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Tai V, Suppiah R. Autoimmune dysphagia. Curr Opin Otolaryngol Head Neck Surg 2024:00020840-990000000-00145. [PMID: 39146237 DOI: 10.1097/moo.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Dysphagia is a complication of several autoimmune rheumatic diseases and otorhinolaryngologists are likely to be involved in the assessment and management of patients with such conditions. This review provides an update on rheumatic diseases that may cause swallowing impairment, with particular focus on the epidemiology, pathophysiology and management of dysphagia in these conditions. RECENT FINDINGS Dysphagia is a common complication of the following rheumatic diseases: idiopathic inflammatory myopathies, systemic sclerosis, Sjogren's syndrome, systemic lupus erythematosus and rheumatoid arthritis. It may also be a complication of rarer autoimmune conditions such as Bechet's syndrome, sarcoidosis and granulomatosis with polyangiitis. All three stages of swallowing (oral, pharyngeal and oesophageal) may be impaired in these conditions. Both medical therapy and surgical intervention play an important role in the management of autoimmune dysphagia. SUMMARY The investigation and management of autoimmune dysphagia requires close collaboration between rheumatologists and otorhinolaryngologists. There is a need for further research to establish standardised guidelines on the assessment and management of autoimmune dysphagia.
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Affiliation(s)
- Vicky Tai
- Department of Rheumatology, Te Toka Tumai Auckland, Health New Zealand
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2
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Lang IM, Medda BK, Shaker R. Biomechanical increase in cervical esophageal wall tension during peristalsis. Am J Physiol Gastrointest Liver Physiol 2024; 326:G726-G735. [PMID: 38626405 PMCID: PMC11376970 DOI: 10.1152/ajpgi.00049.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/18/2024]
Abstract
During pharyngeal phase of swallowing, circumferential tension of the cervical esophagus (CTE) increases caused by a biomechanical process of laryngeal elevation pulling the cervical esophagus orad. The esophagus contracts longitudinally during esophageal peristalsis, therefore, we hypothesized that CTE increases during esophageal peristalsis by a biomechanical process. We investigated this hypothesis using 28 decerebrate cats instrumented with electromyographic (EMG) electrodes on the pharynx and esophagus, and esophageal manometry. We recorded CTE, distal esophageal longitudinal tension (DET), and orad laryngeal tension (OLT) using strain gauges. Peristalsis was stimulated by injecting saline into esophagus or nasopharynx. We investigated the effects of transecting the pharyngo-esophageal nerve (PEN), hypoglossal nerve (HG), or administering (10 mg/kg iv) hexamethonium (HEX). We found that the durations of CTE and DET increased and OLT decreased simultaneously during the total extent of esophageal peristalsis. CTE duration was highly correlated with DET but not esophageal EMG or manometry. The peak magnitudes of the DET and CTE were highly correlated. After HEX administration, peristalsis in the distal esophagus did not occur, and the duration of the CTE response decreased. PEN transection blocked the occurrence of cricopharyngeal or cervical esophageal response during peristalsis but had no significant effect on the CTE response. HG transection had no significant effect on CTE. We conclude that there is a significant CTE increase, independent of laryngeal elevation or esophageal muscle contraction, which occurs during esophageal peristalsis. This response is a biomechanical process caused by esophageal shortening that occurs during esophageal longitudinal contraction of esophageal peristalsis.NEW & NOTEWORTHY Circumferential tension of cervical esophagus (CTE) increases during esophageal peristalsis. CTE response is correlated with distal longitudinal tension on cervical esophagus during esophageal peristalsis but not laryngeal elevation or esophageal muscle contraction. CTE response is not blocked by transection of motor innervation of laryngeal elevating muscles or proximal esophagus but is temporally reduced after hexamethonium administration. We conclude that the CTE response is a biomechanical effect caused by longitudinal esophageal contraction during esophageal peristalsis.
