Dysphagia with recurrent severe aspiration due to cervical diffuse idiopathic skeletal hyperostosis (Forestier’s disease)

Abstract

Dysphagia is a common symptom in patients presenting to the gastroenterologist. However, extraluminal causes of dysphagia may be missed by endoluminal diagnosis alone. This case report presents a 72-year-old man with slowly progressive dysphagia that occurred with the ingestion of certain solid foods and was intermittently associated with severe aspiration. Esophagogastroduodenoscopy and barium swallow study were both normal. However, a conventional x-ray and computed tomography (CT) scan of the neck revealed diffuse idiopathic skeletal hyperostosis (Forestier's disease) of the anterior cervical spine (C2–C7). Fiber endoscopic evaluation of swallowing (FEES) revealed functionally incomplete emptying of the oral cavity during swallowing, and the patient reported dysphagia score (EAT-10) was 23 (normal < 3). Surgical removal of the hyperostosis (C3–C6) resulted in immediate and sustained improvement in dysphagia at 3 months.

Zusammenfassung

Die Dysphagie ist ein häufiges Symptom von Patienten, welche sich beim Gastroenterologen vorstellen. Extraluminale Ursachen der Dysphagie können jedoch bei alleiniger endoluminaler Diagnostik übersehen werden. Dieser Fallbericht stellt einen 72-jährigen Mann mit langsam progredienten Schluckbeschwerden vor, welche bei Aufnahme bestimmter fester Nahrungsmittel auftraten und intermittierend mit schweren Aspirationen einhergingen. Die Ösophagogastroduodenoskopie und die Röntgen-Breischluckuntersuchung waren unauffällig. Eine konventionelle Röntgenaufnahme sowie eine Computertomographie (CT) des Halses wiesen jedoch eine diffuse idiopathische Skeletthyperostose (Morbus Forestier) der vorderen Halswirbelsäule (C2–C7) nach. Die fiberendoskopische Evaluation des Schluckaktes (FEES) zeigte funktionell eine unvollständige Entleerung der Mundhöhle beim Schlucken und der Score der vom Patienten berichteten Schluckbeschwerden (EAT-10) betrug 23 (normal < 3). Die chirurgische Entfernung der Hyperostose (C3–C6) führte zu einer umgehenden und anhaltenden Besserung der Dysphagie in der dreimonatigem Nachbeobachtung.

Keywords

Swallowing Disorders - Diffuse Idiopathic Skeletal Hyperostosis - Respiratory Aspiration

Schlüsselwörter

Schluckstörung - Diffuse Idiopathische Skelettale Hyperostose (M. Forestier) - Aspiration

Publikationsverlauf

Eingereicht: 09. Mai 2024

Artikel online veröffentlicht:
25. September 2024

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