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Hu X, Ma YN, Karako K, Tang W, Song P, Xia Y. Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects. Biosci Trends 2024; 18:116-126. [PMID: 38658363 DOI: 10.5582/bst.2024.01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.
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Affiliation(s)
- Xiqi Hu
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Ya-Nan Ma
- Department of Gastroenterology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Kenji Karako
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wei Tang
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Peipei Song
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Ying Xia
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Huang D, Schar M, Wu PI, Maclean J, Pandey D, Cock C, Omari T, Szczesniak MM. Development and validation of an electronic version of Sydney Swallow Questionnaire. Neurogastroenterol Motil 2024; 36:e14766. [PMID: 38396334 DOI: 10.1111/nmo.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND AIMS Accurate assessment of patient-reported oropharyngeal dysphagia (OPD) is essential to guide appropriate management and evaluate response. The Sydney Swallow Questionnaire (SSQ) is a paper-based 17-item inventory developed and validated to objectively detect risk of OPD. An easy-to-use electronic version with digital output has significant potential in streamlining patient assessment. This study aims to develop and validate an electronic version of the SSQ (eSSQ) against the original paper version. METHOD The English-based paper SSQ was adapted on the online REDcap (Research Electronic Data Capture) platform to be accessible on computer and mobile devices. Patients with OPD and asymptomatic controls completed both electronic and paper versions in randomized order. Patients with stable symptoms then repeated the eSSQ after ≥14 days for test-retest reliability. Paper-based and eSSQs were also collected from an independent cohort for external validation. Agreement of total scores between both versions and eSSQ test-retest reliability were calculated using two-way mixed-effects intra-class correlation coefficient (ICC). RESULTS 47 dysphagic patients, 32 controls, and 31 patients from an external validation cohort were recruited. The most common underlying etiology was head and neck cancer. Mean eSSQ total score was 789 in dysphagic patients, and 68 in controls. eSSQ had excellent agreement with paper SSQ in total scores among all participants, with ICC 0.97 (95% CI [0.93, 0.98]) in controls, 0.97 (95% CI [0.94, 0.98]) in dysphagic patients and 0.96 (95% CI [0.92, 0.98]) in validation cohort. Test-retest reliability was also excellent (ICC 0.96, 95% CI [0.90, 0.98]). CONCLUSION The newly developed eSSQ shows excellent agreement with the paper version and test-retest reliability. Future applications of its use may allow for more efficient and accessible patient assessment.
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Affiliation(s)
- Dazhong Huang
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Mistyka Schar
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Peter I Wu
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of NSW, Sydney, New South Wales, Australia
| | - Julia Maclean
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of NSW, Sydney, New South Wales, Australia
| | - Dheeraj Pandey
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of NSW, Sydney, New South Wales, Australia
| | - Charles Cock
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Taher Omari
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Michal M Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of NSW, Sydney, New South Wales, Australia
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Hossain MZ, Kitagawa J. Transient receptor potential channels as an emerging therapeutic target for oropharyngeal dysphagia. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:421-430. [PMID: 38022386 PMCID: PMC10665593 DOI: 10.1016/j.jdsr.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Oropharyngeal dysphagia is a serious health concern in older adults and patients with neurological disorders. Current oropharyngeal dysphagia management largely relies on compensatory strategies with limited efficacy. A long-term goal in swallowing/dysphagia-related research is the identification of pharmacological treatment strategies for oropharyngeal dysphagia. In recent decades, several pre-clinical and clinical studies have investigated the use of transient receptor potential (TRP) channels as a therapeutic target to facilitate swallowing. Various TRP channels are present in regions involved in the swallowing process. Animal studies have shown that local activation of these channels by their pharmacological agonists initiates swallowing reflexes; the number of reflexes increases when the dose of the agonist reaches a particular level. Clinical studies, including randomized clinical trials involving patients with oropharyngeal dysphagia, have demonstrated improved swallowing efficacy, safety, and physiology when TRP agonists are mixed with the food bolus. Additionally, there is evidence of plasticity development in swallowing-related neuronal networks in the brain upon TRP channel activation in peripheral swallowing-related regions. Thus, TRP channels have emerged as a promising target for the development of pharmacological treatments for oropharyngeal dysphagia.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
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Ambrus A, Rovó L, Sztanó B, Burián A, Molnár-Tóth A, Bach Á. [Introduction of fiberoptic endoscopic evaluation of swallowing and increase of the range of indications in our department]. Orv Hetil 2023; 164:1817-1823. [PMID: 37980634 DOI: 10.1556/650.2023.32912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/16/2023] [Indexed: 11/21/2023]
Abstract
Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.
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Affiliation(s)
- Andrea Ambrus
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - László Rovó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - Balázs Sztanó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - András Burián
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Pécs Magyarország
| | - Alinka Molnár-Tóth
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Neurológiai Klinika Szeged Magyarország
| | - Ádám Bach
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
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Alfaris A, Alamri GA, Kurdi AM, Mallisho A, Al Awaji N. Could Plummer-Vinson Syndrome Be Associated with Celiac Disease? Int Med Case Rep J 2023; 16:425-431. [PMID: 37501941 PMCID: PMC10370416 DOI: 10.2147/imcrj.s415775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
A 16-year-old female presented to our hospital clinic with a main complaint of difficulty swallowing. She reported mild dizziness and frequent fatigue and denied weight loss, fever, joint pain, or a history of diarrhea. Lab and physical results showed low weight; low hemoglobin, ferritin, and vitamin D levels; and a low red blood cell count. Swallowing assessment showed esophageal webs and swallowing difficulty, especially in the pharyngeal stage, and aspiration. It was initially suspected that clinical manifestations, including esophageal webs, iron deficiency anemia (IDA), and swallowing difficulty, were related to Plummer-Vinson syndrome (PVS). However, further investigations and pathological findings revealed several gastrointestinal manifestations consistent with celiac disease (CD). Based on this finding, the patient began a gluten-free diet for the management of CD. Afterward, she began to gain weight, followed by a resolution of swallowing difficulty. Therefore, clinicians should be familiar with the symptoms of CD when conducting a thorough clinical examination and maintain a high level of suspicion to rule out other causes and reach an accurate diagnosis. It is also recommended to screen all patients presenting with IDA, esophageal web, and dysphagia for CD even in the absence of diarrhea.
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Affiliation(s)
- Abdullah Alfaris
- Rehabilitation Department, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ghadi Awad Alamri
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amr Mohammed Kurdi
- Department of Internal Medicine and Critical Care, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ammar Mallisho
- Medical Imaging Department, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Nisreen Al Awaji
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases 2023; 11:2363-2373. [PMID: 37123321 PMCID: PMC10131003 DOI: 10.12998/wjcc.v11.i11.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.
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Affiliation(s)
- Hai-Yang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
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Hou L, Li Y, Wang J, Wang Y, Wang J, Hu G, Ding XR. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33153. [PMID: 36897733 PMCID: PMC9997834 DOI: 10.1097/md.0000000000033153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU). METHODS We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration's Revman 5.3 software. RESULTS A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU. CONCLUSION This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.
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Affiliation(s)
- Lingyu Hou
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Ying Li
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jianhua Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Yuqi Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jingchao Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - GuoJing Hu
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Xiao Rong Ding
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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Abstract
The upper gastrointestinal (GI) tract is frequently involved in systemic sclerosis (SSc) and may impact quality of life, physical function and survival. Although we are currently very proactive in terms of screening for heart and lung involvement, patients with SSc are not routinely screened for GI involvement. This review details the available investigations for common upper GI symptoms in SSc, including dysphagia, reflux and bloating and provides advice as to how to integrate these investigations into current clinical care.
