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Grobman M, Carluen E, Reinero CR. Incidence, clinical signs, and videofluoroscopic swallow study abnormalities associated with airway penetration and aspiration in 100 dogs. J Vet Intern Med 2022; 36:2149-2159. [PMID: 36259261 DOI: 10.1111/jvim.16553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Videofluoroscopic swallow studies (VFSS) utilizing penetration-aspiration (P-A) scoring assesses airway protection in people. On VFSS, penetration (ingesta or secretions immediately cranial to the vocal folds) and aspiration (material caudal to the vocal folds) are associated with increased risk of lung injury in people. Penetration-aspiration (P-A) scoring has been validated in animal models, but the incidence of P-A, clinical signs (CS), and dysphagic disorders associated with P-A in dogs are unknown. OBJECTIVES Using VFSS, identify the incidence of P-A, compare CS between dogs with and without P-A, and identify predisposing dysphagic abnormalities for P-A. ANIMALS One hundred client-owned dogs. METHODS Sequential VFSS and associated medical records from dogs presenting to the veterinary teaching hospitals at Auburn University (n = 53) and the University of Missouri (n = 47) were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney tests, one-way analysis of variance (ANOVA) on ranks, multiple linear regression, and Spearman rank order correlation (P < .05). RESULTS On VFSS, the incidence of pathologic P-A was 39%. No significant differences in CS were found between dogs with or without P-A (P > .05), with 14/39 dogs with P-A presenting without respiratory CS. Pharyngeal (P < .001) and esophageal (P = .009), but not oral-preparatory (P = .2) dysphagia was more common with P-A. Pharyngeal weakness (P < .001) and esophago-oropharyngeal reflux (EOR; P = .05) were independent predictors of P-A and were moderately and weakly positively correlated with P-A score respectively (P < .001, r = 0.489; P = .04, r = 0.201). CONCLUSIONS Penetration-aspiration occurs in dogs in the absence of respiratory CS (i.e., occult P-A). Dogs with pharyngeal weakness and EOR should be considered at risk for P-A.
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Affiliation(s)
- Megan Grobman
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Enrico Carluen
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Arizona Veterinary Emergency and Critical Care Center, Peoria, Arizona, USA
| | - Carol R Reinero
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
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Luciani E, Reinero C, Grobman M. Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs. J Vet Intern Med 2022; 36:1229-1236. [PMID: 35789042 PMCID: PMC9308441 DOI: 10.1111/jvim.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Aerodigestive diseases (AeroD), hybrid disorders between the respiratory and gastrointestinal (GI) tracts, may present without GI signs. Sliding hiatal hernia (sHH) is an important AeroD in brachycephalic dogs linked to respiratory pathology. The spectrum of other AeroD and respiratory clinical signs (CS) in brachycephalic and nonbrachycephalic dogs with sHH is unknown. Objectives Characterize CS of AeroD in dogs with sHH, compare CS between brachycephalic and nonbrachycephalic dogs, and compare thoracic radiographs and videofluoroscopic swallow study (VFSS) for diagnosing sHH. Animals Sixty‐seven client‐owned dogs with sHH. Methods Medical records of dogs with sHH presented to the veterinary teaching hospitals at Auburn University and the University of Missouri between 1 January 2009 and 31 December 2020 were retrospectively reviewed. Between group, comparisons were made using Mann‐Whitney test, Chi‐square analysis, and Spearman correlation (P < .05). Results Dogs with sHH presented with exclusively GI signs (28/67), mixed respiratory and GI signs (22/67), or with exclusively respiratory signs (17/67). Wheras brachycephalic dogs were not significantly more likely to present with respiratory CS (P = .145), they were younger (P < .001), and more likely to present in respiratory distress (P = .02), and with radiographic evidence of aspiration pneumonia (P < .001) compared to nonbrachycephalic dogs. Six of 12 dogs with normal thoracic radiographs having sHH presented with respiratory CS. For detection of sHH, VFSS was superior to radiographs (P < .001). Conclusions and Clinical Importance Dogs with sHH may present with exclusively respiratory signs. Respiratory signs may be more severe in brachycephalic compared to nonbrachycephalic dogs. Videofluoroscopic swallow study was superior to thoracic radiographs for detection of sHH in dogs.
