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Li X, Jin L, Gu C, Zhang W, Zhou X, You X. Effect of Cold Fluid Compensatory Swallowing Combined with Balloon Dilation on the Treatment of Poststroke Cricopharyngeal Achalasia: A Pilot Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4171561. [PMID: 36254140 PMCID: PMC9569196 DOI: 10.1155/2022/4171561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
Objective This study is aimed at comparing the treatment efficacy between catheter balloon dilation combined with cold fluid compensatory swallowing training and catheter balloon dilation alone on poststroke cricopharyngeal achalasia (CPA). Methods We conducted a single-blind, randomized controlled trial (RCT). Poststroke patients with CPA were divided into two groups: the control group (treated with catheter balloon dilation) and the trial group (catheter balloon dilation combined with cold fluid compensatory swallowing). Videofluoroscopic swallowing study (VFSS) was performed, and functional oral intake scale (FOIS) was used to evaluate and compare the swallowing function of patients in the 2 groups before and after intervention. Posttreatment VAS pain scores and recovery time were also measured. Results VFSS and FOIS scores in the two groups were improved after treatment (P < 0.05). In the trial group, VFSS scores in the pharyngeal phase and aspiration degree were significantly higher compared with the control group (P < 0.05) but not in the oral phase (P > 0.05). The difference in FOIS scores and patients' recovery time from intervention to eating mushy food between the trial and control groups was significant (P < 0.05), but not the VAS scores (P > 0.05). Conclusion The catheter balloon dilation combined with cold fluid compensatory swallowing was superior to catheter balloon dilation alone in terms of relieving dysphagia and reducing aspiration in patients with CPA following stroke. Long-term efficacy should be followed up with more objective and quantitative indicators in future studies.
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Affiliation(s)
- Xiangwei Li
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Linna Jin
- Department of Rehabilitation, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Chengxiao Gu
- Department of Nursing, Hangzhou Anatorium of People's Liberation Army, Hangzhou 310013, China
| | - Wangyuan Zhang
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiao Zhou
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiaoting You
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
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2
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Bianca A, Schindler V, Schnurre L, Murray F, Runggaldier D, Gyawali CP, Pohl D. Endoscope presence during endoluminal functional lumen imaging probe (FLIP) influences FLIP metrics in the evaluation of esophageal dysmotility. Neurogastroenterol Motil 2020; 32:e13823. [PMID: 32100389 DOI: 10.1111/nmo.13823] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The functional lumen imaging probe (FLIP) system is an FDA-approved tool for dynamic evaluation of the esophagogastric junction (EGJ). Even though commercially available since 2009, FLIP utilization remains low, partly due to lack of consensus in methodology and interpretation. Therefore, we aimed to analyze the influence of concurrent endoscopy on FLIP measurements. METHODS In this single-center study, we reviewed data from 93 patients undergoing FLIP for symptomatic esophageal motility disorders between 2016 and 2018. During sedated endoscopy, we measured luminal values (distensibility, cross-sectional area (CSA), and balloon pressure) at the EGJ and distal esophagus using 30, 40, and 50 mL distension volumes, with and without concurrent endoscope presence. All recorded values were compared at the various distension volumes between the two measurements using a Wilcoxon rank sum test. KEY RESULTS There was a significant difference in distensibility and CSA with index distension volume (40 mL) at the EGJ comparing the two measurements: Lower median distensibility was 2.1 mm2 mm Hg-1 in the group with concurrent inserted endoscope, respectively, 3.4 mm2 mm Hg-1 without endoscope (P < .001), and median CSA was 86.0 resp. 110.0 mm2 (P < .001). No significant difference could be found in the measurements of the distal esophagus. CONCLUSIONS & INFERENCES Our results show a significant difference in FLIP measurements with and without endoscope presence. This underlines the importance of establishing a consensus of a standardized FLIP protocol to define normal luminal values and guiding future FLIP diagnostic studies.