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Nielsen AH, Eskildsen SJ, Danielsen J, Haastrup P, Jellinghof AB, Riis J, Krarup AL, Mortensen HR, Philipsen BB, Rommel N, Melgaard D. Defining dysphagia - a modified multi-professional Danish Delphi study. Scand J Gastroenterol 2022; 58:583-588. [PMID: 36476215 DOI: 10.1080/00365521.2022.2151850] [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] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To establish a generally accepted Danish definition of dysphagia to enhance collaboration across sectors and professions. METHODS The study was initiated by a multi-professional group of experienced researchers and board members of the Danish Society for Dysphagia. We used a modified Delphi methodology to achieve consensus among experienced health care professionals from different professions and contexts. The initial stage consisted of a literature search leading to the draft of different definitions followed by two Delphi rounds between professionals and a stakeholder consultation round. RESULTS We conducted two Delphi rounds until one definition was clearly preferred. A total of 194 participants responded in round one, and 279 in round two. Both rounds had a broad representation of sectors and geography and most participants had worked with dysphagia for more than four years. CONCLUSION The preferred definition was 'Dysphagia is a functional impairment that either prevents or limits the intake of food and fluids, and which makes swallowing unsafe, inefficient, uncomfortable or affects quality of life'. The definition was widely accepted among different health professional groups, patients and across sectors.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark.,Institute for Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark.,Faculty of Health, Aarhus University, Aarhus C, Denmark
| | - Janne Danielsen
- Department of Health & Care, Aarhus Municipality, Aarhus N, Denmark
| | - Peter Haastrup
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark. J.B, Odense C, Denmark
| | | | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Anne Lund Krarup
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Aalborg, Denmark
| | - Hanna Rahbek Mortensen
- Danish Center of Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | | | - Nathalie Rommel
- Ear Nose Throat Head & Neck surgery - Gastroenterology (Neurogastroenterology & Motility), Faculty of Medicine, Neurosciences, Experimental Otorhinolaryngology, Deglutology - University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Dorte Melgaard
- Department of Clinical Medicine and Centre for Clinical Research, Aalborg University and North Denmark Regional Hospital, Hjoerring, Denmark
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Jin S, Lee W, Nam HJ, Kim K. Intra-oral acupuncture treatment for chronic aspiration after esophageal cancer surgery: a case report. Acupunct Med 2022; 41:110-111. [PMID: 36433738 DOI: 10.1177/09645284221125249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- SunKyung Jin
- Department of Clinical Korean Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - WooJeong Lee
- Cosoom Korean Medical Clinic, Seoul, Republic of Korea
| | - Hae Jeong Nam
- Department of Clinical Korean Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyuseok Kim
- Department of Clinical Korean Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Atar S, Atar Y, Ilgin C, Uygan U, Demirhan E, Anarat MEA, Tutar B, Sari H, Berkiten G, Kuru Ö. Validity and Reliability of the Turkish Version of the Sydney Swallow Questionnaire. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1726-1735. [PMID: 35549458 DOI: 10.1044/2022_ajslp-21-00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to assess the validity and reliability of the Turkish version of the Sydney Swallow Questionnaire (SSQ-T) and calculate a cutoff value to help clinicians to suspect/predict oropharyngeal dysphagia (OPD). METHOD The original questionnaire was translated into Turkish by two bilingual English Turkish translators. The study included 170 Turkish adult subjects. Half of the participants were patients presenting with OPD, and half were healthy controls. Fiberoptic endoscopic evaluation of swallowing (FEES) was administered to all subjects. Patients were evaluated using the Turkish Penetration Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale. Additionally, the final version of the SSQ-T questionnaire and the Turkish Eating Assessment Tool were administered to all subjects. RESULTS Internal consistency was high on all questions (Cronbach's α = .974). Test-retest reliability was also high (intraclass correlation coefficient = .975, p < .001; 95% confidence interval [.948-.988]). The SSQ-T score range was 0-1,240 for all participants, 57-1,240 for the patients with OPD, and 0-152 for the healthy controls. The cutoff value was 174 with 85.96% sensitivity and 99.12% specificity. CONCLUSION The SSQ-T was demonstrated to be a valid and reliable assessment to assess the self-perceived severity of OPD.
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Affiliation(s)
- Sevgi Atar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Department of Otorhinolaryngology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Can Ilgin
- Infectious Diseases and Environmental Health Division, Sirnak Province Health Directory, Turkey
| | - Ugur Uygan
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Esma Demirhan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Belgin Tutar
- Göktürk Florence Nightingale Medical Centre, Istanbul, Turkey
| | - Hüseyin Sari
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Güler Berkiten
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ömer Kuru
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Ng ML, Lui HY. Rice congee as an alternative to thickened liquids for patients with swallowing disorders. J Texture Stud 2022; 53:405-416. [PMID: 35255166 DOI: 10.1111/jtxs.12673] [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: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Seeing the popularity of rice congee consumption among Asian families, the present study examined the possibility of preparing thickened liquids from rice congee of different consistency levels that are commonly prescribed for individuals with swallowing disorders. METHODS The two most common rice varieties in Hong Kong, indica and japonica rice grains, were used to prepare rice congee from which thickened liquids were extracted. By varying the water-to-rice ratio, cooking time, optional reheating on a frying pan, and temperature, slightly thick, mildly thick, moderately thick, and extremely thick liquids were obtained. RESULTS Recipes for extracting thickened liquids of different consistencies from rice congee cooked with indica and japonica rice grains were established. The consistency levels were defined with reference to although not strictly following the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Results revealed that the consistency of the product varied with water-to-rice ratio, cooking time and temperature. CONCLUSION Recipes were established for preparing thickened liquids using rice grains at both serving and room temperatures. Findings support that thickened liquids so obtained can be used as an alternative to thickened liquids preparing using commercial thickeners.
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Affiliation(s)
- Manwa L Ng
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Hoi Ying Lui
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
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Schwartz R, Khalifa Y, Lucatorto E, Perera S, Coyle J, Sejdic E. A Preliminary Investigation of Similarities of High Resolution Cervical Auscultation Signals Between Thin Liquid Barium and Water Swallows. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:4900109. [PMID: 34963825 PMCID: PMC8694539 DOI: 10.1109/jtehm.2021.3134926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/27/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022]
Abstract
Dysphagia, commonly referred to as abnormal swallowing, affects millions of people annually. If not diagnosed expeditiously, dysphagia can lead to more severe complications, such as pneumonia, nutritional deficiency, and dehydration. Bedside screening is the first step of dysphagia characterization and is usually based on pass/fail tests in which a nurse observes the patient performing water swallows to look for dysphagia overt signs such as coughing. Though quick and convenient, bedside screening only provides low-level judgment of impairment, lacks standardization, and suffers from subjectivity. Recently, high resolution cervical auscultation (HRCA) has been investigated as a less expensive and non-invasive method to diagnose dysphagia. It has shown strong preliminary evidence of its effectiveness in penetration-aspiration detection as well as multiple swallow kinematics. HRCA signals have traditionally been collected and investigated in conjunction with videofluoroscopy exams which are performed using barium boluses including thin liquid. An HRCA-based bedside screening is highly desirable to expedite the initial dysphagia diagnosis and overcome all the drawbacks of the current pass/fail screening tests. However, all research conducted for using HRCA in dysphagia is based on thin liquid barium boluses and thus not guaranteed to provide valid results for water boluses used in bedside screening. If HRCA signals show no significant differences between water and thin liquid barium boluses, then the same algorithms developed on thin liquid barium boluses used in diagnostic imaging studies, it can be then directly used with water boluses. This study investigates the similarities and differences between HRCA signals from thin liquid barium swallows compared to those signals from water swallows. Multiple features from the time, frequency, time-frequency, and information-theoretic domain were extracted from each type of swallow and a group of linear mixed models was tested to determine the significance of differences. Machine learning classifiers were fit to the data as well to determine if the swallowed material (thin liquid barium or water) can be correctly predicted from an unlabeled set of HRCA signals. The results demonstrated that there is no systematic difference between the HRCA signals of thin liquid barium swallows and water swallows. While no systematic difference was discovered, the evidence of complete conformity between HRCA signals of both materials was inconclusive. These results must be validated further to confirm conformity between the HRCA signals of thin liquid barium swallows and water swallows.