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Affiliation(s)
- Elizabeth Luciani
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin, USA
| | - Carol Reinero
- Department of Veterinary Medicine & Surgery, University of Missouri Veterinary Health Center, Columbia, Missouri, USA
| | - Megan Grobman
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Department of Veterinary Medicine & Surgery, University of Missouri Veterinary Health Center, Columbia, Missouri, USA
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Grobman ME, Masseau I, Reinero CR. Aerodigestive disorders in dogs evaluated for cough using respiratory fluoroscopy and videofluoroscopic swallow studies. Vet J 2019; 251:105344. [PMID: 31492390 DOI: 10.1016/j.tvjl.2019.105344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
Aerodigestive diseases, hybrid disorders representing a pathologic link between respiratory and alimentary tracts, may manifest with respiratory signs without gastrointestinal signs. These are underdiagnosed in dogs due to poor clinical recognition and diagnostic limitations. We hypothesize that a subset of dogs presenting for cough without gastrointestinal signs would have occult aerodigestive disorders identified using videofluoroscopic swallow study (VFSS). Data were retrospectively obtained from 31 client-owned dogs presenting for cough, with thoracic radiographs, and a VFSS between April 2015 and December 2017. Exclusion criteria were cough of cardiac origin or gastrointestinal signs within 6 months. Swallow study parameters included pharyngeal/esophageal motility, laryngeal obstruction/defects, penetration-aspiration, reflux, excessive aerophagia, megaesophagus (ME), lower-esophageal sphincter achalasia-like syndrome (LES-AS), and sliding hiatal hernia (HH). The median (interquartile range) duration of cough was 4 (2-8) months. Thoracic radiographs were unremarkable in 11 dogs, with aspiration pneumonia suspected in seven. In 25/31 dogs (81%), VFSS abnormalities were detected and some dogs had more than one defect: pharyngeal (n=10) or esophageal hypomotility (n=10), reflux (n=9), penetration-aspiration (n=8), excessive aerophagia (n=6), laryngeal obstruction (n=3), ME (n=3), HH (n=2), and LES-AS (n=1). A respiratory disorder causing cough was identified in 17 dogs with VFSS abnormalities (laryngeal obstruction/defect and airway disease including chronic or eosinophilic bronchitis, tracheal/mainstem bronchial collapse, bronchiectasis, and bronchomalacia). An alimentary disorder identified on VFSS in absence of a discrete respiratory disorder causing cough was diagnosed in eight dogs. In conclusion, canine aerodigestive disorders can manifest as cough without alimentary signs. VFSS is a useful diagnostic to determine the contribution of esophageal/gastrointestinal pathology in dogs with cough.
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Affiliation(s)
- M E Grobman
- University of Missouri, College of Veterinary Medicine, Department of Veterinary Medicine and Surgery, 900 East Campus Drive, Columbia, MO 65211, USA
| | - I Masseau
- Université de Montréal, Faculté de Médecine Vétérinaire, Département of Sciences Cliniques, St-Hyacinthe, Québec, Canada
| | - C R Reinero
- University of Missouri, College of Veterinary Medicine, Department of Veterinary Medicine and Surgery, 900 East Campus Drive, Columbia, MO 65211, USA.
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Rodrigues MG, Araujo VJFD, Matos LLD, Hojaij FC, Simões CA, Araujo VJFD, Ramos DM, Mahmoud RL, Mosca LDM, Manta GB, Volpi EM, Brandão LG, Cernea CR. Substernal goiter and laryngopharyngeal reflux. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:348-353. [PMID: 28658344 PMCID: PMC10118925 DOI: 10.1590/2359-3997000000266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/23/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. SUBJECTS AND METHODS A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. RESULTS The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. CONCLUSION This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.
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Affiliation(s)
| | | | - Leandro Luongo de Matos
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | | | - Cesar Augusto Simões
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | | | - Daniel Marin Ramos
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | | | - Letícia de Moraes Mosca
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | - Gustavo Borges Manta
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | - Erivelto Martinho Volpi
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | - Lenine Garcia Brandão
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | - Claudio Roberto Cernea
- Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
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Rotsides JM, Krakovsky GM, Pillai DK, Sehgal S, Collins ME, Noelke CE, Bauman NM. Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist? Ann Otol Rhinol Laryngol 2017; 126:537-543. [DOI: 10.1177/0003489417708579] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To determine the utility of a pediatric multidisciplinary aerodigestive clinic (ADC) in treating recalcitrant aerodigestive conditions. Methods: Longitudinal observational study of presenting complaints, evaluation, management, and outcome of patients seen during 12 monthly ADCs beginning August 2013. Results: Fifty-five patients were seen by the ADC team (otolaryngology/gastroenterology/pulmonology/speech pathology/nurse practitioner) and followed for a mean 17.6 months (range, 12-26 months). Mean age was 4.3 years (range, 0.5-19 years). All were seen by at least 1 specialist before ADC referral but without significant improvement. Chronic cough was the most common primary symptom (44%). Clinic evaluation included flexible nasopharyngolaryngoscopy (FFL, 53%) and pulmonary function testing (36%.) FFL influenced management in 79%. An operative procedure usually combined endoscopy was warranted in 58%. Endoscopy provided high diagnostic yield, detecting laryngeal cleft (8), adenoid hypertrophy (8), vocal cord dysfunction (4), pulmonary infection (4), reflux disease (3), laryngomalacia (3), tracheomalacia (2), cilia abnormality (2), celiac disease (1), Helicobacter pylori (1), duodenal web (1), and eosinophilic esophagitis (1). Outcome was available for 48 of 55 patients, with 73% reporting resolved to markedly improved symptoms and 27% minimal to no improvement. Conclusions: The ADC team approach resulted in resolved to markedly improved symptoms in 73% of patients whose symptoms persisted despite seeing a single specialist prior to referral.
