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Journal of the Neurological Sciences Nov 2021Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but... (Review)
Review
BACKGROUND
Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD.
OBJECTIVE
To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management.
METHODS
A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.
RESULTS
The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed.
CONCLUSIONS
The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.
Topics: Consensus; Deglutition Disorders; Humans; Italy; Parkinson Disease
PubMed: 34624796
DOI: 10.1016/j.jns.2021.120008 -
Dysphagia Feb 2023Oropharyngeal dysphagia is common post-stroke and can have serious consequences for patients. Understanding dysphagia recovery is critically important to inform... (Review)
Review
Oropharyngeal dysphagia is common post-stroke and can have serious consequences for patients. Understanding dysphagia recovery is critically important to inform prognostication and support patients and professionals with care planning. This systematic review was undertaken to identify clinical predictors of dysphagia recovery post-stroke. Online databases (EMBASE, Scopus, Web of Science, PubMed, CINAHL, and Cochrane) were searched for studies reporting longitudinal swallowing recovery in adults post-stroke. Dysphagia recovery was defined as improvement measured on a clinical swallowing scale or upgrade in oral and/or enteral feeding status by the end of the follow-up period. The search strategy returned 6598 studies from which 87 studies went through full-text screening, and 19 studies were included that met the eligibility criteria. Age, airway compromise identified on instrumental assessment, dysphagia severity, bilateral lesions, and stroke severity were identified as predictors of persistent dysphagia and negative recovery in multiple logistic regression analysis. The available literature was predominated by retrospective data, and comparison of outcomes was limited by methodological differences across the studies in terms of the choice of assessment, measure of recovery, and period of follow-up. Future prospective research is warranted with increased representation of haemorrhagic strokes and uniform use of standardized scales of swallowing function.
Topics: Adult; Humans; Deglutition Disorders; Retrospective Studies; Stroke; Deglutition; Enteral Nutrition
PubMed: 35445366
DOI: 10.1007/s00455-022-10443-3 -
European Geriatric Medicine Oct 2022Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the... (Review)
Review
PURPOSE
Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions.
METHODS
We performed a literature search in MEDLINE, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for "aspiration pneumonia" and "aged" were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission.
RESULTS
A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP.
CONCLUSION
There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients' general frailty rather than in relation to swallowing function itself.
Topics: Aged; Community-Acquired Infections; Deglutition; Humans; Pneumonia; Pneumonia, Aspiration; Water
PubMed: 36008745
DOI: 10.1007/s41999-022-00689-3 -
Gut Mar 2018Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them.
DESIGN
Medline, Embase and Embase Classic were searched (until September 2016) to identify population-based studies that reported the prevalence of gastro-oesophageal reflux symptoms in adults (≥15 years); gastro-oesophageal reflux was defined using symptom-based criteria or questionnaires. The prevalence was extracted for all studies, and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, OR and 95% CIs were calculated.
RESULTS
Of the 14 132 citations evaluated, 102 reported the prevalence of gastro-oesophageal reflux symptoms in 108 separate study populations, containing 460 984 subjects. Prevalence varied according to country (from 2.5% in China to 51.2% in Greece) and criteria used to define gastro-oesophageal reflux symptoms. When only studies using a weekly frequency of heart burn or regurgitation to define presence were considered, pooled prevalence was 13.3% (95% CI 12.0% to 14.6%). Prevalence was higher in subjects ≥50 years (OR 1.32; 95% CI 1.12 to 1.54), smokers (OR 1.26; 95% CI 1.04 to 1.52), non-steroidal anti-inflammatory drug (NSAID)/aspirin users (OR 1.44; 95% CI 1.10 to 1.88) and obese individuals (OR 1.73; 95% CI 1.46 to 2.06).
CONCLUSIONS
The prevalence of gastro-oesophageal reflux symptoms varied strikingly among countries, even when similar definitions were used to define their presence. Prevalence was significantly higher in subjects ≥50 years, smokers, NSAID users and obese individuals, although these associations were modest.
Topics: Age Factors; Alcohol Drinking; Anti-Inflammatory Agents, Non-Steroidal; Educational Status; Gastroesophageal Reflux; Global Health; Humans; Obesity; Prevalence; Risk Factors; Smoking; Social Class
PubMed: 28232473
DOI: 10.1136/gutjnl-2016-313589 -
Archivos Argentinos de Pediatria Dec 2017Pediatric cerebral palsy is a non-progressive neurological disorder. It is one of the most common causes of disability among children. Numerous physical therapy... (Review)
Review
Pediatric cerebral palsy is a non-progressive neurological disorder. It is one of the most common causes of disability among children. Numerous physical therapy techniques are currently used for treatment, and kinesio taping is one of them. The main objective of this study was to review the outcomes of using kinesio taping in published scientific studies conducted in pediatric patients with cerebral palsy and determine their methodological quality. The main scientific databases and the studies published in the official site of the Asociación Española de Vendaje Neuromuscular (Spanish Association for Neuromuscular Taping) were reviewed. Nine studies were included, which provided important outcomes. These studies show the effectiveness of recovering upper limb and motor function and solving dysphagia, which could be present in these patients, although scientific evidence may expand due to improvements in methodology.
Topics: Athletic Tape; Bibliometrics; Cerebral Palsy; Child; Humans
PubMed: 29087112
DOI: 10.5546/aap.2017.eng.e356 -
Nutrients Apr 2022Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older adults with symptoms of dysphagia might have a higher prevalence of frailty or prefrailty than those without dysphagia.
METHODS
We systematically searched the PubMed, Embase, and Cochrane Library databases for relevant studies published through 20 April 2022. Cross-sectional and longitudinal studies that examined the associations between dysphagia and the existence of frailty or prefrailty in community-dwelling, facility-dwelling, or hospitalized adults aged 50 years or older were synthesized. The Newcastle-Ottawa Scale was used to evaluate study quality.
