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Karhan AN, Aydemir Y, Demir N, Arslan SS, Gümüş E, Demir H, Özen H, Yüce A, Karaduman AA, Saltık-Temizel İN. Assessment of swallowing function in pediatric patients with Wilson's disease: Results of a videofluoroscopic swallowing study. Arab J Gastroenterol 2021; 22:215-219. [PMID: 34538586 DOI: 10.1016/j.ajg.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/25/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Wilson's disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders. The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS). PATIENTS AND METHODS A total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity. RESULTS According to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1. CONCLUSION The current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.
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Affiliation(s)
- Asuman Nur Karhan
- Department of Paediatrics, Division of Gastroenterology, Mersin University, Faculty of Medicine, Ankara, Turkey.
| | - Yusuf Aydemir
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Numan Demir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Selen Serel Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ersin Gümüş
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hülya Demir
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hasan Özen
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Aysel Yüce
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Aynur Ayşe Karaduman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
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Suntrup-Krueger S, Muhle P, Kampe I, Egidi P, Ruck T, Lenze F, Jungheim M, Gminski R, Labeit B, Claus I, Warnecke T, Gross J, Dziewas R. Effect of Capsaicinoids on Neurophysiological, Biochemical, and Mechanical Parameters of Swallowing Function. Neurotherapeutics 2021; 18:1360-1370. [PMID: 33449304 PMCID: PMC8423940 DOI: 10.1007/s13311-020-00996-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/25/2023] Open
Abstract
Oropharyngeal dysphagia is prevalent in age-related neurological disorders presenting with impaired efficacy and safety of swallowing due to a loss of muscle force and sensory deficits. Stimulating the oropharynx with capsaicin that mediates Substance P release is an emerging pharmacological treatment option which needs further scientific evidence. Our aim was to comprehensively evaluate the effect of capsaicin on biochemical, neurophysiological, and biomechanical parameters of swallowing function. In a randomized study on healthy individuals, the impact of orally administered capsaicinoids at different dosages and application durations in comparison to non-carbonated water was evaluated. Time course and magnitude of salivary Substance P increase were monitored. Magnetoencephalography was used to detect cortical swallowing network alterations. Modifications in swallowing biomechanics were measured applying high-resolution pharyngeal manometry. Capsaicinoids at 10 μmol/L improved swallowing efficacy as seen by a significant increase of pharyngeal contractile integral and upper esophageal sphincter activation and relaxation times in manometry. Significant improvement of precision in a challenging swallow task accompanied by a reduction in swallowing-related submental electromyographic power was observed with capsaicinoids preconditioning at 10 μmol/L over 5 min, but not with continuous stimulation. The cortical activation pattern remained unchanged after any intervention. A significant increase of salivary Substance P was not detected with 10 μmol/L but with 50 μmol/L and lasted for 15 min after application. Capsaicinoids mediate dose-dependent Substance P release and positively alter swallowing biomechanics in healthy subjects. The results provide supportive evidence for the value of natural capsaicinoids to improve swallowing function.
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Affiliation(s)
- Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Isabella Kampe
- Pediatrics Department, St. Franziskus-Hospital Ahlen, Robert-Koch-Straße 55, 59227, Ahlen, Germany
| | - Paula Egidi
- Department of Anesthesiology and Intensive Care Medicine, Clemenshospital Münster, Duesbergweg 124, 48153, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Frank Lenze
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Richard Gminski
- Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Bendix Labeit
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
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Rogus-Pulia NM, Jones CA, Forgues AL, Orne J, Macdonald CL, Connor NP, McCulloch TM. Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1550-1562. [PMID: 32569478 PMCID: PMC7893517 DOI: 10.1044/2020_ajslp-19-00134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/02/2019] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Purpose We assessed experienced clinicians' perceptions of benefits and drawbacks to the clinical adoption of pharyngeal high-resolution manometry (HRM). This article focuses on the professional and institutional factors that influence the clinical adoption of pharyngeal HRM by speech-language pathologists (SLPs). Method Two surveys (closed- and open-ended questions) and a series of focus groups were completed with SLP members of both the American Speech-Language-Hearing Association and the Dysphagia Research Society (DRS). Transcripts were inductively coded for emergent themes. Results Thirteen SLPs were recruited to attend focus group sessions at the American Speech-Language-Hearing Association. Eighty-seven SLPs responded to the DRS open-set response survey. Two additional focus groups of 11 SLPs were convened at the DRS meeting. Conventional content analysis revealed overall SLP enthusiasm for the clinical use of HRM, with some concerns about the technology adoption process. The following themes related to the professional and institutional factors influencing clinical adoption were identified: (a) scope of practice, (b) access, (c) clinical workflow, and (d) reimbursement. Conclusion These data serve to elucidate the most salient factors relating to the clinical adoption of pharyngeal HRM into routine speech-language pathology clinical practice. While enthusiasm exists, a variety of systems-level issues must be addressed to support this process.
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Affiliation(s)
- Nicole M. Rogus-Pulia
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
- Department of Medicine, University of Wisconsin–Madison
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Corinne A. Jones
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Department of Neurology, The University of Texas at Austin
| | | | - Jason Orne
- Qualitative Health Research Consultants, LLC, Madison, WI
| | | | - Nadine P. Connor
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
| | - Timothy M. McCulloch
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
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