Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Phagia: A Case Report and Review of Literature of a Rare Disease Manifestation

Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a clinical entity characterized by ossification of the anterolateral ligaments of the spine. DISH is more commonly diagnosed in older males, with an estimated prevalence of 42% in patients older than 65 years. As the disease affects predominantly the thoracic spine, dysphagia is a rare presentation of this entity observed in only 0.6-1.0% of the cases. We present a clinical case of an 84-year-old male with complaints of progressive dysphagia and foreign body sensation within one year of evolution. Computed tomography imaging revealed an anterior C4-C5 osteophyte compressing the posterior hypopharyngeal wall. Flexible endoscopy revealed a deformed and stenotic hypopharynx. The patient underwent surgical treatment with anterior cervical osteophyte resection using the Smith-Robinson approach. The patient showed significant improvement in preoperative symptoms, and no recurrence was detected at six months of follow-up. We also aim to discuss the clinical and radiological characteristics of the disease, as well as the crucial steps for a correct diagnosis and treatment of this rare disease.