Swallow syncope

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released September 28, 2004; last updated January 31, 2017; expires January 31, 2020

This article includes discussion of swallow syncope, deglutition syncope, esophageal syncope, swallow bradycardia, swallow tachycardia, and esophageal spasm. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author explains the clinical presentation, pathophysiology, diagnostic work-up, and management of swallow syncope. Swallow syncope is most commonly associated with esophageal disorders that affect the afferent limb of a vagovagal reflex, including such disorders as hiatal hernia, gastroesophageal reflux, diffuse esophageal spasm, esophageal carcinoma, esophageal stricture, esophageal stenosis from ascending aortic aneurysm, distal esophageal Schatzki ring, hypertensive peristaltic waves (“nutcracker esophagus”), achalasia, and esophageal diverticula.

Key points

 

• Swallow syncope may occur within 3 to 5 seconds of swallowing. Many bouts result only in presyncope, with associated visual greyout, tunnel vision, etc.

 

• Swallow syncope is frequently triggered by liquids, particularly cold, carbonated beverages.

 

• Swallow syncope is caused by stimulation, irritation, or dysfunction of the afferent origin of a vagovagal reflex (eg, the distal esophagus), the vagus nerve itself, or the efferent target of the vagovagal reflex (ie, the heart).

 

• Swallow syncope may be confused with epilepsy, particularly as the syncopal attacks may be associated with secondary arrhythmic convulsive jerks of the extremities (ie, convulsive syncope).

Historical note and terminology

Swallow syncope is a loss of consciousness during or immediately following a swallow (Levin and Posner 1972). Recognition of the disorder dates from the late 1700s, but most cases have been reported since 1900 (Levin and Posner 1972). Swallow syncope is usually caused by upper gastrointestinal-cardiac vagovagal reflexes initiated by swallowing and rapid gastric distention (Palmer 1976). As such, swallow syncope is often considered 1 of a number of neurally mediated, "situational" syncopes that include those which occur after micturition, defecation, coughing, or, rarely, laughing (Gaitatzis and Petzold 2012). Cases have also been reported in animals (Phan et al 2013).

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.