Cervical diffuse idiopathic skeletal hyperostosis (DISH) causing oropharyngeal dysphagia

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterised by calcification and ossification of the vertebral ligaments. It is most commonly seen to affect the thoracic and lumbar vertebrae and is usually seen among elderly men. The cause of this condition is unknown. Risk factors include male gender, obesity, diabetes and advancing age. The majority of these cases are found incidentally on imaging and patients are generally asymptomatic. Cervical DISH is less common than its thoracic and lumbar counterparts. When symptomatic, it can cause dysphagia or sometimes airway compromise. If this happens, surgical intervention should be performed. Although a rare cause of dysphagia, DISH is easily diagnosed with imaging. When identified, surgical decompression produces very good clinical outcomes.

<p>Plummer-Vinson syndrome: improving outcomes with a multidisciplinary approach</p>

“…This can be from direct invasion by the tumors themselves or as sequelae of their treatment which might include surgery or radiation that may bring about inflammatory changes such as esophageal strictures 34. Very rarely, oropharyngeal dysphagia can be caused by degenerative bony changes called osteophytes that may impinge on the esophagus most especially in the cervical area which can be from diffuse idiopathic skeletal hyperostosis or DISH 35. While the perceived level of obstruction or dysphagia might assist us in coming up with the diagnosis or differential diagnosis, it should be noted that some distal esophageal lesions might give a perceived proximal referred sensation of obstruction 36,37.…”

Síndrome de Forestier: caso clínico y revisión de la literatura

“…A pesar de ser una patología descrita desde hace varias décadas, el síndrome de Forestier es una enfermedad de etiología no establecida, asociada con algunas patologías: diabetes mellitus, hipertensión, dislipidemia y enfermedades metabólicas, 1,2 patologías que van en aumento por lo que es de esperarse mayor incidencia en los casos de síndrome de Forestier. Respecto a las manifestaciones clínicas se deben a la alteración de la biomecánica de las estructuras adyacentes, 3 como se observa en el caso expuesto, los síntomas de la paciente han sido progresivos iniciando con cervicalgia, luego disfonía, parestesias en miembros superiores y disfagia, resultado de alteración en dos estructuras de la región cervical, esófago y tráquea.…”

“…Es más común en hombres que en mujeres. 3,4 La etiología es desconocida, pero se asocia con la diabetes mellitus tipo 2, hipertensión arterial, edad avanzada, síndrome metabólico, obesidad, y otras enfermedades cardiovasculares. A nivel molecular, está relacionada con factores genéticos, metabólicos, mecánicos, vasculares, con cambios en las vías de señalización y aumentos de los factores de crecimiento.…”

The surgical management of dysphagia secondary to diffuse idiopathic skeletal hyperostosis

“…Patients usually demonstrate significant symptomatic improvement within 3 months post-operatively. 17,18 Reported risks of surgery include: haematoma; resection or compression of the superior and/or inferior laryngeal nerves, the hypoglossal nerve or its descending branch and the cervical sympathetic nerve; pharyngocutaneous fistula and oesophageal perfortation and infection. 5,9 In our study, one patient suffered from a haematoma requiring evacuation.…”