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Lee SH, Jung JY, Yoon MJ, Kim JS, Hong BY, Im S, Yoo YJ. Isolated Acute Dysphagia as a Probable Rare Presentation of Guillain-Barré Syndrome with Complete Recovery: A Case Report. Geriatrics (Basel) 2024; 9:90. [PMID: 39051254 PMCID: PMC11270192 DOI: 10.3390/geriatrics9040090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Dysphagia is prevalent among the elderly and can lead to serious complications, often manifesting as a clinical symptom of various neurological or muscular pathologies, including Guillain-Barré Syndrome (GBS). GBS is an acute immune-mediated polyradiculoneuropathy, and dysphagia may arise during its course due to cranial nerve involvement. In rare GBS variants, dysphagia may present as the initial or sole clinical manifestation, posing diagnostic challenges. In this study, we present the case of an elderly female patient with dysphagia, eventually diagnosed with an atypical variant of GBS. Initially, the patient required nasogastric tube feeding; however, complete recovery was achieved through immunotherapy. This case underscores the importance of clinicians conducting thorough evaluations of factors influencing the swallowing mechanism and remaining vigilant about identifying uncommon causative factors. Such approaches enable the implementation of effective disease-modifying therapies, potentially leading to the resolution of dysphagic symptoms.
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Affiliation(s)
- Soo Ho Lee
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
| | - Ji Yoon Jung
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
| | - Joon-Sung Kim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Republic of Korea;
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.L.); (J.Y.J.); (M.-J.Y.); (J.-S.K.); (B.Y.H.)
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Ogawa M, Kenjiro K, Ohno T, Okamoto K, Fujishima I. Mechanism of the Immediate Effect of Balloon Dilation Therapy in Spinal Muscular Atrophy With Dysphagia: A High-Resolution Manometric Study. Cureus 2024; 16:e62191. [PMID: 39006706 PMCID: PMC11239239 DOI: 10.7759/cureus.62191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 07/16/2024] Open
Abstract
Balloon dilation therapy (BDT) is used to treat pharyngeal dysphagia in patients with impaired upper esophageal sphincter (UES) relaxation due to cricopharyngeal dysfunction. However, the mechanism underlying this immediate effect remains unclear. Here, we present a case in which we investigated the immediate effects of BDT on UES dysfunction using high-resolution manometry (HRM). A 67-year-old man was diagnosed with spinal muscular atrophy (SMA). He gradually developed dysphagia, and a gastrostomy was performed. Despite continuing oral intake of supplemental nutrition, the patient developed dysphagia. Videofluoroscopic (VF) examination of swallowing revealed pharyngeal residue, while HRM showed weak pharyngeal contractility and impaired UES opening. BDT was performed to address the UES dysfunction. Immediately following BDT, VF demonstrated improved pharyngeal bolus passage. As for the UES function during swallowing, HRM revealed that the UES relaxation duration was significantly longer and the UES nadir pressure was significantly decreased. The patient continued the BDT before oral intake. HRM revealed immediate and prolonged UES opening with decreased UES pressure during swallowing as an immediate effect of BDT. This suggests that these findings represent the mechanisms underlying dysphagia in this patient with SMA. BDT resulted in an immediate improvement in UES function, potentially leading to dysphagia improvement. BDT should be combined with conventional rehabilitation for impaired UES opening. However, further studies are needed to confirm the long-term effectiveness of BDT for dysphagia due to SMA.
