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[Fainting during ingestion. Deglutition syncope ]
Medical History:
A 49-year-old woman was referred to the ENT department with a 1.5-year history of dysphagia accompanied by globus sensation and regurgitation as well as recurrent syncopal attacks associated with swallowing solid foods.
Clinical Findings:
Endoscopic examination revealed hyperplasia of the tongue base and redness of the aryepiglottic region. An axial hiatal hernia (> 3 cm) was seen on esophago-gastro-duodenoscopy. Esophageal manometry showed a diffuse esophageal spasm. Holter monitoring (24 h) revealed a third-degree atrioventricular block.
Therapy:
The patient’s symptoms resolved following placement of a permanent cardiac pacemaker. Globus sensation and regurgitation persisted. Treatment with proton pump inhibitors was successful. The final functional endoscopic evaluation of swallowing revealed no relevant findings.
Conclusion:
We describe a case of a rare and extreme form of a vagal reflex. Deglutition syncope can be successfully treated by a multidisciplinary team consisting of otorhinolaryngologists, neurologists and cardiologists.
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