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01-10-2005

Swallow Syncope in Association with Schatzki Ring and Hypertensive Esophageal Peristalsis: Report of Three Cases and Review of the Literature

Authors: Samer Gawrieh, MD, Ty Carroll, MD, Walter J. Hogan, MD, Konrad H. Soergel, MD, Reza Shaker, MD

Published in: Dysphagia | Issue 4/2005

Abstract

Syncope caused by swallowing-induced cardiac arrhythmia is an uncommon condition. The recognition of this syndrome is paramount but often difficult. We report three cases of deglutition syncope evaluated at our institution over a three-year period. Two patients had distal esophageal (Schatzki) ring and two had hypertensive peristaltic waves (commonly referred to as “nutcracker esophagus”), neither of which had been described before in association with deglutition syncope. Two patients underwent placement of a demand cardiac pacemaker with subsequent resolution of their syncopal symptoms, while the third patient refused any further intervention. Swallow syncope usually follows a benign course from a cardiac standpoint. Placement of a demand cardiac pacemaker can prevent recurrence of presyncopal and syncopal attacks and their untoward consequences.

Spens T: Medical Commentary 7:463, 1793, quoted by Major RH: Classical Descriptions of Disease. Springfield, IL: Charles C. Thomas, 1939, p 358

Mathias CJ, Deguchi K, Schatz I. Observations on recurrent syncope and presyncope in 641 patients. Lancet 357(9253):348–353, 2001CrossRefPubMed

Haumer M, Geppert A, Karth GD, Gschwandtner ME, Neunteufl T, Zauner C, et al.: Transient swallow syncope during periods of hypoxia in a 67-year-old patient after self-extubation. Crit Care Med 28(5):1635–1637, 2000PubMed

Bortolotti M, Cirignotta F, Labo G: Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. JAMA 248(18):2297–2299, 1982CrossRefPubMed

Schima W, Sterz F, Pokieser P: Syncope after eating. N Engl J Med 328(21):1572, 1993CrossRefPubMed

Tolman KG, Ashworth WD: Syncope induced by dysphagia. Correction by esophageal dilatation. Am J Dig Dis 16(11):1026–1031, 1971CrossRefPubMed

Tomlinson IW, Fox KM: Carcinoma of the esophagus with “swallow syncope” Br Med J 2(5966):315–316, 1975PubMed

Golf S, Forfang K: Congenital swallowing-induced symptomatic heart block: a case report of a probably hereditary disorder. Pacing Clin Electrophysiol 9(4):602–605, 1986PubMed

Nakagawa S, Hisanaga S, Kondoh H, Koiwaya Y, Tanaka K: A case of swallow syncope induced by vagotonic visceral reflex resulting in atrioventricular node suppression. J Electrocardiol 20(1):65–69, 1987CrossRefPubMed

10.

Waddington JK, Matthews HR, Evans CC, Ward DW: Letter: Carcinoma of the oesophagus with “swallow syncope.” Br Med J 3(5977):232, 1975PubMed

11.

Armstrong PW, McMillan DG, Simon JB. Swallow syncope. Can Med Assoc J 132(11):1281–1284, 1985PubMed

12.

Guberman A, Catching J: Swallow syncope. Can J Neurol Sci 13(3):267–269, 1986PubMed

13.

Marshall TM, Mizgala HF, Yeung-Lai-Wah JA, Steinbrecher UP: Successful treatment of deglutition syncope with oral beta-adrenergic blockade. Can J Cardiol 9(10): 865–868, 1993PubMed

14.

Antonelli D, Rosenfeld T: Deglutition syncope associated with carotid sinus hypersensitivity. Pacing Clin Electrophysiol 20(9 Pt 1):2282–2283, 1997PubMed

15.

Nakano T, Okano H, Konishi T, Ma W, Takezawa H: Swallow syncope after aneurysmectomy of the thoracic aorta. Heart Vessels 3(1):42–46, 1987CrossRefPubMed

16.

Brick JE, Lowther CM, Deglin SM: Cold water syncope. South Med J 71(12):1579–1580, 1978PubMed

17.

Kunis RL, Garfein OB, Pepe AJ, Dwyer Jr EM: Deglutition syncope and atrioventricular block selectively induced by hot food and liquid. Am J Cardiol 55(5):613, 1985CrossRefPubMed

18.

