Dysphagia

, Volume 20, Issue 4, pp 273–277 | Cite as

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

  • Samer Gawrieh
  • Ty Carroll
  • Walter J. Hogan
  • Konrad H. Soergel
  • Reza Shaker
Article
First Online:

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.

Keywords

Schatzki ring Swallow syncope Hypertensive esophageal peristalsis Deglutition Deglutition disorders nutcracker esophagus 
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References

  1. 1.
    Spens T: Medical Commentary 7:463, 1793, quoted by Major RH: Classical Descriptions of Disease. Springfield, IL: Charles C. Thomas, 1939, p 358Google Scholar
  2. 2.
    Mathias CJ, Deguchi K, Schatz I. Observations on recurrent syncope and presyncope in 641 patients. Lancet 357(9253):348–353, 2001CrossRefPubMedGoogle Scholar
  3. 3.
    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, 2000PubMedGoogle Scholar
  4. 4.
    Bortolotti M, Cirignotta F, Labo G: Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. JAMA 248(18):2297–2299, 1982CrossRefPubMedGoogle Scholar
  5. 5.
    Schima W, Sterz F, Pokieser P: Syncope after eating. N Engl J Med 328(21):1572, 1993CrossRefPubMedGoogle Scholar
  6. 6.
    Tolman KG, Ashworth WD: Syncope induced by dysphagia. Correction by esophageal dilatation. Am J Dig Dis 16(11):1026–1031, 1971CrossRefPubMedGoogle Scholar
  7. 7.
    Tomlinson IW, Fox KM: Carcinoma of the esophagus with “swallow syncope” Br Med J 2(5966):315–316, 1975PubMedGoogle Scholar
  8. 8.
    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, 1986PubMedGoogle Scholar
  9. 9.
    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, 1987CrossRefPubMedGoogle Scholar
  10. 10.
    Waddington JK, Matthews HR, Evans CC, Ward DW: Letter: Carcinoma of the oesophagus with “swallow syncope.” Br Med J 3(5977):232, 1975PubMedGoogle Scholar
  11. 11.
    Armstrong PW, McMillan DG, Simon JB. Swallow syncope. Can Med Assoc J 132(11):1281–1284, 1985PubMedGoogle Scholar
  12. 12.
    Guberman A, Catching J: Swallow syncope. Can J Neurol Sci 13(3):267–269, 1986PubMedGoogle Scholar
  13. 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, 1993PubMedGoogle Scholar
  14. 14.
    Antonelli D, Rosenfeld T: Deglutition syncope associated with carotid sinus hypersensitivity. Pacing Clin Electrophysiol 20(9 Pt 1):2282–2283, 1997PubMedGoogle Scholar
  15. 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, 1987CrossRefPubMedGoogle Scholar
  16. 16.
    Brick JE, Lowther CM, Deglin SM: Cold water syncope. South Med J 71(12):1579–1580, 1978PubMedGoogle Scholar
  17. 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, 1985CrossRefPubMedGoogle Scholar
  18. 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, 1990PubMedGoogle Scholar
  19. 19.
    Olshansky B. A Pepsi challenge. N Engl J Med 340(25):2006, 1999CrossRefPubMedGoogle Scholar
  20. 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, 1989PubMedGoogle Scholar
  21. 21.
    Kakuchi H, Sato N, Kawamura Y: Swallow syncope associated with complete atrioventricular block and vasovagal syncope. Heart 83(6):702–704, 2000CrossRefPubMedGoogle Scholar
  22. 22.
    Wik B, Hillestad L: Deglutition syncope. Br Med J 3(5986):747, 1975PubMedGoogle Scholar
  23. 23.
    Shapira Y, Strasberg B, Ben-Gal T: Deglutition syncope with coexistent carotid sinus hypersensitivity. Chest 99(6):1541–1543, 1991PubMedGoogle Scholar
  24. 24.
    Deguchi K, Mathias CJ: Continuous haemodynamic monitoring in an unusual case of swallow induced syncope. J Neurol Neurosurg Psychiatry 67(2):220–222, 1999PubMedGoogle Scholar
  25. 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, 1984CrossRefPubMedGoogle Scholar
  26. 26.
    Ausubel K, Gitler B: Swallow syncope in an otherwise healthy young man. Am Heart J 113(3):831–832, 1987CrossRefPubMedGoogle Scholar
  27. 27.
    Farb A, Valenti SA: Swallow syncope. Md Med J 48(4):151–154, 1999PubMedGoogle Scholar
  28. 28.
    Gordon J, Saleem SM, Ngaage DL, Thorpe JA: Swallow syncope associated with paroxysmal atrial fibrillation. Eur J Cardiothorac Surg 21(3):587–590, 2002CrossRefPubMedGoogle Scholar
  29. 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, 2002PubMedGoogle Scholar
  30. 30.
    Lichstein E, Chadda KD: Atrioventricular block produced by swallowing, with documentation by His bundle recordings. Am J Cardiol 29(4):561–563, 1972CrossRefPubMedGoogle Scholar
  31. 31.
    Alstrup P, Pedersen SA: A case of syncope on swallowing secondary to diffuse oesophageal spasm. Acta Med Scand 193(4):365–368, 1973PubMedGoogle Scholar
  32. 32.
    Berges W, Wienbeck M: Cardiac arrhythmia during pneumatic dilatation of achalasia of the esophagus. Z Gastroenterol. 16(6):376–380, 1978PubMedGoogle Scholar
  33. 33.
    Levin B, Posner JB: Swallow syncope. Report of a case and review of the literature. Neurology 22(10):1086–1093, 1972PubMedGoogle Scholar
  34. 34.
    Palmer ED: The abnormal upper gastrointestinal vagovagal reflexes that affect the heart. Am J Gastroenterol 66(6):513–522, 1976PubMedGoogle Scholar
  35. 35.
    Basker MR, Cooper DK: Esophageal syncope. Ann R Coll Surg Engl 82(4):249–253, 2000PubMedGoogle Scholar
  36. 36.
    Carey BJ, de Caestecker J, Panerai RB: More on deglutition syncope. N Engl J Med 341(17):1316–1317, 1999CrossRefPubMedGoogle Scholar
  37. 37.
    Sy AO, Plantholt S: Swallowing-induced atrioventricular block. South Med J 84(10):1274–1275, 1991PubMedGoogle Scholar
  38. 38.
    Sapru R: An unusual cause of syncope. Proc R Soc Med 61(10):955–6, 1968PubMedGoogle Scholar
  39. 39.
    Mitchell GA, Warwick R: The dorsal vagal nucleus. Acta Anat (Basel) 25(2–4):371–395, 1955Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Samer Gawrieh
    • 1
  • Ty Carroll
    • 1
  • Walter J. Hogan
    • 1
  • Konrad H. Soergel
    • 1
  • Reza Shaker
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineMedical College of WisconsinMilwaukeeUSA

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