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Affiliation(s)
- Mika Ogawa
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Kunieda Kenjiro
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
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3
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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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Khatri S, Chamay S, Chacko S, Sharma S. Hemiazygos vein dilation as a radiological finding and multifactorial cause of dysphagia. Radiol Case Rep 2023; 18:2581-2585. [PMID: 37250481 PMCID: PMC10220463 DOI: 10.1016/j.radcr.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Dysphagia is a common issue observed among the elderly, which can arise from various etiologies such as motility disorders and chronic neurologic conditions. Radiologists play a crucial role in diagnosing the cause of dysphagia, as they can identify anatomical abnormalities that may lead to the condition. One such anomaly is the hemiazygos vein, which is the left side equivalent of the azygos vein and can cause dysphagia if it crosses over the esophagus. To our knowledge, there are only 2 other recorded cases of azygos aneurysm/dilation causing esophageal dysphagia. In this context, we present a case report of a 73-year-old female with a 1-month history of weight loss and dysphagia due to a prominent hemiazygos vein. The case highlights the importance of thorough radiological evaluation in identifying the underlying cause of dysphagia and ensuring timely and appropriate treatment.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, 160 Convent Ave, New York, NY 10031, USA
| | - Salomon Chamay
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
| | - Steven Chacko
- CUNY School of Medicine, 160 Convent Ave, New York, NY 10031, USA
| | - Shorabh Sharma
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
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Grossi E, Rocco C, Stilo L, Guarneri B, Inzitari M, Bellelli G, Gentile S, Morandi A. Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium. Eur Geriatr Med 2023:10.1007/s41999-023-00773-2. [PMID: 37052832 DOI: 10.1007/s41999-023-00773-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting. METHODS Retrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis. RESULTS We included 1040 patients, (65% females, mean age 81.9 ± 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08-3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI - 1.1; - 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI - 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI - 1.01;2.62). CONCLUSION Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.
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Affiliation(s)
- Eleonora Grossi
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Chiara Rocco
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Leone Stilo
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Barbara Guarneri
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Marco Inzitari
- REFiT Bcn Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca and Acute Geriatric Unit IRCCS Foundation San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Simona Gentile
- Intermediate Care and Rehabilitation Unit, Azienda Speciale "Cremona Solidale", Via Zocco 21, 26100, Cremona, Italy
| | - Alessandro Morandi
- Intermediate Care and Rehabilitation Unit, Azienda Speciale "Cremona Solidale", Via Zocco 21, 26100, Cremona, Italy.
- REFiT Bcn Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain.
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Min C, Zhang C, Cao Y, Li H, Pu H, Huang J, Xiong YL. Rheological, textural, and water-immobilizing properties of mung bean starch and flaxseed protein composite gels as potential dysphagia food: The effect of Astragalus polysaccharide. Int J Biol Macromol 2023; 239:124236. [PMID: 37001775 DOI: 10.1016/j.ijbiomac.2023.124236] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
The effects of Astragalus polysaccharide (APS) on rheological, textural, water-holding, and microstructural properties of mung bean starch (MBS)/flaxseed protein (FP) composite gels were investigated. Results showed that the storage modulus (G') of gels with APS were significantly lower than that of the control gel, while different concentrations of APS possessed diverse effects on the hardness, gumminess and cohesiveness of the gels. Adding APS significantly improved the water retention capacity by trapping more immobilized and free water in the gel network. Microstructurally, the MBS/FP/APS composite gels displayed a complex network with reduced pore size compared with that of the control gel (MBS/FP). International dysphagia diet standardization initiative (IDDSI) tests suggested that gels with APS contents below 0.09 % could be classified into level 6, while gel with 0.12 % APS could be categorized as level 7. Mechanistically, APS could influence the interactions between starch and protein within the tri-polymeric composite systems by affecting starch gelatinization and hydrogen bonding, further contributing to the formation of strengthened gel network and the change of gel properties. These results suggest that the macromolecular APS can improve the structural and textural properties of the starch-protein composite systems, and impart various functional properties to the FP-based gel foods.
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Bioenergetic Evaluation of Muscle Fatigue in Murine Tongue. Dysphagia 2022:10.1007/s00455-022-10537-y. [DOI: 10.1007/s00455-022-10537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
AbstractMuscle fatigue is the diminution of force required for a particular action over time. Fatigue may be particularly pronounced in aging muscles, including those used for swallowing actions. Because risk for swallowing impairment (dysphagia) increases with aging, the contribution of muscle fatigue to age-related dysphagia is an emerging area of interest. The use of animal models, such as mice and rats (murine models) allows experimental paradigms for studying the relationship between muscle fatigue and swallowing function with a high degree of biological precision that is not possible in human studies. The goal of this article is to review basic experimental approaches to the study of murine tongue muscle fatigue related to dysphagia. Traditionally, murine muscle fatigue has been studied in limb muscles through direct muscle stimulation and behavioral exercise paradigms. As such, physiological and bioenergetic markers of muscle fatigue that have been validated in limb muscles may be applicable in studies of cranial muscle fatigue with appropriate modifications to account for differences in muscle architecture, innervation ratio, and skeletal support. Murine exercise paradigms may be used to elicit acute fatigue in tongue muscles, thereby enabling study of putative muscular adaptations. Using these approaches, hypotheses can be developed and tested in mice and rats to allow for future focused studies in human subjects geared toward developing and optimizing treatments for age-related dysphagia.