Kunimoto S, Sibata S, Abiru M, Takigami Y, Fujise Y, Hanawa K, et al.: A case of swallow syncope induced by vagovagal reflex. Jpn J Med 29(2):199–202, 1990PubMed

19.

Olshansky B. A Pepsi challenge. N Engl J Med 340(25):2006, 1999CrossRefPubMed

20.

Elam MP, Laird JR, Johnson S, Stratton JR: Swallow syncope associated with complete atrioventricular block: a case report and review of the literature. Mil Med 154(9):465–466, 1989PubMed

21.

Kakuchi H, Sato N, Kawamura Y: Swallow syncope associated with complete atrioventricular block and vasovagal syncope. Heart 83(6):702–704, 2000CrossRefPubMed

22.

Wik B, Hillestad L: Deglutition syncope. Br Med J 3(5986):747, 1975PubMed

23.

Shapira Y, Strasberg B, Ben-Gal T: Deglutition syncope with coexistent carotid sinus hypersensitivity. Chest 99(6):1541–1543, 1991PubMed

24.

Deguchi K, Mathias CJ: Continuous haemodynamic monitoring in an unusual case of swallow induced syncope. J Neurol Neurosurg Psychiatry 67(2):220–222, 1999PubMed

25.

Drake CE, Rollings HE, Ham OE Jr, Heidary DH, Yeh TJ: Visually provoked complete atrioventricular block: an unusual form of deglutition syncope. Am J Cardiol 53(9):1408–1409, 1984CrossRefPubMed

26.

Ausubel K, Gitler B: Swallow syncope in an otherwise healthy young man. Am Heart J 113(3):831–832, 1987CrossRefPubMed

27.

Farb A, Valenti SA: Swallow syncope. Md Med J 48(4):151–154, 1999PubMed

28.

Gordon J, Saleem SM, Ngaage DL, Thorpe JA: Swallow syncope associated with paroxysmal atrial fibrillation. Eur J Cardiothorac Surg 21(3):587–590, 2002CrossRefPubMed

29.

Maekawa T, Suematsu M, Shimada T, Go M, Shimada T: Unusual swallow syncope caused by huge hiatal hernia. Intern Med 41(3):199–201, 2002PubMed

30.

Lichstein E, Chadda KD: Atrioventricular block produced by swallowing, with documentation by His bundle recordings. Am J Cardiol 29(4):561–563, 1972CrossRefPubMed

31.

Alstrup P, Pedersen SA: A case of syncope on swallowing secondary to diffuse oesophageal spasm. Acta Med Scand 193(4):365–368, 1973PubMed

32.

Berges W, Wienbeck M: Cardiac arrhythmia during pneumatic dilatation of achalasia of the esophagus. Z Gastroenterol. 16(6):376–380, 1978PubMed

33.

Levin B, Posner JB: Swallow syncope. Report of a case and review of the literature. Neurology 22(10):1086–1093, 1972PubMed

34.

Palmer ED: The abnormal upper gastrointestinal vagovagal reflexes that affect the heart. Am J Gastroenterol 66(6):513–522, 1976PubMed

35.

Basker MR, Cooper DK: Esophageal syncope. Ann R Coll Surg Engl 82(4):249–253, 2000PubMed

36.

Carey BJ, de Caestecker J, Panerai RB: More on deglutition syncope. N Engl J Med 341(17):1316–1317, 1999CrossRefPubMed

37.

Sy AO, Plantholt S: Swallowing-induced atrioventricular block. South Med J 84(10):1274–1275, 1991PubMed

38.

Sapru R: An unusual cause of syncope. Proc R Soc Med 61(10):955–6, 1968PubMed

39.

Mitchell GA, Warwick R: The dorsal vagal nucleus. Acta Anat (Basel) 25(2–4):371–395, 1955

Title: Swallow Syncope in Association with Schatzki Ring and Hypertensive Esophageal Peristalsis: Report of Three Cases and Review of the Literature
Authors: Samer Gawrieh, MD
Ty Carroll, MD
Walter J. Hogan, MD
Konrad H. Soergel, MD
Reza Shaker, MD
Publication date: 01-10-2005
Publisher: Springer-Verlag
Published in: Dysphagia / Issue 4/2005
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-005-0024-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Swallow Syncope in Association with Schatzki Ring and Hypertensive Esophageal Peristalsis: Report of Three Cases and Review of the Literature

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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