of esophagus. It may also occur due to motility disorders of esophagus, benign and malignant diseases of mediastinum, cervical spine diseases. Dysphagia secondary to compression of esophagus by a cervical osteophyte is rare. The most common causes of osteophyte (bony outgrowth) in the cervical spine are diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis (AS), and cervical spondylosis. Patients with cervical osteophytes are mostly asymptomatic. Hence, when considering cervical osteophytes as a cause of dysphagia other pathologic entities in the esophagus (e.g. tumors, webs, rings, strictures) should be excluded. We present a 68 year female patient who presented with complaints of dysphagia and neck stiffness since 3 months. She has been evaluated and found that dysphagia is due to large anterior cervical osteophytes compressing pharynx at C2/C3 and esophagus at C5/C6 and C6/C7 vertebral levels respectively. The objective of this case report is to emphasize the importance of anterior cervical osteophyte as a cause of dysphagia in elderly.</p>

scholarly journals Dysphagia due to ossification of anterior longitudinal ligament with diffuse idiopathic skeletal hyperostosis (DISH) : Two cases report

1999 ◽  
Vol 13 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Tohru Kobayashi ◽  
Kazutoshi Hida ◽  
Yoshinobu Iwasaki ◽  
Fumio Ito ◽  
Yoshihiko Kohama ◽  
...  
Keyword(s):  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Anterior Longitudinal Ligament

scholarly journals Dysphagia caused by Anterior Cervical Osteophyte: A Rare Entity Revisited

2012 ◽  
Vol 3 (3) ◽  
pp. 168-171
Author(s):  
Prashanth Veerabhadraiah ◽  
Vishal Rao ◽  
Raghavendra Shankar ◽  
Naveen Shivappa ◽  
TM Nagaraj
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Cervical Spondylosis ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Anterolateral Approach ◽  
Rare Entity ◽  
External Compression ◽  
Radiographic Findings ◽  
Cervical Osteophytes ◽  
Life Threatening

ABSTRACT Large anterior cervical osteophytes can occur in degeneration of the cervical spine, cervical spondylosis or in diffuse idiopathic skeletal hyperostosis (DISH). Voluminous anterior cervical osteophytes which can develop from C3 to C7 can cause narrowing of the pharyngoesophageal segment by external compression and may cause dysphagia, which may be life threatening when it is associated with aspiration and or dyspnea. The objective of this case report is to highlight how commonly occurring anterior cervical osteophytes may become an unrecognized cause for life-threatening dysphagia. The clinical and radiographic findings in patient with dysphagia and ventral osteophytes of the cervical spine due to degeneration are demonstrated. The anterolateral approach for removal of these osteophytes is described. How to cite this article Veerabhadraiah P, Rao V, Shankar R, Shivappa N, Kumar P, Nagaraj TM. Dysphagia caused by Anterior Cervical Osteophyte: A Rare Entity Revisited. Int J Head and Neck Surg 2012;3(3):168-171.

scholarly journals Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

2020 ◽  
pp. 219256822091270
Author(s):  
Joshua M. Kolz ◽  
Mohammed A. Alvi ◽  
Atiq R. Bhatti ◽  
Marko N. Tomov ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Neck Surgery ◽  
High Complication Rate ◽  
Disc Space ◽  
Swallowing Function ◽  
Cervical Osteophytes ◽  
Cervical Disease ◽  
The Mean

Study Design: This was a retrospective cohort study. Objectives: When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. Methods: Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). Results: Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia ( P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. Conclusions: Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.

Epiglottic Position after Cricothyroidotomy: A Comparison with Tracheotomy

1997 ◽  
Vol 106 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Jessica W. Lim ◽  
Patricia Kerman Lerner ◽  
Stephen G. Rothstein
Keyword(s):  
New York ◽  
Medical Center ◽  
Upper Esophageal Sphincter ◽  
Barium Swallow ◽  
New York University ◽  
Laryngeal Elevation ◽  
Posterior Displacement ◽  
Tube Removal ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.

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