Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review

Abstract

Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.

Diffuse Idiopathic Skeletal Hyperostosis (DISH): Role of Logopedic Rehabilitation in Dysphagia

“…DISH is considered a rheumatic disorder. Although its pathogenesis is not yet fully understood, its seems to share an inflammatory pathway with metabolic syndrome; in fact, diabetes, hypercholesterolemia, and hyperuricemia appear to be risk factors [ 3 , 10 ].…”

“…Despite radiographic evidence, the management of DISH is closely related to the degree of symptoms. This can be based on conservative treatment such as dietary modifications, swallowing therapy, and the prescription of NSAI drugs; alternatively, in the case of failure, a surgical treatment is preferred [ 10 ].…”

“…When present, the general symptoms are mild in nature and include back pain and axial stiffness [ 10 ]. In the highest-grade forms, the clinical otolaryngologic manifestations can alter aerodigestive functions, leading to dysphonia, severe dyspnea, or dysphagia, thereby compromising the normal mobility of the musculoskeletal system of the cervicofacial district.…”

“…Most patients are asymptomatic, are capable of mild spinal movement, or possess joint pain. The disease has long been thought to be an asymptomatic condition, which is usually detected incidentally during old age [ 10 , 11 ].…”

Diffuse Idiopathic Skeletal Hyperostosis (DISH): Palaeopathological Study on Human Remains from Parthian Cemetery, Liyarsangbon, Guilan, Iran; With a Special Reference to Metastatic Cancer as the Cause of Death

“…Ossi cation changes in the right side of the thoracic spine are greater than those in the left side; the main reason for this change may be the presence of the left-sided descending aorta (Rogers & Waldron, 1995). It is also closely related to ossi cation/calci cation of capsule insertion (enthesis), ligament, and tendon, which occurs in several peripheral locations (Ghammam et al, 2019). The gradual ossi cation of the involved organs, i.e., the thoracic or lumbar spine, ultimately causes a decrease in movement operations, mild pain, or minor stiffness in the patient (Resnick et al, 1975).…”