Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus
A 59-year-old male was referred to hospital for the evaluation of about four episodes of syncope which he had experienced for 1 year. The first episode occurred with a loss of consciousness for 5 minutes following eating foods with feeling obstruction in the esophagus. No specific kinds or forms of foods had been associated with the symptom. He had experienced syncopal episodes usually right after eating, but sometimes while eating foods. The patient had been in good health except for having about ten episodes of an obstructive feeling while eating for 3 years. The result of an esophagogastroscopy conducted 1 year ago had been normal. Physical examination results showed no abnormality. The laboratory FT4: 26.445 pmol/L, TSH receptor antibody 30.5%). The blood count and liver function tests were normal. An electrocardiography showed sinus bradycardia (57 beats per minutes). A chest X-ray showed a compression fracture at the lower thoracic spine. A thyroid scan showed no demonstrable abnormal finding. The Holter monitoring test could not be done for refusal of patient and rarity of the symptoms. Inflation of the balloon in the lower esophagus and gastroesophageal junction that was at the 9th thoracic spine level resulted in junctional rhythm (32~36 beats per minutes) with lightheadedness (, ). However, an atropine pretreatment blocked this response (). A syncopal episode was considered to occur with eating a bolus of food in a hurry; thus, he was treated by changing his eating habits for syncope and given propylthiouracil for Graves' disease.