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Affiliation(s)
- Ryan Schwartz
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - Yassin Khalifa
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - Erin Lucatorto
- Department of Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA 15260 USA
| | - Subashan Perera
- Division of Geriatric MedicineDepartment of MedicineUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - James Coyle
- Department of Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA 15260 USA
| | - Ervin Sejdic
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
- The Edward S. Rogers Department of Electrical and Computer EngineeringFaculty of Applied Science and EngineeringUniversity of Toronto Toronto ON M5S 2E4 Canada
- North York General Hospital Toronto ON M2K 1E1 Canada
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14
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Mari A, Abu Baker F, Said Ahmad H, Omari A, Jawabreh Y, Abboud R, Shahin A, Shibli F, Sbeit W, Khoury T. The Yield of Endoscopy and Histology in the Evaluation of Esophageal Dysphagia: Two Referral Centers’ Experiences. Medicina (B Aires) 2021; 57:medicina57121336. [PMID: 34946281 PMCID: PMC8705225 DOI: 10.3390/medicina57121336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The initial diagnostic test required to evaluate esophageal dysphagia is upper endoscopy (EGD) to assess the structure of the esophagus and the esophageo-gastric junction (EGJ). Taking biopsies during EGD has become a common practice in patients with dysphagia to rule out eosinophilic esophagitis (EoE). The aims of this study were to evaluate the endoscopic findings of patients who underwent EGD for esophageal dysphagia, to assess the rate of biopsy taking from the esophagus to diagnose/exclude EoE, and to report histology outcomes of these biopsies. Materials and Methods: This was a retrospective multicenter study that included individuals ≥18 years who underwent EGD due to esophageal dysphagia between the years 2015 and2020, (with no other alarm signs, such as weight loss, new iron deficiency anemia, and lymphadenopathy). We obtained data from patients’ electronic files. The endoscopy and histology findings were obtained from endoscopy reports saved in our electronic files. Results: A total of 209 patients were included in the study. The average age was 57.1 ± 17.1 years. The most common endoscopic findings were normal endoscopy in 76 patients (36.4%) and erosive esophagitis in 75 patients (35.9%). Barrett’s esophagus and esophageal malignancy were encountered in 11 patients (5.3%) and 2 patients (0.95%), respectively. Esophageal biopsies were taken in 50.2% of patients, and one patient had histological evidence of EoE (0.5%). On univariate analysis, there was a trend for association between proton pump inhibitors (PPIs) use and a normal EGD, but it was not statistically significant (OR 0.28, 95% CI 0.07–1.11, p = 0.07). Conclusions: Endoscopic findings were prevalent in dysphagia patients even when no other alarm symptoms exist. Neoplastic lesions and EOE were rare in our study.
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Affiliation(s)
- Amir Mari
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth 16100, Israel;
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; (A.S.); (W.S.); (T.K.)
- Correspondence: ; Tel.: +972-0-54214-2070
| | - Fadi Abu Baker
- Department of Gastroenterology, Hillel Yaffe Medical Center, Hadera 38100, Israel;
| | - Helal Said Ahmad
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth 16100, Israel;
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; (A.S.); (W.S.); (T.K.)
| | - Ali Omari
- Internal Medicine Department, The Nazareth Hospital, EMMS, Nazareth 16100, Israel; (A.O.); (Y.J.)
| | - Yazed Jawabreh
- Internal Medicine Department, The Nazareth Hospital, EMMS, Nazareth 16100, Israel; (A.O.); (Y.J.)
| | - Rand Abboud
- Surgery Department, The Nazareth Hospital, EMMS, Nazareth 16100, Israel;
| | - Amir Shahin
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; (A.S.); (W.S.); (T.K.)
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
| | - Fahmi Shibli
- Department of Gastroenterology and Liver Disease, Emek Medical Center, Afula 1855701, Israel;
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 38100, Israel
| | - Wisam Sbeit
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; (A.S.); (W.S.); (T.K.)
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
| | - Tawfik Khoury
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; (A.S.); (W.S.); (T.K.)
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
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15
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Newberry C, Lynch K. Using Diet to Treat Diseases of Esophagus: Back to the Basics. Gastroenterol Clin North Am 2021; 50:959-972. [PMID: 34717881 DOI: 10.1016/j.gtc.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The esophagus plays a crucial role in oral nutrition and digestive pathophysiology. In addition, diet is now considered an important primary or augmentative therapy in several esophageal disease states. This review highlights common dietary therapies used in treating diseases of the esophagus as well as the underlying data that support such practices. Specially, diet and its relationship to swallowing dysfunction, motility disorders, malignancies, and inflammatory mucosal diseases such as gastroesophageal reflux disease and eosinophilic esophagitis is explored.
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Affiliation(s)
- Carolyn Newberry
- Division of Gastroenterology, Weill Cornell Medical Center, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - Kristle Lynch
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 7th Floor, South Tower, Philadelphia, PA 19104, USA.
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16
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Abstract
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
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Affiliation(s)
- E Berryhill McCarty
- Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street #500, Pittsburgh, PA 15213, USA
| | - Tiffany N Chao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
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17
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Hsiao MY, Wu CH, Wang TG. Emerging Role of Ultrasound in Dysphagia Assessment and Intervention: A Narrative Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:708102. [PMID: 36188819 PMCID: PMC9397709 DOI: 10.3389/fresc.2021.708102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022]
Abstract
Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the evaluation of oropharyngeal structures and movement. Yet, a universal consensus on the examination protocols and clinical implications remains to be established. This review aimed to provide a brief introduction of the application of ultrasound in dysphagia assessment and intervention, encompassing the ultrasonography of swallowing-related muscles, tongue movement, and hyolaryngeal excursion, as well as ultrasound-guided interventions in the management of dysphagia. In addition to non-invasiveness, ultrasonography, a portable, easy to use, and low-cost technique, could compliment videofluoroscopic swallowing study as a first-line screening and follow-up tool for the evaluation of swallowing function, although further study is warranted to provide quantitative diagnostic and prognostic values. Finally, ultrasonography aids in the precisely targeted injection of botulinum toxin in patients exhibiting oropharyngeal muscle spasticity.
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Affiliation(s)
- Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-chu Branch, Hsinchu, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Tyng-Guey Wang
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18
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Honnens de Lichtenberg Broge E, Wendin K, Hyldig G, Bredie WLP. Development of an olfactory test method for measuring perception of everyday food odors among older adults. J SENS STUD 2021. [DOI: 10.1111/joss.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eva Honnens de Lichtenberg Broge
- Department of Food Science, Section for Food Design and Consumer Behaviour, Future Consumer Lab University of Copenhagen Frederiksberg Denmark
| | - Karin Wendin
- Department of Food Science, Section for Food Design and Consumer Behaviour, Future Consumer Lab University of Copenhagen Frederiksberg Denmark
- Department of Food and Meal Science Kristianstad University Kristianstad Sweden
| | - Grethe Hyldig
- Division of Food Technology, National Food Institute Technical University of Denmark Lyngby Denmark
| | - Wender L. P. Bredie
- Department of Food Science, Section for Food Design and Consumer Behaviour, Future Consumer Lab University of Copenhagen Frederiksberg Denmark
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19
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Selvanderan S, Wong S, Holloway R, Kuo P. Dysphagia: clinical evaluation and management. Intern Med J 2021; 51:1021-1027. [PMID: 34278699 DOI: 10.1111/imj.15409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Dysphagia is a common problem affecting all ages. It is increasing in frequency particularly among the younger population due to the rising incidence of eosinophilic oesophagitis, a condition which often leads to acute presentation to hospital for the first time with food bolus obstruction requiring endoscopic removal. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus oesophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined by the eventual diagnosis, often in a multi-disciplinary setting.
