[Fainting during ingestion. Deglutition syncope ]

Area of Science:

• Otorhinolaryngology
• Cardiology
• Gastroenterology

Background:

• A 49-year-old woman presented with a 1.5-year history of dysphagia, globus sensation, regurgitation, and recurrent syncopal attacks triggered by swallowing solid foods.

Observation:

• Endoscopic examination showed tongue base hyperplasia and aryepiglottic redness.
• Esophago-gastro-duodenoscopy revealed a large hiatal hernia (>3 cm).
• Esophageal manometry indicated diffuse esophageal spasm, and 24-hour Holter monitoring identified a third-degree atrioventricular block.

Findings:

• The patient's syncopal episodes resolved after permanent cardiac pacemaker implantation.
• Persistent globus sensation and regurgitation were successfully managed with proton pump inhibitors.
• Post-treatment swallowing evaluation showed no significant abnormalities.

Implications:

• This case highlights a rare, extreme presentation of a vagal reflex associated with deglutition.
• Successful treatment required a multidisciplinary team including otorhinolaryngologists, neurologists, and cardiologists.
• Deglutition syncope, though rare, can be effectively managed through coordinated specialist care.