Skip to main content
SpringerLink
Log in

Swallow-induced syncope after magnetic sphincter augmentation: a case report and physiologic explanation

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Swallow-induced syncope is a rare cause of syncope that occurs during or immediately after swallowing. This phenomenon has been reported in association with few esophageal pathologies and the likely explanation is a vagal reflex during deglutition that results in inhibition of the cardiac conduction system. This report describes a case of swallow-induced syncope related to the implantation of a magnetic sphincter augmenting (MSA) device. Two episodes of syncope after food bolus occurred with the device in place and upon removal of the device, the patient had no further episodes of syncope. Vagal stimulation from distention of the esophagus or vagus nerve contact irritation by the implant are the potential explanation for syncope in this patient. Although this is an extremely rare complication of magnetic sphincter device augmentation, it is one that physicians should be cognizant of given the dangers of syncope events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nakagawa S, Hisanaga S, Kondoh H, et al. A case of swallow syncope induced by vagotonic visceral reflex resulting in atrioventricular node suppression. J Electrocardiol. 1987;20:65–9.

    Article  CAS  Google Scholar 

  2. Levin B, Posner JB. Swallow syncope. Report of a case and review of the literature. Neurology. 1972;22:1086–93.

    Article  CAS  Google Scholar 

  3. Kopald HH, Roth HP, Fleshler B, et al. Vagovagal syncope. Report of a case associated with diffuse esophageal spasm. N Engl J Med. 1964;271:1238–41.

    Article  CAS  Google Scholar 

  4. Bortolotti M, Cirignotta F, Labo G. Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. JAMA. 1982;248:2297–9.

    Article  CAS  Google Scholar 

  5. Omi W, Murata Y, Yaegashi T, et al. Swallow syncope, a case report and review of the literature. Cardiology. 2006;105:75–9.

    Article  Google Scholar 

  6. Garg S, Girotra M, Glasser S, et al. Swallow syncope: clinical presentation, diagnostic criteria, and therapeutic options. Saudi J Gastroenterol. 2014;20:207–11.

    Article  Google Scholar 

  7. Spens T. Medical commentary. In: Major RH, editor. Classic Descriptions of Disease. 2nd ed. Springfield: Charles C. Thomas; 1939. p. 355.

    Google Scholar 

  8. Kang KH, Cho WH, Kim MC, et al. Cases of swallow syncope induced by the activation of mechanorecepters in the lower esophagus. Korean J Intern Med. 2005;20:68–71.

    Article  Google Scholar 

  9. Armstrong PW, McMillan DG, Simon JB. Swallow syncope Canad Med Assoc J. 1985;132:1281–4.

    CAS  PubMed  Google Scholar 

  10. Bhogal S, Sethi P, Taha Y, et al. Deglutition syncope: two case reports attributed to vagal hyperactivity. Case Rep Cardiol. 2017;2017:2145678.

    PubMed  PubMed Central  Google Scholar 

  11. Kakuchi H, Sato N, Kawamura Y. Swallow syncope associated with complete atrioventricular block and vasovagal syncope. Heart. 2000;83:702–4.

    Article  CAS  Google Scholar 

  12. Kadish AH, Wechsler L, Marchlinski FE. Swallowing syncope: observations in the absence of conduction system or esophageal disease. Am J Med. 1986;81:1098–100.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  14. Sobrino-Cossío S, Soto-Pérez JC, Coss-Adame E, et al. Post-fundoplication symptoms and complications: diagnostic approach and treatment. Rev Gastroenterol Mex. 2017;82:234–47.

    PubMed  Google Scholar 

  15. Basker MR, Cooper DK. Oesophageal syncope. Ann R Coll Surg Engl. 2000;82:249–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Ayazi S, Zheng P, Zaidi AH, et al. Clinical outcomes and predictors of favorable result after laparoscopic magnetic sphincter augmentation: single-institution experience with more than 500 patients. J Am Coll Surg. 2020;230:733–43.

    Article  Google Scholar 

  17. Ayazi S, Zheng P, Zaidi AH, et al. Magnetic sphincter augmentation and postoperative dysphagia: characterization, clinical risk factors, and management. J Gastrointest Surg. 2020;24:39–49.

    Article  Google Scholar 

  18. Ayazi S, Grubic AD, Zheng P, et al. Measurement of outflow resistance imposed by magnetic sphincter augmentation: defining normal values and clinical implication. Surg Endosc. 2020.

  19. Siew KSW, Tan MP, Hilmi IN, et al. Swallow syncope: a case report and review of literature. BMC Cardiovasc Disord. 2019;19:191.

    Article  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA

    Mathew R. Smith, Shahin Ayazi, Andrew D. Grubic, Xinxin Shen & Blair A. Jobe

Authors
  1. Mathew R. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahin Ayazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew D. Grubic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xinxin Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Blair A. Jobe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahin Ayazi.

Ethics declarations

Conflict of interest

Drs. Ayazi and Jobe are on the scientific advisory board of Johnson and Johnson and receive consulting fee. The other authors have no relevant financial relationship to disclose.

Human and animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, M.R., Ayazi, S., Grubic, A.D. et al. Swallow-induced syncope after magnetic sphincter augmentation: a case report and physiologic explanation. Clin J Gastroenterol 14, 1318–1323 (2021). https://doi.org/10.1007/s12328-021-01448-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-021-01448-w

Keywords

Search

Navigation