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Affiliation(s)
- Amanda Bianca
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Valeria Schindler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Division of Internal Medicine, Stadtspital Triemli, Zurich, Switzerland
| | - Larissa Schnurre
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Fritz Murray
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Runggaldier
- Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland
| | - Chandra Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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3
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Pandit S, Boktor M, Alexander JS, Becker F, Morris J. Gastroesophageal reflux disease: A clinical overview for primary care physicians. ACTA ACUST UNITED AC 2017; 25:1-11. [PMID: 28943113 DOI: 10.1016/j.pathophys.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/26/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE GERD is among the most common outpatient disease processes encountered by clinicians on a daily basis. This review provides insights about how to approach GERD in terms of disease management and treatment. METHODS Review articles were searched using PUBMED and MEDLINE using criteria that included English language articles published in the last 5 years concerning studies carried out only in humans. The key words used in the searches were GERD, PPI, and erosive esophagitis. Recommendations from the American College of Gastroenterology are also included in this manuscript. RESULTS The search resulted in ∼260 articles. The manuscript brings together and presents the results of recent recommendations from professional societies and recently published review articles on GERD. CONCLUSION GERD is one of the most common diagnoses made by gastroenterologists and primary care physicians. It is important to recognize the typical and atypical presentations of GERD. This paper helps primary care physicians understand the disease's pathophysiology, and when, how, and with what to treat GERD before referring patients to gastroenterologists or surgeons.
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Affiliation(s)
- Sudha Pandit
- Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, School of Medicine, Shreveport, LA, United States
| | - Moheb Boktor
- Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, School of Medicine, Shreveport, LA, United States
| | - Jonathan S Alexander
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, School of Medicine, Shreveport, LA,United States
| | - Felix Becker
- Department for General and Visceral Surgery, University Hospital Muenster, Germany
| | - James Morris
- Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, School of Medicine, Shreveport, LA, United States.
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Ihara E, Muta K, Fukaura K, Nakamura K. Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry. Digestion 2017; 95:29-35. [PMID: 28052278 DOI: 10.1159/000452354] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes. SUMMARY Based on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively. Key Messages: The classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO.
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Affiliation(s)
- Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ertekin C. Electrophysiological evaluation of oropharyngeal Dysphagia in Parkinson's disease. J Mov Disord 2014; 7:31-56. [PMID: 25360228 PMCID: PMC4213532 DOI: 10.14802/jmd.14008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 12/14/2022] Open
Abstract
Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings.
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Affiliation(s)
- Cumhur Ertekin
- Department of Neurology and Clinical Neurophysiology, Aegean University, Bornova-Izmir, Turkey
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6
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Addington WR, Stephens RE, Miller SP, Ockey RR. Inspiration closure reflex: The effect of respiration on intrinsic sphincters. Muscle Nerve 2013; 47:424-31. [DOI: 10.1002/mus.23680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/07/2022]
Affiliation(s)
| | - Robert E. Stephens
- Kansas City University of Medicine and Biosciences; 1750 Independence Ave. Kansas City MO 64106
| | - Stuart P. Miller
- Brevard Rehabilitation Medicine; 101 E. Florida Ave. Melbourne FL 32901
| | - Robin R. Ockey
- Utah Valley Pain Management; 3585 N. University Ave. Provo UT 84604
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7
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Tibbling L, Gezelius P, Franzén T. Factors influencing lower esophageal sphincter relaxation after deglutition. World J Gastroenterol 2011; 17:2844-7. [PMID: 21734792 PMCID: PMC3120944 DOI: 10.3748/wjg.v17.i23.2844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 03/01/2011] [Accepted: 03/08/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To study the relationship between upper esophageal sphincter (UES) relaxation, peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects. METHODS Ten non-dysphagic adult subjects had a high-resolution manometry probe passed transnasally and positioned to cover the UES, the esophageal body and the LES. Ten water swallows in each subject were analyzed for time lag between UES relaxation and LES relaxation, LES pressure at time of UES relaxation, duration of LES relaxation, the distance between the transition level (TL) and the LES, time in seconds that the peristaltic wave was before (negative value) or after the TL when the LES became relaxed, and the maximal peristaltic pressure in the body of the esophagus. RESULTS Relaxation of the LES occurred on average 3.5 s after the bolus had passed the UES and in most cases when the peristaltic wave front had reached the TL. The LES remained relaxed until the peristaltic wave faded away above the LES. CONCLUSION LES relaxation seemed to be caused by the peristaltic wave pushing the bolus from behind against the LES gate.
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Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia 2010; 25:323-33. [PMID: 20814803 PMCID: PMC2992653 DOI: 10.1007/s00455-010-9301-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 08/14/2010] [Indexed: 01/21/2023]
Abstract
Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research.
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Affiliation(s)
- Catriona M Steele
- Toronto Rehabilitation Institute, 550 University Avenue, #12030, Toronto, ON, M5G 2A2, Canada.
