A case of swallowing syncope due to metastatic esophageal carcinoma / 대한내과학회지

ABSTRACT

Swallowing syncope is a rare syndrome of a sudden and temporary loss of consciousness on swallowing. 66- year-old man was admitted due to dysphagia and syncope. He had no history of cardiac or gastrointestinal problem. In manometry, there was increased pressure of lower esophageal sphincter consistent to secondary achalasia and 24-hour Holter monitoring showed sinus arrest and atrioventricular block while swallowing. Head-up tilt test and provocation test with ballooning tube were shown mixed pattern of cardioinhibitory and vasodepressor response. Propranolol was given but not effective. Permanent pacemaker was implanted and there was no more syncopal episode. For evaluation of dysphagia symptom gastrofiberscopy was done and we found stomach carcinoma at the gastric cardia portion that infiltrated to the lower end of esophagus. Partial esophagogastrectomy with anastomosis was done and then the cardiac arrhythmias were disappeared. In the microscopic finding of gastroesophageal portion, it revealed tumor cells infiltrated to vagus nerve located in esophageal submucosa. We propose that swallowing syncope is induced mainly by esophageal abnormality with or without cardiac abnormality and stomach carcinoma metastasized to esophagus is an etiology of swallowing syncope. We report a case of swallowing syncope due to metastatic esophageal carcinoma involving vagal nerve.