Dysphagia aortica

Abstract

Summary Background Dysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica. Materials and methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades. Results A total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias. Conclusion Dysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.

Elderly woman with rapid progression of swallowing difficulty

“…Dysphagia aortica is a relatively rare cause of mechanical swallowing difficulty. Typically, it manifests slowly from extrinsic compression of the esophagus by an aneurysmal, dilated, or tortuous aorta 1 . In the present case, acute dysphagia occurred due to an infected aortic aneurysm, which is characterized by a rapid enlargement, leading to potential aneurysmal rupture or AEF 2 .…”

“…Typically, it manifests slowly from extrinsic compression of the esophagus by an aneurysmal, dilated, or tortuous aorta. 1 In the present case, acute dysphagia occurred due to an infected aortic aneurysm, which is characterized by a rapid enlargement, leading to potential aneurysmal rupture or AEF. 2 Although our patient was managed supportively, immediate surgical intervention is required to avoid fatal consequences.…”

Aortic aneurysm: An uncommon cause of dysphagia

“…Other surgical procedures done to relieve esophageal compression include Heller myotomy. 4 , 6 In our setting, the options were insertion of a gastric-feeding tube or referring the patient to a cardio-thoracic center of which both options were given to the caretakers of the patient.…”

“…Complications of thoracic aortic aneurysm include aortic dissection, compression, and erosion into an adjacent structure such as an aorto-esophageal fistula, leak or rupture, and thromboembolism such as disseminated intravascular coagulation, DVT, and pulmonary embolism as seen in our patient and could be the cause of death. 5 , 6 , 14 , 15 …”

“…Workup should include a chest X-ray, chest CT-scan with oral and intravenous contrast which show a dilated aortic arch and tortuous dilated aorta which aided in the diagnosis of our patient, and upper gastrointestinal endoscopy which may show stenosis and kinking of the esophagus which unfortunately was not performed in the index case, barium or video fluoroscopic swallowing study which may reveal partial esophageal obstruction and pulsatile movement of the barium synchronous with aortic pulsation, and esophageal manometry which may show a localized high-pressure band with superimposed pounding that is synchronous with the cardiac pulsation. 5,6 Management depends on disease severity. Most patients are managed with diet modification to liquid diets and treated for underlying heart failure and arterial hypertension.…”