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8
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Qian S, Wu Y, Wang Z, Zhang C, Huang J, Yu J. Bionic design of the oral swallowing in vitro and its application in the dysphagia. J Texture Stud 2022; 53:430-443. [PMID: 35696487 DOI: 10.1111/jtxs.12702] [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: 02/13/2022] [Revised: 04/10/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
Dysphagia, the swallowing disorder, is a common disease among the elders and stroke patients. Therefore, based on the bionic swallowing device (BSD) in vitro of similar human-tongue motion during swallowing, the development of functional food is necessary to improve the food swallowing quality of the deglutition disorders patients. In this study, the tongue motion was thoroughly investigated by extracting the characteristic data, and appropriate mechanisms in vitro were adopted to replicate the motion of the tongue swallowing according to the normal swallowing oropharyngeal data. The application of the BSD was also investigated at different swallowing grades (SGs). The study results indicated that the tongue motion consisted of tongue root point (TRP) and several tongue motor points (TMPs). The cam-link and push-rod mechanisms showed ellipse lines for TRP motion and straight lines for TMPs, respectively. Higher correlation coefficients between the tongue trajectories in the oropharyngeal data and simulated curves of the combined mechanism were observed. The average correlation coefficients between the tongue trajectories of patients at five SGs and those of the BSD were 0.87, proving its effectiveness and potential application. Furthermore, the corn-paste experiments of the BSD showed that dysphagia at five SGs could be a suitable choice for certain food concentrations. This will provide valuable insight into developing more functional foods in vitro for high deglutition disorders.
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Affiliation(s)
- Shanhua Qian
- School of Mechanical Engineering, Jiangnan University, Wuxi, Jiangsu, China.,Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Yue Wu
- School of Mechanical Engineering, Jiangnan University, Wuxi, Jiangsu, China
| | - Zhiyong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fugian, China
| | - Cheng Zhang
- School of Mechanical Engineering, Jiangnan University, Wuxi, Jiangsu, China
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jinghu Yu
- School of Mechanical Engineering, Jiangnan University, Wuxi, Jiangsu, China
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Jung S, Kim JS, Jang I, Kim H. Factors related to dysphagia-specific quality of life in aged patients with neurologic disorders: A cross-sectional study. Geriatr Nurs 2021; 43:159-166. [PMID: 34902750 DOI: 10.1016/j.gerinurse.2021.11.016] [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: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support-a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains-the subscales of dysphagia-specific quality of life-are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.
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Affiliation(s)
- Sujin Jung
- Department of Nursing, Seoul National University BORAMAE Medical Center, Seoul, Republic of Korea
| | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea.
| | - Insil Jang
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea
| | - Hyejin Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea
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Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res 2021; 2021:6650675. [PMID: 33936197 PMCID: PMC8056871 DOI: 10.1155/2021/6650675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.
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Nakato R, Manabe N, Hanayama K, Kusunoki H, Hata J, Haruma K. Diagnosis and treatments for oropharyngeal dysphagia: effects of capsaicin evaluated by newly developed ultrasonographic method. J Smooth Muscle Res 2020; 56:46-57. [PMID: 32581185 PMCID: PMC7324726 DOI: 10.1540/jsmr.56.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may
cause fatal complications such as aspiration pneumonia. However, there is no
established treatment for OD. The relationship between the transient receptor
potential vanilloid 1 (TRPV1) and substance P released by activated TRPV1 was
recently demonstrated. Further, there are several reports showing that
capsaicin, a specific agonist of TRPV1, can improve OD. Currently, the
evaluation of swallowing is mainly performed by videofluoroscopic examination.