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Affiliation(s)
- Shane Selvanderan
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephanie Wong
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Richard Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul Kuo
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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20
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Castejón-Hernández S, Latorre-Vallbona N, Molist-Brunet N, Cubí-Montanyà D, Espaulella-Panicot J. Association between anticholinergic burden and oropharyngeal dysphagia among hospitalized older adults. Aging Clin Exp Res 2021; 33:1981-1985. [PMID: 32949383 DOI: 10.1007/s40520-020-01707-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/01/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia is an emerging age-related disorder that affects 23% of inpatients leading to malnutrition, dehydration, or aspiration pneumonia. Anticholinergic drugs can cause reduced peristalsis and dry mouth, both related to dysphagia. AIM To determine the association between anticholinergic burden and oropharyngeal dysphagia in older inpatients. METHODS Retrospective descriptive observational study. There are 239 patients. Dysphagia diagnosis based on routine volume-viscosity swallow test. Characteristics: age, functional loss (instrumental and basic activities), frailty (Frail-VIG-Index), geriatric syndromes, polypharmacy, and anticholinergic-cognitive-burden scale at admission. RESULTS 25.5% of elderly patients diagnosed with dysphagia are more dependent and frailer than non-dysphagic patients. 83.6% scored ≥ 3 points on the ACB Scale [odds ratio: 4.46 (2.13-9.33)], which is statistically associated with dysphagia (p < 0.001). CONCLUSION Patients with an ACB of ≥ 3 points at admission are more than four times as likely to develop oropharyngeal dysphagia. Evaluating anticholinergic burden routinely should be considered and, whenever possible, reduce it.
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Affiliation(s)
- Santiago Castejón-Hernández
- Acute Geriatric Unit (AGU), Geriatric Department, Hospital Universitari de Vic, Vic, Barcelona, Spain.
- Geriatric Department, Hospital Universitari de La Santa Creu, Vic, Barcelona, Spain.
- Santiago Castejón-Hernández, Rambla del Hospital, 52, 08500, Vic, Barcelona, Spain.
| | - Nadina Latorre-Vallbona
- Acute Geriatric Unit (AGU), Geriatric Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
- Geriatric Department, Hospital Universitari de La Santa Creu, Vic, Barcelona, Spain
| | - Núria Molist-Brunet
- Acute Geriatric Unit (AGU), Geriatric Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
- Geriatric Department, Hospital Universitari de La Santa Creu, Vic, Barcelona, Spain
| | - Dolors Cubí-Montanyà
- Acute Geriatric Unit (AGU), Geriatric Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
- Geriatric Department, Hospital Universitari de La Santa Creu, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Acute Geriatric Unit (AGU), Geriatric Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
- Geriatric Department, Hospital Universitari de La Santa Creu, Vic, Barcelona, Spain
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21
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Kim HN, Kim JY. A Systematic Review of Oropharyngeal Dysphagia Models in Rodents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094987. [PMID: 34067192 PMCID: PMC8125817 DOI: 10.3390/ijerph18094987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea;
| | - Ji-Youn Kim
- Department of Dental Hygiene, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4376
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22
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Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis. Dysphagia 2021; 37:21-27. [PMID: 33580368 DOI: 10.1007/s00455-021-10245-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing-remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.
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23
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Mohammadi S, Dolatshahi M, Rahmani F. Shedding light on thyroid hormone disorders and Parkinson disease pathology: mechanisms and risk factors. J Endocrinol Invest 2021; 44:1-13. [PMID: 32500445 DOI: 10.1007/s40618-020-01314-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons. Dopaminergic system is interconnected with the hypothalamic-pituitary-thyroid axis. Dopamine (DA) upregulates thyrotropin releasing hormone (TRH) while downregulating thyroid stimulating hormone (TSH) and thyroid hormones. Moreover, TRH stimulates DA release. PD is associated with impaired regulation of TSH and thyroid hormones (TH) levels, which in turn associate with severity and different subtypes of PD, while levodopa and bromocriptine treatment can interfere with hypothalamic-pituitary-thyroid axis. Thyroid disturbances, including hypothyroidism, Hashimoto's thyroiditis (HT), hyperthyroidism and Graves' disease (GD) not only increase the risk of PD but also share some clinical signs with PD. Also, several genes including RASD2, WSB1, MAPT, GIRK2, LRRK2 and gene products like neurotensin and NOX/DUOX affect the risk for both PD and thyroid disease. Hypothyroidism is associated with obesity, hypercholesterolemia, anemia and altered cerebral blood flow which are associated with PD pathology. Herein we provide a comprehensive view on the association between PD and thyroid hormones regulation and dysregulations, hoping to provide new avenues towards targeted treatment of PD. We performed a comprehensive search in literature using Pubmed and Scopus, yielding to a total number of 36 original articles that had addressed the association between thyroid hormone disorders and PD.
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Affiliation(s)
- S Mohammadi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - M Dolatshahi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - F Rahmani
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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24
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Cock C, Omari TI, Burgstad CM, Thompson A, Doeltgen SH. Biomechanical correlates of sequential drinking behavior in aging. Neurogastroenterol Motil 2021; 33:e13945. [PMID: 32666615 DOI: 10.1111/nmo.13945] [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: 05/02/2020] [Revised: 06/13/2020] [Accepted: 06/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The timed water swallow test (TWST) is a test of sequential swallowing where a measured volume is ingested as quickly as comfortably possible. We undertook a study of the biomechanics underpinning the TWST in healthy young and older participants. METHODS Thirty healthy volunteers underwent high-resolution impedance manometry (MMS; Unisensor, 2.7 mm diameter, 32 pressure sensors, 16 impedance segments). Participants were asked to drink 150 mL, 0.9% normal saline solution rapidly. Swallowing biomechanics and bolus flow characteristics were assessed using pressure-flow analysis and compared using t test and Fisher's exact test with significance as P < .05. KEY RESULTS Older participants (n = 18; 76 ± 11 years) took longer to complete the TWST (21.2 ± 2.5 vs 9.2 ± 1.0 seconds; P < .001) and displayed reduced volume per swallow (16.6 ± 1.3 vs 27.8 ± 2.9 mL; P < .001) compared to younger participants (n = 12; 29 ± 5 years). Two distinctive pharyngeal swallowing patterns were observed: (a) a single rapid sequence of swallows with or without a clearing swallow (Pattern I) or (b) multiple, shorter sequences interrupted and/or interspersed with single swallows or breaks (Pattern II). Some older participants showed biomechanical evidence of upper esophageal sphincter restriction (n = 7) or impaired deglutitive inhibition (n = 7), associated with the more prolonged Pattern II (TWST duration 30.1 ± 1.5 vs Pattern I 11.9 ± 1.5 seconds; P < .001). CONCLUSIONS AND INFERENCES Healthy older participants had an increased duration of TWST, suggesting a need to adapt normative values for this population. Rapid sequential swallowing was associated with evidence of UES restriction and impaired deglutitive inhibition in some older participants.
