Diffuse Idiopathic Skeletal Hyperostosis (DISH)—A Rare Etiology of Dysphagia

Staten Island University Hospital, Staten Island, NY, USA.
Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 09/2011; 4:71-5. DOI: 10.4137/CMAMD.S6949
Source: PubMed


A 72-year-old gentleman presented to the hospital with progressively worsening dysphagia to soft foods and liquids. He was diagnosed with severe pharyngeal dysphagia by modified barium swallow. A CT scan of the neck with IV contrast showed anterior flowing of bridging osteophytes from C3-C6, indicative of DISH, resulting in esophageal impingement. He underwent resection of the DISH segments. Following the surgery, a PEG tube for nutrition supplementation was placed. However, the PEG tube was removed after five months when the speech and swallow evaluation showed no residual dysphagia. DISH is a rare non-inflammatory condition that results in pathological ossification and calcification of the anterolateral spinal ligaments.

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Available from: Edwin M Chang, Apr 08, 2015
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    • "DISH and ankylosing spondylitis are the most common causes of bony outgrowth of the cervical spine, causing dysphagia and aspiration in the elderly5,9). However, with depending their size and location, symptoms such as dysphagia or dyspnea, may occur. "
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    ABSTRACT: Symptomatic diffuse idiopathic skeletal hyperostosis (DISH) is not common. Gelfoam is one of the most commonly used topical hemostatic agents. But, in the partially moistened state, air retained in its pores may result in excessive expansion on contact with liquid. The onset of swallowing difficulty after anterior cervical spine surgery due to appling gelfoam is a rare complication. A 77-year-old man with swallowing difficulty was admitted to our hospital and we diagnosed him as DISH confirmed by radiological study. After removing the DISH, patient's symptom was relieved gradually. However, on postoperative day (POD) 7, the symptom recurred but lesser than the preoperative state. We confirmed no hematoma and esophageal perforation on the operation site. We observed him closely and controlled the diet. Three months later, he had no symptom of swallowing difficulty, and was able to be back on a regular diet, including solid foods. We present a complication case of swallowing difficulty occurring by gelfoam application.
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    ABSTRACT: In diffuse idiopathic skeletal hyperostosis (DISH), recurrence of hyperostosis after surgical removal is common. While both non-steroidal anti-inflammatory drugs (NSAIDs) and radiotherapy have been used in the prevention of heterotopic ossification, only NSAIDs have been applied for prophylaxis in DISH. As a previously undescribed prophylaxis of recurrence in DISH, we report a case treated with local radiotherapy.
    Full-text · Article · Jan 2014