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Affiliation(s)
- Ivan M Lang
- Dysphagia Research Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Bidyut K Medda
- Dysphagia Research Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Reza Shaker
- Dysphagia Research Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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3
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Benfaremo D, Pacenti N, Paterno I, Dichiara C, Galli FL, Moroncini G. Role of cognitive impairment and malnutrition as determinants of quality of life in patients with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:143-153. [PMID: 38910598 PMCID: PMC11188851 DOI: 10.1177/23971983231224522] [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: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/25/2024]
Abstract
Background Increasing evidence supports the presence of cognitive impairment in patients with systemic sclerosis. Malnutrition is a well-known severe complication of systemic sclerosis and is a consequence of multiple factors, mainly oropharyngeal and gastrointestinal involvement. Recent studies have shown a link between nutrition and cognitive decline in several chronic diseases. Thus, we decided to evaluate a possible association between malnutrition and cognitive impairment in patients with systemic sclerosis. Methods In total, 100 consecutive systemic sclerosis patients were enrolled in a cross-sectional study to assess clinical and demographic features, nutritional status (body mass index, Global Leadership Initiative on Malnutrition criteria), gastrointestinal involvement (University of California Los Angeles Gastrointestinal Scale 2.0, Eat Assessment Tool 10), cognitive function (Montreal Cognitive Assessment), anxiety and depression (Patient Health Questionnaire 9, Beck Depression Inventory II), and quality of life (Short Form 36, Health Assessment Questionnaire-Disability Index, Scleroderma Health Assessment Questionnaire). Patients were stratified for the presence/absence of malnutrition and cognitive decline and compared for clinical characteristics and quality-of-life measures. Results Half of the patients had cognitive impairment (Montreal Cognitive Assessment < 26). These patients were older, had more comorbidities, and a significantly worse quality of life. There were no statistically significant associations with body mass index, malnutrition, and gastrointestinal involvement. About one-third of patients had clinically relevant malnutrition. They were older, had higher skin score, lung and esophageal involvement. They also showed significantly worse scores for dysphagia, gastrointestinal symptoms, functional disability, and quality of life. Gastrointestinal symptoms and dysphagia, but not body mass index and Montreal Cognitive Assessment, were significantly associated with depression scores, which in turn were negatively associated to quality-of-life measures. With regression analysis, cognitive impairment was predicted only by age, whereas malnutrition was significantly associated with age, dysphagia, and modified Rodnan skin scores. Conclusion In this study, we showed that cognitive impairment and malnutrition are not directly linked but are both independently associated with greater functional disability and worse quality of life of patients with systemic sclerosis. Early recognition of these comorbidities is therefore pivotal to better address the chronic needs of patients affected by this disease.
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Affiliation(s)
- Devis Benfaremo
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Clinica Medica, Department of Internal Medicine, Marche University Hospital, Ancona, Italy
| | - Nikla Pacenti
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Ilaria Paterno
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Cristina Dichiara
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Federica Lucia Galli
- Deparment of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Clinica Medica, Department of Internal Medicine, Marche University Hospital, Ancona, Italy
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Hakobyan K, Acob T, Aleksanyan M, Jumaah O, Prabhakaran S. Upper Gastrointestinal (GI) Manifestations of Inflammatory Myositis: A Tale of Two Patients. Cureus 2024; 16:e62153. [PMID: 38993454 PMCID: PMC11238612 DOI: 10.7759/cureus.62153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Myositis is a group of rare autoimmune disorders characterized by chronic inflammation of skeletal muscles that leads to a hallmark triad of muscle weakness, fatigue, and myalgia. Extra-muscular manifestations are sometimes seen and involve various organ systems, including the gastrointestinal (GI) tract. In this case series, two patients with polymyositis (PM) and dermatomyositis (DM), both of whom developed dysphagia as a complication of myositis, are discussed. Case 1 was a female with a known history of biopsy-proven dermatomyositis who presented with progressive peripheral edema and weakness affecting all extremities. Concurrently, she displayed symptoms of pneumonia and dysphagia associated with frequent spontaneous or self-induced vomiting to alleviate retrosternal discomfort. Esophagogastroduodenoscopy (EGD) revealed esophageal dilatation and an absence of a contractile response, consistent with myositis. Treatment comprised intravenous immunoglobulin (IVIG), mycophenolate, and lifestyle modifications, including dietary adjustments and maintaining an upright position postprandial. The second case was a female with muscle weakness and dysphagia. Video-fluoroscopic swallow assessment was significant for pharyngeal dysfunction without a sensory response to penetrated material, and the patient was at high risk of aspiration with any oral intake. The presence of pharyngeal dysfunction and dysphagia prompted treatment with IVIG, mycophenolate, and percutaneous endoscopic gastrostomy (PEG) tube placement. These cases have highlighted the upper GI complications observed in patients with myositis, accentuating the necessity for a personalized treatment approach. Timely intervention has shown promising results in symptomatic relief and improving patient outcomes. This emphasizes the importance of a multidisciplinary approach when addressing myositis-related upper GI manifestations.