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Affiliation(s)
- Charles Cock
- Department of Gastroenterology & Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Taher I Omari
- Department of Gastroenterology & Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Carly M Burgstad
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Alison Thompson
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Sebastian H Doeltgen
- Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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25
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Prevalence of Swallowing and Eating Difficulties in an Elderly Postoperative Hip Fracture Population-A Multi-Center-Based Pilot Study. Geriatrics (Basel) 2020; 5:geriatrics5030052. [PMID: 32947876 PMCID: PMC7555319 DOI: 10.3390/geriatrics5030052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Elderly patients operated for hip fracture are characterized by high age and high degree of comorbidity and need of care, factors previously found to be associated with swallowing and eating difficulties. The aim of this study was to investigate the prevalence of swallowing and eating difficulties in an elderly postoperative hip fracture population and to identify factors associated with swallowing and eating difficulties. A cross-sectional multi-center pilot study was performed, including patients ≥65 years, operated for hip fracture, and able to participate in a swallowing and eating assessment. A clinical assessment was conducted using Danish versions of the standardized tools Volume-Viscosity Swallow Test and Minimal Eating Observation Form-version II. Demographic data and clinical characteristics were examined. A total of 78 patients (mean age 81.4 years (SD 7.8), 30.8% male) were included. Swallowing and eating difficulties were present in 60 patients (77%). Swallowing and eating difficulties were significantly associated with living in a nursing home before hospital admission (p = 0.014), low habitual New Mobility Score (p = 0.018), and absence of cardiac comorbidity (p = 0.023). The results underline the importance of focusing on swallowing and eating difficulties in elderly patients operated for hip fracture to ensure effectivity and safety and optimize the prognosis for the patient.
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Levy AD, Carucci LR, Bartel TB, Cash BD, Chang KJ, Feig BW, Fowler KJ, Garcia EM, Kambadakone AR, Lambert DL, Marin D, Moreno C, Peterson CM, Scheirey CD, Smith MP, Weinstein S, Kim DH. ACR Appropriateness Criteria ® Dysphagia. J Am Coll Radiol 2020; 16:S104-S115. [PMID: 31054737 DOI: 10.1016/j.jacr.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/18/2022]
Abstract
This review summarizes the relevant literature for the initial imaging of patients with symptoms of dysphagia. For patients with oropharyngeal dysphagia who have an underlying attributable cause, a modified barium swallow is usually appropriate for initial imaging but for those who have unexplained dysphagia a fluoroscopic biphasic esophagram is usually appropriate. Fluoroscopic biphasic esophagram is usually appropriate for initial imaging in both immunocompetent and immunocompromised patients who have retrosternal dysphagia. For postoperative patients with dysphagia, fluoroscopic single-contrast esophagram and CT neck and chest with intravenous (IV) contrast are usually appropriate for oropharyngeal or retrosternal dysphagia occurring in the early postoperative period where water-soluble contrast is usually preferred rather than barium sulfate. In the later postoperative period (greater than 1 month), CT neck and chest with IV contrast and fluoroscopic single-contrast esophagram are usually appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | - Brooks D Cash
- University of Texas McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | - Barry W Feig
- The University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
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Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
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Lo KB, Albano J, Sandhu N, Candelario N. Plummer-Vinson syndrome: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2019; 12:471-477. [PMID: 31417270 PMCID: PMC6593774 DOI: 10.2147/jmdh.s180410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022] Open
Abstract
Plummer-Vinson syndrome is a rare condition associated with dysphagia, iron deficiency, and esophageal webs. Data regarding this condition is limited to mostly case reports and a few small cohort studies. Although most cases have a benign and indolent course, the risk of malignancy warrants long-term surveillance. A multidisciplinary approach among healthcare providers is of the utmost importance in the management of this condition.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jeri Albano
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Naemat Sandhu
- Department of Gastroenterology and Hepatology, Einstein Medical Center, Philadelphia, PA, USA
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Cousins O, Girelli E, Harikrishnan S. Neuromyelitis optica: an elusive cause of dysphagia. BMJ Case Rep 2019; 12:12/1/bcr-2018-227041. [PMID: 30642856 DOI: 10.1136/bcr-2018-227041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare neurological condition infrequently associated with dysphagia on initial presentation. We describe the case of a 54-year-old woman who presented multiple times to healthcare professionals with severe vomiting, followed by sudden profound dysphagia. Her diagnosis was elusive, initially attributed to achalasia cardia and subsequently to stroke. A dorsal medullary lesion was revealed on MRI of the brain, which involved and extended beyond the area postrema. The patient required percutaneous gastrostomy, and repeated aspiration pneumonia complicated her clinical course. After aquaporin-4 antibodies returned positive, a diagnosis of NMOSD was made and she improved with immunosuppression. We discuss the process of lesion localisation and aetiology determination, as well as the difficulties that this case presented. Our hope is that this report will facilitate earlier diagnosis in similar cases in the future.
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Affiliation(s)
- Oliver Cousins
- Department of Neurology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Elena Girelli
- Faculty of Life Sciences and Medicine, King's College London School of Medical Education, London, UK
| | - Sreedharan Harikrishnan
- Department of Neurology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK.,Department of Neurology, King's College London School of Medical Education, London, UK
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Helldén J, Bergström L, Karlsson S. Experiences of living with persisting post-stroke dysphagia and of dysphagia management - a qualitative study. Int J Qual Stud Health Well-being 2019; 13:1522194. [PMID: 30257150 PMCID: PMC6442869 DOI: 10.1080/17482631.2018.1522194] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate people's experiences of living with dysphagia after stroke, and their experiences of dysphagia management. METHODS The study design was qualitative, and an open-ended approach to data collection was used, with follow-up probing questions to gain more information as needed. Personal interviews were conducted with five persons who had persisting moderate to severe dysphagia after stroke, living in the south-west part of Sweden. The data were analysed with qualitative content analysis. RESULTS When analysing the data, the following theme emerged; "Dysphagia impacts life situations negatively and requires individually adapted, long term support from skilled health care professionals". The theme consists of three categories: "Learning to manage dysphagia and its complications", "Professional support with dysphagia varies" and "Finding small moments of joy despite large restrictions in life situations". CONCLUSIONS Findings indicated that people with dysphagia experienced a lack of support from health care professionals. Better health care support following discharge from hospital is required to ensure an optimal quality of life. Actions to achieve this may include developing national guidelines for adequate dysphagia follow-up and establishing multidisciplinary dysphagia teams in hospitals and long-term care facilities.
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Affiliation(s)
- Josefin Helldén
- a Department of Health Sciences , Lund University , Sweden , Lund.,b Geriatric and rehabilitation clinic , Kungälv Hospital , Kungälv , Sweden
| | - Liza Bergström
- c Department of Speech and Language Pathology , University of Gothenburg , Gothenburg , Sweden
| | - Staffan Karlsson
- a Department of Health Sciences , Lund University , Sweden , Lund.,d Sweden School of Health and Welfare , Halmstad University , Halmstad , Sweden
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Souza LF, Nascimento WV, Alves LMT, Silva ACV, Cassiani RA, Alves DC, Dantas RO. Medication swallowing difficulties in people without dysphagia. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/20192140119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to assess the difficulty in swallowing medications and correlate it with age and gender in healthy adults and elderly. Methods: a total of 439 asymptomatic healthy volunteers (270 females and 169 males), who were not taking any medication on a regular basis, aged from 20 to 84 years, were questioned as for dysphagia, by using the Eating Assessment Tool (EAT-10). Question number five of the EAT-10, specifically, approached the difficulty in swallowing drugs, considering zero as “no swallowing problem” and 1 to 4 as “some degree of difficulty” (4 as great difficulty).The chi-square test (x2) was used for the statistical analysis. Results: a total of 365 (83%) volunteers reported having no difficulty in swallowing medications (89% of men and 80% of women), whereas 74 (17%) reported some degree of difficulty (11% of men and 20% of women)(p = 0.01). These represented 20% of those aged between 20 and 49, and 9% of those aged 50 and over (p = 0.02). Conclusion: in this study, it was observed that both age and gender influence on medication swallowing, a difficulty more frequent among women and young adults. Some degree of difficulty was reported by 17% of the volunteers.
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Jackson AS, Aye RW. Endoscopic Approaches to Cricopharyngeal Myotomy and Pyloromyotomy. Thorac Surg Clin 2018; 28:507-520. [DOI: 10.1016/j.thorsurg.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cock C, Omari T. Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years). Geriatrics (Basel) 2018; 3:geriatrics3040067. [PMID: 31011102 PMCID: PMC6371098 DOI: 10.3390/geriatrics3040067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/15/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.
