Fainting during ingestion. Deglutition syncope

A 49-year-old woman was referred to the ENT department with a 1.5-year history of dysphagia accompanied by globus sensation and regurgitation as well as recurrent syncopal attacks associated with swallowing solid foods. Endoscopic examination revealed hyperplasia of the tongue base and redness of the aryepiglottic region. An axial hiatal hernia (> 3 cm) was seen on esophago-gastro-duodenoscopy. Esophageal manometry showed a diffuse esophageal spasm. Holter monitoring (24 h) revealed a third-degree atrioventricular block. The patient’s symptoms resolved following placement of a permanent cardiac pacemaker. Globus sensation and regurgitation persisted. Treatment with proton pump inhibitors was successful. The final functional endoscopic evaluation of swallowing revealed no relevant findings. We describe a case of a rare and extreme form of a vagal reflex. Deglutition syncope can be successfully treated by a multidisciplinary team consisting of otorhinolaryngologists, neurologists and cardiologists.