However, there are no reports on the clinical application of ultrasonography
using tissue Doppler imaging. In this review, we describe the pathophysiology
and treatments for OD, introduce our novel US method to evaluate cervical
esophageal motility, and then outline our clinical study examining the effects
of capsaicin, a specific TRPV1 agonist, in older patients with OD.
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Affiliation(s)
- Rui Nakato
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroaki Kusunoki
- Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School, Kurashiki, Japan
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Abu-Ghanem S, Chen S, Amin MR. Oropharyngeal Dysphagia in the Elderly: Evaluation and Prevalence. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00258-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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13
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Abstract
PURPOSE OF REVIEW To present current literature regarding swallowing function in advanced age, including healthy ageing, dysphagia and trends in multidisciplinary team service delivery. RECENT FINDINGS Normative studies support swallowing efficiency but greater variability in healthy advanced age, through to 100 years old. Deviations from normative data and symptoms of dysphagia leading to aspiration or nutritional risk, imply swallowing disorder, rather than simply the ageing process. Quantitative and qualitative studies are emerging that promote management of swallow dysfunction for an ageing society, including innovative assessment, home treatment, swallowing exercise and optimized mealtimes. SUMMARY Current literature on swallowing function in advanced age provides multidisciplinary perspectives and initiatives, with clear commitment to improving quality of life for older adults. The diversity of the older population and serious consequences of swallowing difficulties calls for routine screening tools for swallowing impairment and malnutrition risk. Representation of 'oldest old' in future normative studies is essential to guide swallowing management in adults over 85 years old.
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14
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Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms. Curr Opin Otolaryngol Head Neck Surg 2018; 26:375-381. [PMID: 30234660 DOI: 10.1097/moo.0000000000000488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia. RECENT FINDINGS Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3-C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter. SUMMARY Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.
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Dantas RO, Cassiani RA, Santos CM, Alves LMT. WATER INGESTION DYNAMICS IN PATIENTS WITH ACHALASIA: INFLUENCE OF SEX AND AGE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:25-29. [PMID: 30184021 DOI: 10.1590/s0004-2803.201800000-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Achalasia is a disease that affects esophageal bolus transit due to the absence of esophageal peristaltic contractions and impaired or absent relaxation of the lower esophageal sphincter. OBJECTIVE The objective of this investigation was: a) to evaluate the dynamics of water ingestion in patients with achalasia, idiopathic or caused by Chagas' disease; b) to evaluate the influence of sex and age on water ingestion dynamics. METHODS The investigation was conducted with 79 patients with achalasia (27 idiopathic and 52 Chagas' disease) and 91 healthy volunteers, all evaluated by the water-drinking test. The individuals drank, in triplicate, 50 mL of water without interruption. The time and the number of swallows for this task were counted. We also measured: (a) inter-swallow interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing rate - volume drunk divided by the time; (c) volume per swallow - volume drunk divided by the number of swallows. RESULTS Patients with achalasia took longer to ingest all the volume (mean 12.2 seconds) than healthy controls (mean 5.4 seconds), had greater number of swallows, longer interval between swallows, lower swallowing rate (5.2 mL/s vs 10.9 mL/s in controls) and lower volume per swallow (9.1 mL vs 14.4 mL in controls, P<0.01). Among healthy volunteers, women had a shorter interval between swallows and lower volume per swallow compared with men, and in the achalasia group, women had a longer interval between swallows and lower ingestion rate. No difference in the drinking test results was found between younger and older subjects in achalasia or control group. Also, no differences were observed between patients with Chagas' disease and those with idiopathic achalasia, or between patients with increased and normal esophageal diameter. CONCLUSION Patients with achalasia have difficulty in ingesting water, taking a longer time to complete the task, which is influenced by sex but not by age or severity of the disease.
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Affiliation(s)
- Roberto Oliveira Dantas
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Rachel Aguiar Cassiani
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Carla Manfredi Santos
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Leda Maria Tavares Alves
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
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