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Affiliation(s)
- Charles Cock
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
| | - Taher Omari
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
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Schar M, Woods C, Ooi EH, Athanasiadis T, Ferris L, Szczesniak MM, Cock C, Omari T. Pathophysiology of swallowing following oropharyngeal surgery for obstructive sleep apnea syndrome. Neurogastroenterol Motil 2018; 30:e13277. [PMID: 29266554 DOI: 10.1111/nmo.13277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Uvulopalatopharyngoplasty (UPPP) and coblation channeling of the tongue (CCT) are oropharyngeal surgeries used to treat obstructive sleep apnea syndrome. The extent to which UPPP and CCT affect pharyngeal swallow has not been determined. We therefore conducted a novel case series study employing high-resolution impedance manometry (HRIM) to quantify the swallowing-related biomechanics following UPPP and/or CCT surgery. METHODS Twelve patients who underwent UPPP+CCT or CCT only were assessed an average 2.5 years postsurgery. Swallow function data were compared with ten healthy controls. All patients completed the Sydney swallow questionnaire (SSQ). Pharyngeal pressure-flow analysis of HRIM recordings captured key distension, contractility and pressure-flow timing swallow parameters testing 5, 10, and 20 mL volumes of thin and thick fluid consistencies. KEY RESULTS Postoperative patients had more dysphagia symptoms with five returning abnormal SSQ scores. Swallowing was biomechanically altered compared to controls, consistent with diminished swallowing reserve, largely driven by elevated hypopharyngeal intrabolus pressure due to a reduced capacity to open the upper esophageal sphincter to accommodate larger volumes. CONCLUSIONS & INFERENCES Patients who have undergone UPPP and/or CCT surgery appear to have a deficiency in normal modulation of the swallowing mechanism and a reduced swallowing functional reserve. We speculate that these changes may become relevant in later life with the onset of age-related stressors to the swallowing mechanism. This case series strikes a note of caution that further studies are needed to determine the role of preoperative swallow assessment in patients undergoing UPPP and/or CCT surgery.
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Affiliation(s)
- M Schar
- Speech Pathology, Flinders Medical Centre, Adelaide, SA, Australia
| | - C Woods
- Otolaryngology, Head & Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - E H Ooi
- Otolaryngology, Head & Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia.,Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - T Athanasiadis
- Otolaryngology, Head & Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia.,Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - L Ferris
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Centre for Neuroscience, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - M M Szczesniak
- Department of Gastroenterology & Hepatology, St George Clinical School University of New South Wales, Sydney, NSW, Australia
| | - C Cock
- Department of Gastroenterology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - T Omari
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Centre for Neuroscience, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Gastroenterology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Okkels SL, Saxosen M, Bügel S, Olsen A, Klausen TW, Beck AM. Acceptance of texture-modified in-between-meals among old adults with dysphagia. Clin Nutr ESPEN 2018; 25:126-132. [PMID: 29779807 DOI: 10.1016/j.clnesp.2018.03.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS Old adults suffering from dysphagia have difficulties swallowing, chewing and/or eating, and are therefore at high risk of undernutrition. In-between-meals that are texture modified are of particular importance for people suffering from dysphagia. To meet their adequate daily amount of food intake they are recommended to eat 3-5 in-between-meals daily. The aim of the current pilot study was to identify the most liked in-between-meals for old adults based on flavour and describe the basic sensory properties of these in-between-meals. Following, the equality between flavour and appearance-based preferences was investigated. METHODS From three nursing homes 30 old adults aged 70 years or older suffering from dysphagia were recruited. They were assessing 20 texture modified in-between-meals based on their flavour and appearance on a 3 point hedonic scale. RESULTS When participants were asked to assign liking based on flavour, the most liked in-between-meals were frozen, cold and sweet (vanilla ice cream, strawberry parfait and panna cotta). These meals were among the in-between-meals richest in fat and energy. Liking based on flavour and appearance was equal in 18 out of 20 samples. Furthermore, nutritional and sensory characteristics of the preferred meals were described. CONCLUSION Flavour and sensory-based ranking of in-between-meals opens the possibility to design new in-between-meals to old adults with dysphagia, by choosing the most liked in-between-meals to offer the target group.
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Affiliation(s)
- S L Okkels
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - M Saxosen
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark
| | - S Bügel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark
| | - A Olsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark
| | - T W Klausen
- Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - A M Beck
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark; Metropolitan University, Faculty of Health and Technology, Department of Nutrition and Midwifery, Copenhagen, Denmark
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Difficulties in thickened water ingestion in healthy subjects. Clin Nutr ESPEN 2018; 22:107-111. [PMID: 29415826 DOI: 10.1016/j.clnesp.2017.07.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/04/2017] [Accepted: 07/31/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND For some patients with dysphagia who have airway aspiration, it is not possible to drink water as a thin liquid, as they need their water to be thickened. OBJECTIVE To evaluate in healthy volunteers the difficulties and dynamics of ingestion of thickened water. METHOD In 94 healthy volunteers aged 18-67 years, the ingestion of 100 mL of water with consistencies of thin liquid and thickened with 1.2 g (nectar-thick), 2.4 g (honey-thick) and 3.6 g (pudding-thick) of a commercial thickener with maltodextrin, xanthan gum and potassium chloride was evaluated. The volunteers drank in a random sequence 100 mL of each consistency. The duration and the number of swallows to drink the volume were measured. The interval between swallows, the flux of ingestion and the volume of each swallow were calculated. After each test, the individual was asked about the sensation during drinking, with ten as the best sensation and zero as the worst sensation, and about the difficulty to swallow each consistency. STATISTICAL ANALYSIS The analysis was done using a linear model with mixed effects. RESULTS The time to ingest the volume increased (liquid: 5.8 s; nectar: 7.9 s; honey: 9.5 s; pudding: 12.7 s; p < 0.01), the flux of ingestion decreased (liquid: 20.3 mL/s; nectar: 15.6 mL/s; honey: 13.4 mL/s; pudding: 10.6 mL/s; p < 0.01), the sensation worsened (liquid: 9.7; nectar: 5.7; honey: 4.3; pudding: 2.8), and the difficult of ingestion increase with the increase of the water consistency. Individuals with dental prosthesis (n = 11) had a decrease in the flux of ingestion with 3.6 g of thickener (prosthesis: 11.1 mL/s, no prosthesis: 6.8 mL/s, p = 0.05) and a decrease in the volume in each swallow (prosthesis: 17.6 mL, no prosthesis: 10.5 mL). CONCLUSIONS There is some difficulty to drink thickened water. The use of dental prosthesis cause further difficulties.
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Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers. Eur J Anaesthesiol 2018; 33:622-30. [PMID: 27191923 DOI: 10.1097/eja.0000000000000461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exposure to remifentanil increases the incidence of pulmonary aspiration in healthy volunteers. This effect may be explained by impairment of airway defence mechanisms and/or altered swallowing function. Pressure-flow analysis is a technique that allows objective assessment of swallowing based on pressure-impedance patterns recorded during bolus swallowing. OBJECTIVES The aim of this study was to use pressure-flow analysis to quantify the effect of remifentanil on healthy pharyngeal swallowing and to compare these effects with morphine. DESIGN A double-blind, randomised, cross-over study. SETTING A tertiary care teaching hospital. VOLUNTEERS Eleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years). INTERVENTIONS Volunteers were studied twice and received either a target-controlled remifentanil infusion (target concentrations: young, 3 ng ml; old, 2 ng ml) or a bolus injection of morphine (dose: young, 0.1 mg kg; old, 0.07 mg kg). Pharyngeal pressure and impedance were recorded with an indwelling catheter while swallowing 10 boluses of liquid during each measuring phase. Variables defining swallowing function were calculated and compared to determine drug effects. MAIN OUTCOME MEASURES Pharyngeal pressure-flow variables following remifentanil exposure. RESULTS Changes produced by remifentanil in the measured variables were consistent with greater dysfunction of swallowing. Both the strength of the pharyngeal contractions and pharyngeal bolus propulsion were reduced, whereas flow resistance was increased. The swallow risk index, a global index of swallowing dysfunction, increased overall. At the experimental doses tested, morphine produced similar, but less extensive effects on swallowing. CONCLUSION Remifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration. TRIAL REGISTRATION NCT01924234 (www.clinicaltrials.gov).
