Diffuse idiopathic skeletal hyperostosis as an overlooked cause of dysphagia: a case report

INTRODUCTION 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. CASE PRESENTATION 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. CONCLUSION 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.