Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2005 Mar;20(1):68-71.
doi: 10.3904/kjim.2005.20.1.68.

Cases of swallow syncope induced by the activation of mechanorecepters in the lower esophagus

Ki Hoon Kang  1 , Wook Hyun Cho, Myung Chan Kim, Hee Jong Chang, Jae Il Chung, Dong Jun Won
Affiliations
Case Reports

Cases of swallow syncope induced by the activation of mechanorecepters in the lower esophagus

Ki Hoon Kang et al. Korean J Intern Med. 2005 Mar.

Abstract

Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed bradycardia when the lower esophagus was stretched by balloon inflation. The activation of mechanoreceptors in the lower esophagus can be regarded as an initiating factor of these cardioinhibitions. The patients were treated with permanent pacemaker implantation and instructed to change eating habits, respectively.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Holter monitoring immediately following the ingestion of a cup of beer (Case 1). The patient had a 7.2-second sinus pause. (B) Electrocardiogram monitoring of the challenge test with a carbonated beverage (a soda pop). The sinus bradycardia caused by the first sip of a soda pop turned into a sinus arrest for 5.4 seconds after the second sip.
Figure 2
Figure 2
(A) A basal electrocardiography shows normal sinus rhythm (75 beats per minutes) in case 1. B. Esophageal balloon inflation at the lower esophagus initiated marked sinus bradycardia (33 beats per minutes) that could not be induced at the middle and upper esophagus.
Figure 3
Figure 3
(A) Esophageal balloon inflation at the T7 level of the esophagus made a sinus pause (3.08 seconds) and marked bradycardia. (Case 2) B. Esophageal balloon inflation at the T9 level of the esophagus initiated a junctional rhythm. C. Esophageal balloon inflation at the T9 level of the esophagus after atropine 1mg IV blocked the reflex. T: thoracic vertebra
Figure 4
Figure 4
Esophageal balloon inflation done under fluoroscopy. White hollow arrows indicate an esophageal balloon inflated at the lower esophagus (9th thoracic vertebra level in case 2). Black arrows indicate the margin of air shadow in the stomach.
See this image and copyright information in PMC

References

    1. Palmer ED. The abnormal upper gastrointestinal vagovagal reflexes that affect the heart. Am J Gastroenterol. 1976;66:513–522. - PubMed
    1. Spens T. Medical commentaries. In: Major RH, editor. Classic descriptions of disease. 3rd ed. Springfield Illinois: Charles C. Thomas; 1978. p. 331.
    1. Linzer M, Yang EH, Estes NA, 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope: pt 1. value of history, physical examination, and electrocardiography. Ann Intern Med. 1997;126:989–996. - PubMed
    1. Farb A, Valenti SA. Swallow syncope. Md Med J. 1999;48:151–154. - PubMed
    1. Armstrong PW, McMillan DG, Simon JB. Swallow syncope. Can Med Assoc J. 1985;132:1281–1284. - PMC - PubMed

Publication types