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Affiliation(s)
- Knkush Hakobyan
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Talar Acob
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Mesrop Aleksanyan
- Oncology, Yerevan State Medical University, Yerevan, ARM
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Omar Jumaah
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Sajina Prabhakaran
- Rheumtology, Capital Health Regional Medical Center, Trenton, USA
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
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5
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Antonacci A, Praino E, Abbinante A, Favia G, Rotondo C, Bartolomeo N, Giotta M, Iannone F, Orrù G, Agneta MT, Capodiferro S, Barile G, Corsalini M. Orofacial Manifestation of Systemic Sclerosis: A Cross-Sectional Study and Future Prospects of Oral Capillaroscopy. Diagnostics (Basel) 2024; 14:437. [PMID: 38396477 PMCID: PMC10888273 DOI: 10.3390/diagnostics14040437] [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: 12/20/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES oral alterations in Systemic Sclerosis (SSc) patients are widespread and include microstomia, periodontitis, telangiectasias, mandibular resorption, bone lesions, and xerostomia. This cross-sectional study aims to evaluate the differences between SSc patients (cases) and healthy subjects (controls) regarding oral manifestations, quality of life (QoL), and microcirculation alterations. METHODS plaque index (PCR), periodontal index (PSR), DMFT, salivary flow rate, and buccal opening were measured by expert clinicians. S-HAQ test, the Self-Rating Anxiety State (SAS), the Self-Rating Depression Scale (SDS), and the WHOQOL-BREF test were administered to patients to evaluate their QoL. Microvascular alterations were assessed by oral videocapillaroscopy, performed on gingival and labial mucosa. A statistical analysis was conducted to find significant differences between healthy people and SSc patients. RESULTS 59 patients were enrolled in this study. Standard salivary flow is significantly more frequent in controls, while xerostomia, reduced flow, microstomia, lip retraction, and periodontitis are significantly more frequent in the cases. Gingival capillaroscopy showed differences concerning loop visibility, thickening of the gum, tortuosity of gingival loops, and reduced gingival density. Labial capillaroscopy demonstrates that visibility of the labial loops, the labial ectasias, and the tortuosity of the loops are significantly associated with the presence of scleroderma. Hand and facial deformities, hypomobility of the tongue, cheeks, lips, microstomia, and xerostomia significantly compromised the quality of life of SSc patients, which was significantly worse among them. Moreover, oral videocapillaroscopy could be a proper diagnostic method to detect oral microcirculation alterations. SSc patients often present ectasias, rarefaction of the reticulum, microhemorrhages, and megacapillaries, which negatively impact their oral health. CONCLUSIONS periodontitis, reduced salivary flow, and microstomia could be considered SSc oral manifestations. Joint deformities, facial appearance, and comorbidities significantly reduce the QoL of SSc patients compared to healthy subjects. Oral videocapillaroscopy could be an innovative and reliable technique to detect oral microcirculation anomalies.
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Affiliation(s)
- Anna Antonacci
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Emanuela Praino
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePReJ), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Antonia Abbinante
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Gianfranco Favia
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Cinzia Rotondo
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Nicola Bartolomeo
- School of Medical Statistics and Biometry, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.B.); (M.G.)
| | - Massimo Giotta
- School of Medical Statistics and Biometry, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.B.); (M.G.)
