Measurement of gastric emptying rate in humans. Simplified scanning method

Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies

OBJECTIVE

To develop a sensitive, specific scale for quantifying functional dysphagia in stroke patients, using results obtained from videofluoroscopic swallowing studies.

DESIGN

Data collected from a serial oral and pharyngeal videofluoroscopic swallowing study.

SETTING

A dysphagia clinic in a department of rehabilitation medicine at a tertiary care university hospital.

PARTICIPANTS

One hundred three consecutively admitted stroke patients.

INTERVENTIONS

Videoflurorscopy to measure a scale of 11 variables: lip closure score, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, and pharyngeal transit time.

MAIN OUTCOME MEASURES

Polychotomous linear logistic regression analysis of videofluoroscopic and aspiration results. Scale sensitivity and specificity, and the correlation between the total score of the scale and aspiration grade were analyzed.

RESULTS

The scale's sensitivity and specificity for detecting supraglottic penetration and subglottic aspiration were 81%, 70.7%, and 78.1%, 77.9%, respectively. A significant positive correlation was found between the scale's total score and the severity of aspiration (Spearman's r =.58943, p =.00001).

CONCLUSION

This functional dysphagia scale, which was based on a videofluoroscopic swallowing study in stroke patients, is a sensitive and specific method for quantifying the severity of dysphagia.

Measurement of gastrointestinal motility in the GI laboratory

Current tests of gastric and small intestinal motor function provide relevant physiological information, but their clinical utility is controversial. This article reviews the current procedures, indications, significance, pitfalls, and guidelines for gastrointestinal motility measurements by scintigraphy, gastroduodenojejunal manometry, and surface electrogastrography in humans. Methods included review of literature and discussions in closed and open fora among investigators, including presentations for peer review at focused (Iowa City American Motility Society Symposium, December 1995) and national meetings (American Gastroenterological Association, May 1996, and American Motility Society, September 1996). The current tests are generally complementary; scintigraphy is typically the first test in the evaluation of gastric motor function and often confirms the clinical suspicion of dysmotility. Manometry identifies patterns suggestive of myopathy, neuropathy, or obstruction but may be most helpful when it shows entirely normal findings, because manometry helps in part to exclude dysmotility as a cause of symptoms. Electrogastrography may identify dysrhythmias or failure of signal power to increase postprandially; rhythm abnormalities may be independent of impaired emptying among dyspeptic patients. The best validated and clinically most significant results pertain to transit tests; manometry may contribute importantly to the diagnostic process; and the significance of electrogastrography remains to be fully elucidated.

Aluminum-27 nuclear magnetic resonance spectroscopy and imaging of the human gastric lumen

Aluminum NMR is proposed as a new imaging and spectroscopy modality. Its potential is exemplified by in vivo studies of the human stomach. The dissolution kinetics of aluminum-containing drugs at physiological doses and their removal from the human stomach have been followed by 27Al magnetic resonance spectroscopy (MRS). Aluminum concentrations as low as 0.5 mg Al3+ in the human stomach can be detected. The time course of gastric emptying has been visualized with 27Al magnetic resonance imaging (MRI) under normal conditions and in the presence of an antimuscarinic agent, which reduces the gastric motor function. 27Al MRI is the only direct method to visualize the gastric pH. 27Al MRI opens new possibilities for medical and pharmaceutical science.