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Kim HJ, Kim N, Kim YS, Nam RH, Lee SM, Park JH, Choi D, Hwang YJ, Lee J, Lee HS, Kim MS, Lee MY, Lee DH. Changes in the interstitial cells of Cajal and neuronal nitric oxide synthase positive neuronal cells with aging in the esophagus of F344 rats. PLoS One 2017; 12:e0186322. [PMID: 29182640 PMCID: PMC5705109 DOI: 10.1371/journal.pone.0186322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 09/28/2017] [Indexed: 01/15/2023] Open
Abstract
The aging-associated cellular and molecular changes in esophagus have not been established, yet. Thus we evaluated histological structure, interstitial cells of Cajal (ICCs), neuronal nitric oxide synthase (nNOS)-positive cells, and contractility in the esophagus of Fischer 344 rat at different ages (6-, 31-, 74-weeks, and 2-years). The lamina propria thickness and endomysial area were calculated. The immunoreactivity of c-Kit, nNOS and protein gene product (PGP) 9.5 was counted after immunohistochemistry. Expression of c-Kit, stem cell factor (SCF), nNOS and PGP 9.5 mRNA was measured by real-time PCR, and expression of c-Kit and nNOS protein was detected by Western blot. Isovolumetric contractile force measurement and electrical field stimulation (EFS) were conducted. The lamina propria thickness increased (6 week vs 2 year, P = 0.005) and the endomysial area of longitudinal muscle decreased with aging (6 week vs 2 year, P<0.001), while endomysial area of circular muscle did not significantly decrease. The proportions of NOS-immunoreactive cells and c-Kit-immunoreactive areas declined with aging (6 week vs 2 year; P<0.001 and P = 0.004, respectively), but there was no significant change of PGP 9.5-immunopositiviy. The expressions of nNOS, c-Kit and SCF mRNA also reduced with aging (6 week vs 2 year; P = 0.006, P = 0.001 and P = 0.006, respectively), while the change of PGP 9.5 mRNA expression was not significant. Western blot showed the significant decreases of nNOS and c-Kit protein expression with aging (6 week vs 2 year; P = 0.008 and P = 0.012, respectively). The EFS-induced esophageal contractions significantly decreased in 2-yr-old rat compared with 6-wk-old rats, however, L-NG-Nitroarginine methylester did not significantly increase the spontaneous and EFS-induced contractions in the 6-wk- and 2-yr-old rat esophagus. In conclusion, an increase of lamina propria thickness, a decrease of endomysial area, c-Kit, SCF and NOS expression with preserved total enteric neurons, and contractility in aged rat esophagus may explain the aging-associated esophageal dysmotility.
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Affiliation(s)
- Hee Jin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
- Department of Internal Medicine, Myongji Hospital, Goyang, S. Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, S. Korea
- * E-mail:
| | - Yong Sung Kim
- Department of Gastroenterology and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, S. Korea
| | - Ryoung Hee Nam
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Sun Min Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Ji Hyun Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Daeun Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Young-Jae Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Jongchan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, S. Korea
| | - Min-Seob Kim
- Department of Physiology and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, S. Korea
| | - Moon Young Lee
- Department of Physiology and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, S. Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, S. Korea
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39
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Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: Thinking outside the box. World J Gastroenterol 2017; 23:6942-6951. [PMID: 29097867 PMCID: PMC5658312 DOI: 10.3748/wjg.v23.i38.6942] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux (GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno- as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pre-test probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.
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Affiliation(s)
- Hamish Philpott
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Mayur Garg
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Dunya Tomic
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Smrithya Balasubramanian
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Rami Sweis
- University College London, London NW1 2BU, United Kingdom
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40
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Shim YK, Kim N, Park YH, Lee JC, Sung J, Choi YJ, Yoon H, Shin CM, Park YS, Lee DH. Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry. J Neurogastroenterol Motil 2017; 23:229-236. [PMID: 28163259 PMCID: PMC5383117 DOI: 10.5056/jnm16104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/19/2016] [Accepted: 01/15/2017] [Indexed: 01/10/2023] Open
Abstract
Background/Aims Disturbances of esophageal motility have been reported to be more frequent the aged population. However, the physiology of disturbances in esophageal motility during aging is unclear. The aim of this study was to evaluate the effects of age on esophageal motility using high-resolution esophageal impedance manometry (HRIM). Methods Esophageal motor function of 268 subjects were measured using HRIM in 3 age groups, < 40 years (Group A, n = 32), 40–65 years (Group B, n = 185), and > 65 years (Group C, n = 62). Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures, integrated relaxation pressure, distal contractile integral, contractile front velocity, distal latency, and pressures and duration of contraction on 4 positions along the esophagus, and complete bolus transit were measured. Results Basal UES pressure was lower in Group C (P < 0.001) but there was no significant difference in the LES pressure among groups. Contractile duration on position 3 (10 cm from proximal LES high pressure zone) was longer in Group C (P = 0.001), and the contractile amplitude on position 4 (5 cm from proximal LES high pressure zone) was lower in Group C (P = 0.005). Distal contractile integral was lower in Group C (P = 0.037). Contractile front velocity (P = 0.015) and the onset velocity (P = 0.040) was lower in Group C. There was no significant difference in impedance values. Conclusions The decrease of UES pressure, distal esophageal motility, and peristaltic velocity might be related with esophageal symptoms in the aged population.
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Affiliation(s)
- Young Kwang Shim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine and Liver Research Institute, Seoul, Korea
| | - Yo Han Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jihee Sung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine and Liver Research Institute, Seoul, Korea
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41
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Chen YC, Hsiao MY, Wang YC, Fu CP, Wang TG. Reliability of Ultrasonography in Evaluating Hyoid Bone Movement. J Med Ultrasound 2017; 25:90-95. [PMID: 30065466 PMCID: PMC6029310 DOI: 10.1016/j.jmu.2017.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/05/2017] [Indexed: 11/15/2022] Open
Abstract
Background Timely and adequate laryngeal elevation along with hyoid bone movement is an essential component of the swallowing movement under normal physiological conditions. The purpose of this study was to verify the reproducibility of using ultrasonography to evaluate hyoid bone displacement during swallowing through the assessment of inter- and intrarater reliability and examine its accuracy by comparing the results with videofluoroscopic swallowing study (VFSS). Methods A self-designed water balloon was fixed to the transducer, which provided good contact between the transducer and the submental skin. Ten participants with dysphagia were recruited. The measurements of hyoid bone displacement using ultrasonography were performed by two of the authors. All the participants underwent ultrasonographic examinations and VFSS within 24 hours. Results The intrarater intraclass correlation coefficient (ICC) of the two examiners was 0.996 and 0.959, respectively (p < 0.01); the interrater ICC between the two examiners was 0.892 (p < 0.05). ICCs between VFSS and ultrasonography for two researchers were 0.815 and 0.916 (p < 0.01). Conclusion Submental ultrasonography is a reliable and accurate method for assessing the hyoid bone movement.
