{
  "abstract": "A man in his late 80s presented with a several-month history of dysphagia, which was restricted to solids. He experienced coughing and choking while eating but had no difficulty drinking. His medical history included chronic heart failure, type 2 diabetes mellitus, hypertension and dyslipidaemia. A physical examination revealed a reduced cervical range of motion in all directions, especially in flexion and extension. There were no other significant findings. While upper gastrointestinal endoscopy found no abnormalities, cervical CT demonstrated ossification of the anterior longitudinal ligament with a protruding osteophyte at C5/6 causing oesophageal compression ( figure 1A). A videofluorographic swallowing study (VFSS) demonstrated oesophageal retention at the pharyngoesophageal junction (figure 1B), and fibreoptic endoscopic evaluation of swallowing identified residue of test-thickened liquid and jelly in the pyriform sinus. Based on these findings, diffuse idiopathic skeletal hyperostosis (DISH) was diagnosed as the cause of his dysphagia. To determine the optimal swallowing posture, VFSS was repeated with the cervical spine in various positions, including left and right rotation, flexion and extension. The results demonstrated that rightward cervical rotation with the chin lowered was the most effective for alleviating the oesophageal compression caused by the osteophytes. The patient was instructed in the optimal posture for swallowing and received rehabilitation, which improved his dysphagia. At the latest follow-up 1 year after the diagnosis, the patient was able to eat normal food although with due attention to maintaining the required swallowing posture.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan"
      ],
      "name": "Chihiro Sekine"
    },
    {
      "affiliations": [
        "Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan"
      ],
      "name": "Yasuhiro Kano"
    },
    {
      "affiliations": [
        "Department of Otolaryngology-Head and Neck Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan"
      ],
      "name": "Ayumi Mori"
    }
  ],
  "title": "Dysphagia due to diffuse idiopathic skeletal hyperostosis",
  "uid": "2d4040ba-9da1-5707-8160-22027cd18d4b"
}