Oesophageal syncope.

Oesophageal syncope is loss of consciousness on swallowing, which is thought to be associated with an abnormal vagovagal reflex that leads to transient bradycardia. Patients with this potentially lethal condition may present to neurologists, cardiologists or gastroenterologists. It may be associated with cardio-active drug therapy, previous myocardial infarction, or with an organic lesion of the lower oesophagus. Barium and manometric studies, in association with ECG monitoring, should, therefore, be carried out in all cases. In many patients, however, it appears to be a functional abnormality for which no cause can be determined. In the absence of a condition necessitating surgical correction, medical therapy in the form of anticholinergic or sympathomimetic agents is occasionally helpful. Total denervation of the affected portion of the oesophagus has successfully prevented further symptoms, but insertion of a programmed cardiac pacemaker is currently the definitive treatment of choice.