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Affiliation(s)
- Yen-Chih Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan, ROC
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan, ROC
| | - Yi-Chian Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan, ROC
| | - Chih-Pin Fu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan, ROC
- Correspondence to: Dr Tyng-Guey Wang, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde Street, Zhongzheng District, Taipei City 10048, Taiwan, ROC. E-mail address: (T.-G. Wang)
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42
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The Prevalence of Oropharyngeal Dysphagia in Danish Patients Hospitalised with Community-Acquired Pneumonia. Dysphagia 2016; 32:383-392. [PMID: 28004179 DOI: 10.1007/s00455-016-9765-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Community-acquired pneumonia (CAP) and oropharyngeal dysphagia (OD) are prevalent conditions in the elderly. The aim of this study was to explore the relationship between CAP, OD, and frailty in patients admitted to a department of respiratory medicine at a regional hospital. The outcome was mortality during hospitalization and within 30 days of discharge and rehospitalization within 30 days of discharge. A total of 154 consecutive patients (54.5% male, mean age 77.4 years (SD 11.51)) hospitalized because of CAP from September 1, 2013 to March 31, 2014 at North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test was conducted for each patient. A total of 34.42% patients presented with OD. Patients with OD and CAP presented significant differences in age, CURB-65, and dementia compared with those of patients with CAP alone. The majority lived in nursing homes, had a lower body mass index, Barthel 20 score, and handgrip strength, and had poor oral health compared with patients with CAP only. Patients with OD presented an increased length of stay in hospital (P < 0.001), intra-hospital mortality (P < 0.001), and 30-day mortality rate (P < 0.001) compared with those of patients with CAP only. Their rate of rehospitalization 0-30 days after discharge was also increased (P < 0.001) compared with that of patients with CAP only. Thus, OD is related to frailty and poor outcome.
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43
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Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, Fraser RJL, Omari TI. Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry. Neurogastroenterol Motil 2016; 28:1890-1901. [PMID: 27346335 DOI: 10.1111/nmo.12892] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/30/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dysphagia becomes more common in old age. We performed high-resolution impedance manometry (HRIM) in asymptomatic healthy adults (including an older cohort >80 years) to assess HRIM findings in relation to bolus clearance. METHODS Esophageal HRIM was performed in a sitting posture in 45 healthy volunteers (n = 30 young control, mean age 37 ± 11 years and n = 15 older subjects aged 85 ± 4 years) using a 3.2-mm solid-state catheter (Solar GI system; MMS, Enschede, The Netherlands) with 25 pressure (1-cm spacing) and 12 impedance segments (2-cm intervals). Five swallows each of 5- and 10-mL liquid and viscous bolus were performed and analyzed using esophageal pressure topography metrics and Chicago classification criteria as well as pressure-flow parameters. Bolus transit was determined using standard impedance criteria. A p-value <0.05 was considered significant. KEY RESULTS Impaired bolus clearance occurred more frequently in asymptomatic older subjects compared with young controls (YC) during liquid (40 vs 18%, χ2 = 4.935; p < 0.05) and viscous (60 vs 17%; χ2 = 39.08; p < 0.001) swallowing. Longer peristaltic breaks (p < 0.05) and more rapid peristalsis (L: p < 0.004, V: p = 0.003) occurred in the older cohort, with reduced impedance-based clearance for both bolus consistencies (L: p < 0.05, V: p < 0.001). Decreased peristaltic vigor (distal contractile integral <450 mmHg/s/cm) was associated with reduced liquid clearance in both age groups (p < 0.001) and of viscous swallows in the older group (p < 0.001). Impedance ratio, a marker of bolus retention, was increased in older subjects during liquid (p = 0.002) and viscous (p < 0.001) swallowing. CONCLUSIONS & INFERENCES Impaired liquid and viscous bolus clearance, esophageal pressure topography, and pressure-flow changes were seen in asymptomatic older subjects.
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Affiliation(s)
- C Cock
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.,School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia
| | - L Besanko
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - S Kritas
- Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia
| | - C M Burgstad
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - A Thompson
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - R Heddle
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - R J L Fraser
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.,School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia
| | - T I Omari
- School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia.,Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia.,Department of Human Physiology, Flinders University, Adelaide, Australia
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44
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Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, Abondano-Garavito JE. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 2016; 127:2002-2010. [DOI: 10.1002/lary.26419] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/19/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Luis Fernando Giraldo-Cadavid
- Research Department; University of La Sabana School of Medicine; Chía Colombia
- Clinical Training Unit; University of Navarra, School of Medicine; Pamplona Spain
- Research Department; Fundacion Neumologica Colombiana; Bogotá Colombia
| | | | | | | | - Rafael Garcia
- Research Department; University of La Sabana School of Medicine; Chía Colombia
| | - Sergio Ovalle
- Research Department; University of La Sabana School of Medicine; Chía Colombia
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Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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46
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Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Tsukamoto M, Manabe N, Kamada T, Hirai T, Hata J, Haruma K, Inoue K. Number of Gastrointestinal Symptoms is a Useful Means of Identifying Patients with Cancer for Dysphagia. Dysphagia 2016; 31:547-54. [DOI: 10.1007/s00455-016-9712-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
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Yuan Y, Zhao Y, Xie T, Hu Y. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2:CD009198. [PMID: 26837233 PMCID: PMC8260094 DOI: 10.1002/14651858.cd009198.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gastrostomy has been established as the standard procedure for administering long-term enteral nutrition in individuals with swallowing disturbances. Percutaneous gastrostomy is a less-invasive approach than open surgical gastrostomy, and can be accomplished via endoscopy (percutaneous endoscopic gastrostomy or PEG) or sonographic or fluoroscopic guidance (percutaneous radiological gastrostomy or PRG). Both techniques have different limitations, advantages, and contraindications. In order to determine the optimal technique for long-term nutritional supplementation many studies have been conducted to compare the outcomes of these two techniques; however, it remains unclear as to which method is superior to the other with respect to both efficacy and safety. OBJECTIVES To compare the safety and efficacy of PEG and PRG in the treatment of individuals with swallowing disturbances. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, January 2016); MEDLINE (1946 to 22 January 2016); EMBASE (1980 to 22 January 2016); the reference lists of identified articles; databases of ongoing trials, including the Chinese Cochrane Centre Controlled Trials Register; and PubMed. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing PEG with PRG in individuals with swallowing disturbances, regardless of the underlying disease. DATA COLLECTION AND ANALYSIS Two authors independently evaluated the search results and assessed the quality of the studies. Data analyses could not be performed as no RCTs were identified for inclusion in this review. MAIN RESULTS We identified no RCTs comparing PEG and PRG for percutaneous gastrostomy in individuals with swallowing disturbances. The large body of evidence in this field comes from retrospective and non-randomised controlled studies and case series. Based on this evidence, both PEG and PRG can be safely performed in selected individuals, although both are associated with major and minor complications. A definitive RCT has yet to be conducted to identify the preferred percutaneous gastrostomy technique. AUTHORS' CONCLUSIONS Both PEG and PRG are effective for long-term enteral nutritional support in selected individuals, though current evidence is insufficient to recommend one technique over the other. Choice of technique should be based on indications and contraindications, operator experience and the facilities available. Large-scale RCTs are required to compare the two techniques and to determine the optimal approach for percutaneous gastrostomy.
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Affiliation(s)
- Yong Yuan
- West China Hospital, Sichuan UniversityDepartment of Thoracic SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Yongfan Zhao
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Tianpeng Xie
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Yang Hu
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
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Giraldo-Cadavid LF, Gutiérrez-Achury AM, Ruales-Suárez K, Rengifo-Varona ML, Barros C, Posada A, Romero C, Galvis AM. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study. Dysphagia 2016; 31:398-406. [DOI: 10.1007/s00455-016-9690-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/02/2016] [Indexed: 10/22/2022]
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50
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Abstract
Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.
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Affiliation(s)
- Nathalie Rommel
- KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, B-3000 Leuven, Belgium
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK
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