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePReJ), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Germano Orrù
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Maria Teresa Agneta
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Saverio Capodiferro
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Giuseppe Barile
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Massimo Corsalini
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
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Shaik MR, Shaik NA, Mikdashi J. Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment. Cureus 2023; 15:e41883. [PMID: 37581141 PMCID: PMC10423619 DOI: 10.7759/cureus.41883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Autoimmune dysphagia is defined as dysphagia caused by autoimmune processes affecting various components of the swallowing process such as muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. These autoimmune causes can be classified into gastroenterological, dermatological, rheumatologic, and neurologic. Rheumatological disorders, such as scleroderma, Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, Behcet's disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, or granulomatosis with polyangiitis, have been associated with dysphagia. Autoimmune dysphagia in the context of rheumatological disorders is particularly significant because it can occur as a sole manifestation or as part of a symptom complex associated with the underlying disorder and often responds to immunosuppressive therapies. However, diagnosing autoimmune dysphagia can be challenging as it requires the exclusion of structural and primary motility disorders through procedures such as endoscopy and manometry. Early diagnosis is important to improve the quality of life and prevent significant mortality and morbidity. Management focuses on treating the underlying disease activity, and a multidisciplinary approach involving various medical specialties may be necessary to achieve success. This article aims to review the autoimmune rheumatological conditions that can lead to dysphagia and discuss the associated pathophysiological mechanisms. We also outline the clinical clues and laboratory testing methods that facilitate early diagnosis, with the goal of improving patient outcomes through timely intervention and appropriate management.
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Affiliation(s)
- Mohammed Rifat Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Nishat Anjum Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, USA
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7
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Motamedi M, Ferrara G, Yacyshyn E, Osman M, Abril A, Rahman S, Netchiporouk E, Gniadecki R. Skin disorders and interstitial lung disease: Part I-Screening, diagnosis, and therapeutic principles. J Am Acad Dermatol 2023; 88:751-764. [PMID: 36228941 DOI: 10.1016/j.jaad.2022.10.001] [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: 06/20/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
Numerous inflammatory, neoplastic, and genetic skin disorders are associated with interstitial lung disease (ILD), the fibrosing inflammation of lung parenchyma that has significant morbidity and mortality. Therefore, the dermatologist plays a major role in the early detection and appropriate referral of patients at risk for ILD. Part 1 of this 2-part CME outlines the pathophysiology of ILD and focuses on clinical screening and therapeutic principles applicable to dermatological patients who are at risk for ILD. Patients with clinical symptoms of ILD should be screened with pulmonary function tests and high-resolution chest computed tomography. Screening for pulmonary hypertension should be considered in high-risk patients. Early identification and elimination of pulmonary risk factors, including smoking and gastroesophageal reflux disease, are essential in improving respiratory outcomes. First-line treatment interventions for ILD in a dermatological setting include mycophenolate mofetil, but the choice of therapeutic agents depends on the nature of the primary disease, the severity of ILD, and comorbidities and should be the result of a multidisciplinary assessment. Better awareness of ILD among medical dermatologists and close interdisciplinary collaborations are likely to prevent treatment delays improving long-term outcomes.
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Affiliation(s)
- Melika Motamedi
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Samia Rahman
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada.
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8
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Volkmann ER, McMahan Z. Gastrointestinal involvement in systemic sclerosis: pathogenesis, assessment and treatment. Curr Opin Rheumatol 2022; 34:328-336. [PMID: 35993874 PMCID: PMC9547962 DOI: 10.1097/bor.0000000000000899] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The majority of patients with systemic sclerosis (SSc) will experience involvement of their gastrointestinal over the course of their disease. Despite the high prevalence of gastrointestinal involvement in SSc, the strategies pertaining to the assessment and treatment for this clinical dimension of SSc have historically been limited. However, the present review highlights recent research contributions that enhance our understanding of SSc-GI patient subsets and provides updates on pathogenic mechanisms of disease, assessment and symptom-directed management. RECENT FINDINGS In the past few years, several studies have identified risk factors for more severe gastrointestinal disease in SSc and have provided insight to optimize diagnosis and management of SSc-GI symptoms. This article also provides a review of currently available investigations and therapies for individual SSc-GI disease manifestations and reflects on actively evolving areas of research, including our understanding the role of the gut microbiome in SSc. SUMMARY Here, we provide important updates pertaining to the risk stratification, assessment, diagnosis and management of SSc patients with gastrointestinal symptoms. These findings provide opportunities to enhance patient care and highlight exciting opportunities for future research.