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Affiliation(s)
- Janine M. Rotsides
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gina M. Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
| | - Dinesh K. Pillai
- Department of Pulmonary and Sleep Medicine, Children’s National Health Services, Washington, DC, USA
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children’s National Health System, Washington, DC, USA
| | - Maura E. Collins
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Carolyn E. Noelke
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Nancy M. Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
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San Giorgi MRM, Helder HM, Lindeman RJS, de Bock GH, Dikkers FG. The association between gastroesophageal reflux disease and recurrent respiratory papillomatosis: A systematic review. Laryngoscope 2016; 126:2330-9. [DOI: 10.1002/lary.25898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Michel R. M. San Giorgi
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
| | - Herman M. Helder
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
| | - Robbert-Jan S. Lindeman
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
| | - Frederik G. Dikkers
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
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Ciorba A, Bianchini C, Zuolo M, Feo CV. Upper aerodigestive tract disorders and gastro-oesophageal reflux disease. World J Clin Cases 2015; 3:102-11. [PMID: 25685756 PMCID: PMC4317603 DOI: 10.12998/wjcc.v3.i2.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/20/2014] [Accepted: 10/28/2014] [Indexed: 02/05/2023] Open
Abstract
A wide variety of symptoms and diseases of the upper aerodigestive tract are associated to gastro-oesophageal reflux disease (GORD). These disorders comprise a large variety of conditions such as asthma, chronic otitis media and sinusitis, chronic cough, and laryngeal disorders including paroxysmal laryngospasm. Laryngo-pharyngeal reflux disease is an extraoesophageal variant of GORD that can affect the larynx and pharynx. Despite numerous research efforts, the diagnosis of laryngopharyngeal reflux often remains elusive, unproven and controversial, and its treatment is then still empiric. Aim of this paper is to review the current literature on upper aerodigestive tract disorders in relation to pathologic gastro-oesophageal reflux, focusing in particular on the pathophysiology base and results of the surgical treatment of GORD.
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Langevin SM, Michaud DS, Marsit CJ, Nelson HH, Birnbaum AE, Eliot M, Christensen BC, McClean MD, Kelsey KT. Gastric reflux is an independent risk factor for laryngopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 2013; 22:1061-8. [PMID: 23703970 DOI: 10.1158/1055-9965.epi-13-0183] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gastric reflux can reach into the upper airway, inducing cellular damage in the epithelial lining. This condition is believed to be a risk factor for development of laryngopharyngeal squamous cell carcinoma (LPSCC), although the literature is conflicting. METHODS To better clarify this relationship, we assessed the association of self-reported heartburn history and medication use among 631 patients with LPSCCs and 1234 control subjects (frequency-matched on age, gender, and town of residence) enrolled as part of a population-based case-control study of head and neck squamous cell carcinoma in the greater Boston area. RESULTS After adjusting for age, gender, race, smoking, alcohol consumption, HPV16 seropositivity, education, and body mass index, subjects reporting a history of frequent heartburn and who were neither a heavy smoker nor heavy drinker had a significantly elevated risk of LPSCCs [OR, 1.78; 95% confidence interval (CI), 1.00-3.16]. Among those with a history of heartburn, there was an inverse association between antacid use and LPSCCs relative to those never taking heartburn medication (OR, 0.59; 95% CI, 0.38-0.93) that remained consistent when analyzed by smoking/drinking status, HPV16 status, or by primary tumor site. CONCLUSIONS Our data show that gastric reflux is an independent risk factor for squamous cancers of the pharynx and larynx. Further studies are needed to clarify the possible chemopreventive role of antacid use for patients with gastric reflux. IMPACT Elucidation of additional risk factors for head and neck cancer can allow for risk stratification and inform surveillance of high-risk patients.
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Affiliation(s)
- Scott M Langevin
- Department of Epidemiology, Brown University, Providence, RI 02912, USA
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