Case Presentation:
A 72‐year‐old man with coronary artery disease, atrial fibrillation, hypertension, gout, and obstructive sleep apnea presented to the hospital with progressively worsening dysphagia to soft foods and liquids for a few days. He had begun to experience dysphagia 5 years ago and had restricted his diet to mainly soft foods and liquids. Esophagogastroduodenoscopy and colonoscopy were done 3 years ago and were unremarkable. Vital signs were stable and the physical exam was unremarkable. Laboratory tests, including an autoimmune panel were normal. CT scan of the head was normal. Speech‐and‐swallow evaluation revealed dysphagia to thin liquids. A modified barium swallow (MBS) revealed severe pharyngeal dysphagia. CT of the neck with IV contrast showed anterior flowing of bridging osteophytes from C3 to C6, indicative of DISH, causing esophageal impingement. He underwent corpectomy of C4 with C3‐C5 spinal fusion and resection of the C3‐C6 DISH segments. Although the postoperative radiological outcome was great, a MBS revealed residual dysphagia. He was discharged with a percutaneous endoscopic gastrostomy (PEG) tube. Five months later, he underwent speech‐and‐swallow evaluation, which showed marked improvement. He no longer requires the PEG tube for feeding.
Discussion:
DISH, also known as Foreslier's disease, is a noninflammatory condition with pathological ossification and calcification of the anterolateral spinal ligaments and attachment sites of the tendons and ligaments. Symptoms depend on the localization and involvement of the adjacent structures. Dysphagia, odynophagia, and aspiration may occur when large anterior osteophytes of the cervical spine impinge on the adjacent structures of the gastrointestinal tract. Dysphagia is usually progressive and greater for solids than liquids. The Resnick radiographic criteria for the diagnosis of DISH include: (a) the presence of flowing ossification and calcification along the anterolateral aspect of at least 4 contiguous vertebral bodies, (b) the preservation of intervertebral disk heights in the involved vertebrae, and (c) the absence of apophyseal joint bony ankylosis and sacroiliac joint erosion. Treatment depends on the presence of symptoms. Surgical intervention is rarely indicated but can result in a good clinicai outcome.
Conclusions:
Although a rare cause of dysphagia, DISH can cause considerable morbidity in the geriatric population. Keeping this clinical entity in the differential diagnosis is important in arriving at the diagnosis.
Author Disclosure:
B. Krishnarasa, none; A. Vivekanandarajah, none; L. Ripoll, none; E. Chang, none; R. Wetz, none.