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10
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Landreau B, Odin I, Nathan N. Inhalation gastrique : épidémiologie et facteurs de risque. ACTA ACUST UNITED AC 2009; 28:206-10. [DOI: 10.1016/j.annfar.2009.01.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 01/14/2009] [Indexed: 11/30/2022]
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Lever TE, Cox KT, Holbert D, Shahrier M, Hough M, Kelley-Salamon K. The Effect of an Effortful Swallow on the Normal Adult Esophagus. Dysphagia 2007; 22:312-25. [PMID: 17694407 DOI: 10.1007/s00455-007-9107-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effect of an effortful swallow on the healthy adult esophagus was investigated using concurrent oral and esophageal manometry (water perfusion system) on ten normal adults (5 males and 5 females, 20-35 years old) while swallowing 5-ml boluses of water. The effects of gender, swallow condition (effortful versus noneffortful swallows), and sensor site within the oral cavity, esophageal body, and lower esophageal sphincter (LES) were examined relative to amplitude, duration, and velocity of esophageal body contractions, LES residual pressure, and LES relaxation duration. The results of this study provide novel evidence that an effortful oropharyngeal swallow has an effect on the esophageal phase of swallowing. Specifically, effortful swallowing resulted in significantly increased peristaltic amplitudes within the distal smooth muscle region of the esophagus, without affecting the more proximal regions containing striated muscle fibers. The findings pertaining to the LES are inconclusive and require further exploration using methods that permit more reliable measurements of LES function. The results of this study hold tremendous clinical potential for esophageal disorders that result in abnormally low peristaltic pressures in the distal esophageal body, such as achalasia, scleroderma, and ineffective esophageal motility. However, additional studies are necessary to both replicate and extend the present findings, preferably using a solid-state manometric system in conjunction with bolus flow testing on both normal and disordered populations, to fully characterize the effects of an effortful swallow on the esophagus.
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Affiliation(s)
- Teresa E Lever
- Department of Communication Sciences and Disorders, School of Allied Health Sciences, East Carolina University, Greenville, North Carolina 27858, USA.
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12
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Ertekin C, Aydogdu I. Electromyography of human cricopharyngeal muscle of the upper esophageal sphincter. Muscle Nerve 2002; 26:729-39. [PMID: 12451598 DOI: 10.1002/mus.10267] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The cricopharyngeus (CP) is a striated muscle sphincter situated at the pharyngoesophageal junction. The upper esophageal sphincter is comprised of the striated CP muscle and nonmuscular components at the level of the cricoid cartilage. This review describes the basic anatomy and physiology of the CP muscle, its central and peripheral relationship, methods of investigating it, and electrophysiological properties related to deglutition. The main function of the CP muscle is to control flow between the pharynx and esophagus. The CP sphincter muscle is tonically contracted at rest and relaxes during swallowing, belching, and vomiting. Electromyography (EMG) of the CP sphincter muscle has been undertaken frequently in a variety of subhuman species with the aim of understanding deglutition, whereas it has seldom been reported in healthy human subjects and patients. Increased knowledge of the physiology and anatomy of the human CP sphincter muscle is not only important scientifically but is necessary for advancing the diagnosis and treatment of oropharyngeal dysphagia, for which neurological causes are responsible in 80% of cases.
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Affiliation(s)
- Cumhur Ertekin
- Department of Clinical Neurophysiology, Ege University, Medical School Hospital, Bornova, Izmir, Turkey.
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Bardan E, Xie P, Aslam M, Kern M, Shaker R. Disruption of primary and secondary esophageal peristalsis by afferent stimulation. Am J Physiol Gastrointest Liver Physiol 2000; 279:G255-61. [PMID: 10915632 DOI: 10.1152/ajpgi.2000.279.2.g255] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recent studies have shown that afferent signals originating from the pharynx inhibit progression of primary esophageal peristalsis. Our aim was to further elucidate the effect of esophageal and pharyngeal afferent stimulation on primary and secondary esophageal peristalsis. We studied the effect of esophageal air distension and pharyngeal water stimulation on progression of primary and secondary peristalsis in nine healthy volunteers aged 27 +/- 2 yr (4 men, 5 women). At a threshold volume, rapid injection of water into the pharynx, directed posteriorly, resulted in complete halt of the progressing secondary and primary esophageal peristalses in both the proximal and distal esophagus. The threshold volume of injected water for inducing inhibition was similar for secondary (0.6 +/- 0.2 ml) and primary (0.5 +/- 0.1 ml) esophageal peristalsis. Progression of primary peristalsis induced by a dry swallow and secondary peristalsis induced by intraesophageal air distension were completely inhibited by intraesophageal injection of 15 +/- 2 ml of air in 70% and 75% of the trials, respectively. We conclude that afferent signals induced by esophageal air distension and pharyngeal water stimulation inhibit propagation of both primary and secondary esophageal peristalsis, suggesting a shared neural control mechanism for these types of peristalsis.
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Affiliation(s)
- E Bardan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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