<abstract xmlns="http://www.w3.org/1999/xhtml">

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea.
<bold>Case description:</bold> A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed.
<bold>Conclusion:</bold> DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.
</abstract>

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea.
Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed.
Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.

DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review

Clinic of Gastroenterology, University Hospital “Tsaritsa Yoanna-ISUL”

Department of Gastroenterology, Medical University – Sofia

University Hospital “Tsaritsa Yoanna-ISUL”, Medical University – Sofia

Acta Medica Bulgarica

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"DISHphagia \u2013 A Riddle Unwrapped a Clinical Case with Literature Review"}

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting...

DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review

Published Online: Oct 22, 2021

Page range: 30 - 33

Received: Sep 21, 2020

Accepted: Nov 20, 2020

DOI: https://doi.org/10.2478/amb-2021-0032

Keywords
Diffuse idiopathic skeletal hyperostosis, DISH, dysphagia, DISHphagia, osteophytes

© 2021 H. Valkov et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review

Published Online: Oct 22, 2021

Page range: 30 - 33

Received: Sep 21, 2020

Accepted: Nov 20, 2020

DOI: https://doi.org/10.2478/amb-2021-0032

KeywordsDiffuse idiopathic skeletal hyperostosis, DISH, dysphagia, DISHphagia, osteophytes

© 2021 H. Valkov et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Keywords
Diffuse idiopathic skeletal hyperostosis, DISH, dysphagia, DISHphagia, osteophytes