Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm

A patient had syncope induced by swallowing. Electrocardiographic monitoring during eating and esophageal balloon inflation demonstrated a second-degree atrioventricular block (Mobitz type II) with dizziness. Radiologic and manometric examinations of the esophagus showed diffuse esophageal spasm associated with hypertension of the upper esophageal sphincter (UES), gastroesophageal reflux, and a sliding hiatal hernia. Cineradiographic observations were made during ingestion of a meal mixed with barium; at the time of cardiac dysrhythmia, the proximal part of the esophagus containing the bolus assumed a balloonlike shape, while the distal part and the UES contracted. On the basis of these observations and review of all published cases, we propose the pathways of this esophagocardiac reflex and discuss up-to-date treatment.