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Affiliation(s)
- Elizabeth R. Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zsuzsanna McMahan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Bernal-Bello D, Serantes-Gómez D, Izquierdo-Martínez A, Morales-Ortega A, Duarte-Millán MÁ, Frutos-Pérez B. Letter to the Editor Regarding Esophageal Dysfunction and Systemic Sclerosis: Drugs Should be Kept in Mind. Rheumatol Ther 2022; 9:1237-1240. [PMID: 35716236 PMCID: PMC9314470 DOI: 10.1007/s40744-022-00459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- David Bernal-Bello
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain.
| | - David Serantes-Gómez
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain
| | - Aida Izquierdo-Martínez
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain
| | - Alejandro Morales-Ortega
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain.,Department of Medicine, Universidad de Alcalá, Madrid, Spain
| | - Miguel Ángel Duarte-Millán
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain
| | - Begoña Frutos-Pérez
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942, Fuenlabrada, Madrid, Spain
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10
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Kershner M, Askren AN. It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia. Curr Opin Otolaryngol Head Neck Surg 2022; 30:194-197. [PMID: 35143423 DOI: 10.1097/moo.0000000000000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Medical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, 'Poor PO intake. Please evaluate and treat.' As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play. RECENT FINDINGS Changes to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os - each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life. SUMMARY In this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.
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Affiliation(s)
- Marnie Kershner
- MedStar National Rehabilitation Hospital, Washington, District of Columbia
| | - Annette N Askren
- VA Puget Sound Healthcare System, Seattle, WA, USA, West Virginia University School of Medicine, Morgantown, WV, USA
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11
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Kumar A, Nigam GB, Vasant DH, Dhar A. Twitter debate: controversies in dysphagia. Frontline Gastroenterol 2022; 14:155-157. [PMID: 36818789 PMCID: PMC9933583 DOI: 10.1136/flgastro-2022-102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/08/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Aditi Kumar
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Gaurav B Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Dipesh Harshvadan Vasant
- Neurogastroenterology Department, Wythenshawe Hospital, Manchester, UK,Division of Diabetes, endocrinology and gastroenterology, The University of Manchester, Manchester, Manchester, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Durham, UK
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12
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Lanzoni G, Sembenini C, Gastaldo S, Leonardi L, Bentivoglio VP, Faggian G, Bosa L, Gaio P, Cananzi M. Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach. Front Pediatr 2022; 10:885308. [PMID: 35813384 PMCID: PMC9263077 DOI: 10.3389/fped.2022.885308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Pediatric esophageal dysphagia (PED) is an infrequent condition that can be determined by a large number of disorders. The etiologic diagnosis is challenging due to overlapping clinical phenotypes and to the absence of pediatric diagnostic guidelines. This review aims to summarize the most relevant causes of ED during childhood, highlight the clinical scenarios of PED presentation and discuss the indications of available diagnostic tools. Available information supports that PED should always be investigated as it can underlie life-threatening conditions (e.g., foreign body ingestion, mediastinal tumors), represent the complication of benign disorders (e.g., peptic stenosis) or constitute the manifestation of organic diseases (e.g., eosinophilic esophagitis, achalasia). Therefore, the diagnosis of functional PED should be made only after excluding mucosal, structural, or motility esophageal abnormalities. Several clinical features may contribute to the diagnosis of PED. Among the latter, we identified several clinical key elements, relevant complementary-symptoms and predisposing factors, and organized them in a multi-level, hierarchical, circle diagram able to guide the clinician through the diagnostic work-up of PED. The most appropriate investigational method(s) should be chosen based on the diagnostic hypothesis: esophagogastroduodenoscopy has highest diagnostic yield for mucosal disorders, barium swallow has greater sensitivity in detecting achalasia and structural abnormalities, chest CT/MR inform on the mediastinum, manometry is most sensitive in detecting motility disorders, while pH-MII measures gastroesophageal reflux. Further studies are needed to define the epidemiology of PED, determine the prevalence of individual underlying etiologies, and assess the diagnostic value of investigational methods as to develop a reliable diagnostic algorithm.
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Affiliation(s)
- Gloria Lanzoni
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Camilla Sembenini
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Stefano Gastaldo
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Letizia Leonardi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | | | - Giovanna Faggian
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Luca Bosa
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Mara Cananzi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
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