“DISH-phagia”: A Case Report and Review of Literature of a Rare Disease Manifestation

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a clinical entity characterized by ossification of the anterolateral ligaments of the spine. DISH is more commonly diagnosed in older males, with an estimated prevalence of 42% in patients older than 65 years. As the disease affects predominantly the thoracic spine, dysphagia is a rare presentation of this entity observed in only 0.6-1.0% of the cases.We present a clinical case of an 84-year-old male with complaints of progressive dysphagia and foreign body sensation within one year of evolution. Computed tomography imaging revealed an anterior C4-C5 osteophyte compressing the posterior hypopharyngeal wall. Flexible endoscopy revealed a deformed and stenotic hypopharynx. The patient underwent surgical treatment with anterior cervical osteophyte resection using the Smith-Robinson approach. The patient showed significant improvement in preoperative symptoms, and no recurrence was detected at six months of follow-up. We also aim to discuss the clinical and radiological characteristics of the disease, as well as the crucial steps for a correct diagnosis and treatment of this rare disease.

A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach

“…The literature on dysphagia caused by cervical osteophytes is limited, suggesting its rarity in comparison to other causes of dysphagia. Existing research and especially case reports, however, emphasize the need to include cervical spine pathology in the differential diagnosis of dysphagia, particularly in elderly people with degenerative abnormalities in the spine [4,5]. The results of Seidler et al demonstrate that dysphagia secondary to ventral osteophytes of the cervical spine presents with varied clinical and radiographic manifestations, with osteophyte location and size playing significant roles in determining the severity of symptoms and influencing the need for surgical intervention [6].…”