Srivastava Seema, Ciapryna Natalia, Bovill Iñaki
Department of Elderly Care, Chelsea and Westminster Foundation Hospital, London, UK.
J Med Case Rep. 2008 Aug 27;2:287. doi: 10.1186/1752-1947-2-287.
Dysphagia is a common presentation in older people. Diffuse idiopathic skeletal hyperostosis affecting the cervical spine is an uncommon cause of dysphagia and may be overlooked.
We present the case of an 88-year-old man with dysphagia and weight loss. Initial investigation with upper gastrointestinal endoscopy was inconclusive. A diagnosis of diffuse idiopathic skeletal hyperostosis as a cause for dysphagia was eventually made using video fluoroscopy. This showed a bony prominence impeding swallow at the level of C3. The patient was unfit for surgical management so a percutaneous endoscopic gastrostomy tube was inserted for feeding.
The diagnosis of diffuse idiopathic skeletal hyperostosis involving the cervical spine often goes unrecognised as a cause of dysphagia despite its prevalence in the elderly population. Diagnosis is made using cervical radiographs, barium swallow and computed tomography. There is a risk of perforation with endoscopy in patients who have cervical diffuse idiopathic skeletal hyperostosis. Conservative management includes non-steroidal anti-inflammatory medications and a modified diet. Surgery may be considered in certain patients where conservative management fails.
吞咽困难是老年人的常见症状。弥漫性特发性骨肥厚累及颈椎是吞咽困难的罕见原因，可能会被忽视。
我们报告一例88岁男性患者，有吞咽困难和体重减轻症状。最初的上消化道内镜检查结果不明确。最终通过视频荧光透视诊断为弥漫性特发性骨肥厚导致吞咽困难。检查显示在C3水平有一个骨突出物阻碍吞咽。患者不适合手术治疗，因此插入了经皮内镜下胃造口管进行喂食。
尽管弥漫性特发性骨肥厚累及颈椎在老年人群中很常见，但作为吞咽困难的一个原因，其诊断往往未被认识到。通过颈椎X线片、吞钡造影和计算机断层扫描进行诊断。颈椎弥漫性特发性骨肥厚患者进行内镜检查有穿孔风险。保守治疗包括使用非甾体类抗炎药和调整饮食。在某些保守治疗失败的患者中可考虑手术治疗。
