Swallow syncope: Clinical presentation, diagnostic criteria, and therapeutic options

Abstract

We recently encountered three patients with episodes of syncope associated with food ingestion. A 31-year-old woman had an episode of syncope in the hospital while drinking soda. Transient asystole was noted on the telemonitor, confirming the diagnosis of swallow syncope. The other two patients were 78- and 80 year old gentlemen, respectively, who presented with recurrent and transient episodes of dizziness during deglutition. Extensive work-up of syncope was negative in both cases and a diagnosis of swallow syncope was made by clinical criteria. These cases illustrate the challenging problem of swallow syncope. The diagnosis can be suspected on the basis of clinical presentation and confirmed with the demonstration of transient brady-arrhythmia during deglutition. Medical management includes avoiding trigger foods, use of anticholinergics, and/or placement of a permanent cardiac pacemaker.

Deglutition Syncope: A Case Report and Review of the Literature

“…Carbonated beverages have been frequently implicated as the inciting agent for DS, as the dissolved carbon dioxide distends the gastric lumen and elicits the vagal reflex. 6 , 9 Cold beverages, sandwiches, and sticky foods have also been linked. 10 - 12 Common underlying conditions, such as gastroesophageal reflux and esophageal spasm, can be treated in the conventional manner.…”

Deglutition Syncope: Two Case Reports Attributed to Vagal Hyperactivity

“…It is important to identify and avoid triggers before proceeding to medical management or pacemaker implantation. Certain foods such as carbonated drinks which are known to distend gastric lumen and triggering vagal response and resulting bradycardia should be avoided [ 2 ]. As there was no triggering factors and no functional or organic disorder of the esophagus (besides small hiatal hernia) present in our first case, medical management with discontinuation of beta blockers was considered.…”

“…Deglutition syncope (DS) is a relatively uncommon cause of syncope. Since the first reported case of swallow syncope in 1793 by Spens [ 1 ], there have been around 100 case reports published in the literature [ 2 ]. The usual presentation includes either presyncopal symptoms such as dizziness, lightheadedness, or overt syncope.…”

Swallow syncope and high-resolution esophageal manometry

“…on swallow syncope. [ 1 ] I really appreciate the authors for this important study and excellent outcomes of three different clinical pictures of patients with swallow syncope. In the present article, the authors postulated that esophageal disorders might alter sensory pathways from the esophagus to central nervous system leading to syncope.…”