More Published Dysphasia Cases Signals Need for Research

The authors of a new study report that the published cases of dysphagia have greatly increased in the last decade, yet no randomized studies or consensus exist on treatment or recurrence prevention.

A good starting point, say these researchers, is more research on dysphasia and idiopathic skeletal hyperostosis (DISH).

The study, “Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: An updated systematic review,” was published online on March 10, 2022, in The Spine Journal.

The authors also found that, in terms of treatment, surgical resection is safe and can effectively resolve symptoms. They also found that long term follow-up is needed for monitoring recurrent symptoms and osteophytes.

“Diffuse idiopathic skeletal hyperostosis is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine,” the researchers wrote.

For this study, they updated their previous systematic review on the epidemiological and clinical knowledge of dysphagia and clinical knowledge of dysphagia and airway obstruction caused by cervical diffuse idiopathic skeletal hyperostosis. They searched publications in Medline and EMBASE from July 2010 to June 2021. Their focus was on surgical treatment and outcomes.

In the end, the review included 138 articles which included 419 patients with dysphagia and/or airway obstruction. The mean age of patient was 67.3 years (range: 35-91 years), and 85.4% were male.

The researchers noted that there was an increase in published cases over the last decade. Sixty-six percent of the patients underwent surgical treatment with the anterolateral approach being the most common technique used.

The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. In addition, they observed improvement of dysphagia in 95.5% of the patients who had surgery.

Dysphagia recurred in 12 surgically treated patients (4%), of which 5 patients had osteophyte regrowth during a follow-up of 3.7 years.

“The amount of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical diffuse idiopathic skeletal hyperostosis,” the researchers wrote.

Study authors included Netania I. Harlianto, Jonneke S. Kuperus, M.D., Firdaus A.A. Mohamed Hoesein, M.D., Pim A de Long, M.D., F. Cumhur Öner, M.D., and Jorrit-Jan Verlaan, M.D., all of the University Medical Center Utrecht in The Netherlands. Jacob A de Ru, M.D., of Central Military Hospital in The Netherlands, also contributed to the study.