RESULTS
The meta-analysis comprised 12 cohorts, including 5,503,543 non-frailty participants and 735,303 cases of frailty or prefrailty. Random-effect meta-analysis demonstrated a significant association between dysphagia and the risk of frailty and prefrailty (OR, 3.24; 95% CI, 2.51-4.20). In addition, we observed consistent results across the subgroups and heterogeneity assessments.
CONCLUSIONS
We propose including dysphagia assessment as a critical factor in the cumulative deficit model for identifying frailty in older adults. Understanding dysphagia and the potential role of nutritional supplements in older adults may lead to improved strategies for preventing, delaying, or mitigating frailty.
Topics: Aged; Cross-Sectional Studies; Deglutition Disorders; Frail Elderly; Frailty; Humans; Independent Living
PubMed: 35565784
DOI: 10.3390/nu14091812 -
The Turkish Journal of Gastroenterology... Dec 2017Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use... (Review)
Review
Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use of such drugs can lead to the emergence of GERD and can also exacerbate existing reflux symptoms. These drugs can contribute to GERD by directly causing mucosal damage, by reducing lower esophageal sphincter pressure (LESP), or by affecting esophagogastric motility. In this article, we report our investigation of the relationships between GERD and medications within the scope of the "Turkish GERD Consensus Group." For the medication groups for which sufficient data were obtained (Figure 1), a systematic literature review in English was conducted using the keywords "gastroesophageal reflux" [MeSH Terms] and "anti-inflammatory agents, non-steroidal" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "acetylsalicylic acid" [MeSH Terms], "gastroesophageal reflux" [All Fields] and "estrogenic agents" [All Fields], "gastroesophageal reflux" [All Fields] and "progesterones" [All Fields], "gastroesophageal reflux" [All Fields] and "hormone replacement therapy" [All Fields], "gastroesophageal reflux" [MeSH Terms] and "diphosphonates" [MeSH Terms] OR "diphosphonates" [All Fields], "calcium channel blockers" [MeSH Terms] and "gastroesophageal reflux" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "nitrates" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "antidepressive agents" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "benzodiazepines" [MeSH Terms] and "hypnotic drugs" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "cholinergic antagonists" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "theophylline" [MeSH Terms], and "gastroesophageal reflux [MeSH Terms] AND "anti-asthmatic agents" [MeSH Terms]. The studies were analyzed and the results are presented here.
Topics: Drug-Related Side Effects and Adverse Reactions; Esophagus; Gastroesophageal Reflux; Humans; Risk Factors
PubMed: 29199166
DOI: 10.5152/tjg.2017.11 -
Clinical Gastroenterology and... Feb 2016Gastroesophageal reflux disease (GERD) affects up to 30% of adults in Western populations and is increasing in prevalence. GERD is associated with lifestyle factors,... (Review)
Review
BACKGROUND & AIMS
Gastroesophageal reflux disease (GERD) affects up to 30% of adults in Western populations and is increasing in prevalence. GERD is associated with lifestyle factors, particularly obesity and tobacco smoking, which also threatens the patient's general health. GERD carries the risk of several adverse outcomes and there is widespread use of potent acid-inhibitors, which are associated with long-term adverse effects. The aim of this systematic review was to assess the role of lifestyle intervention in the treatment of GERD.
METHODS
Literature searches were performed in PubMed (from 1946), EMBASE (from 1980), and the Cochrane Library (no start date) to October 1, 2014. Meta-analyses, systematic reviews, randomized clinical trials (RCTs), and prospective observational studies were included.
RESULTS
Weight loss was followed by decreased time with esophageal acid exposure in 2 RCTs (from 5.6% to 3.7% and from 8.0% to 5.5%), and reduced reflux symptoms in prospective observational studies. Tobacco smoking cessation reduced reflux symptoms in normal-weight individuals in a large prospective cohort study (odds ratio, 5.67). In RCTs, late evening meals increased time with supine acid exposure compared with early meals (5.2% point change), and head-of-the-bed elevation decreased time with supine acid exposure compared with a flat position (from 21% to 15%).
CONCLUSIONS
Weight loss and tobacco smoking cessation should be recommended to GERD patients who are obese and smoke, respectively. Avoiding late evening meals and head-of-the-bed elevation is effective in nocturnal GERD.
Topics: Behavior Therapy; Gastroesophageal Reflux; Humans; Life Style; Obesity; Prospective Studies; Smoking
PubMed: 25956834
DOI: 10.1016/j.cgh.2015.04.176 -
Journal of Clinical Medicine May 2022This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia... (Review)
Review
BACKGROUND
This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia assessment methods.
METHODS
Five major databases were systematically searched through January 2022. A random-effects model for meta-analysis was conducted to obtain the pooled prevalence.
RESULTS
Prevalence of dysphagia in the community-dwelling elderly screened by water swallow test was 12.14% (95% CI: 6.48% to 19.25%, I = 0%), which was significantly lower than the combined prevalence of 30.52% (95% CI: 21.75% to 40.07%, I = 68%) assessed by Standardized Swallowing Assessment (SSA) and volume-viscosity swallow test (V-VST). The dysphagia prevalence among elderly nursing home residents evaluated by SSA was 58.69% (95% CI: 47.71% to 69.25%, I = 0%) and by the Gugging Swallowing Screen test (GUSS) test was 53.60% (95% CI: 41.20% to 65.79%, I = 0%). The prevalence of dysphagia in hospitalized older adults screened by the 10-item Eating Assessment Tool was 24.10% (95% CI: 16.64% to 32.44%, I = 0%), which was significantly lower than those assessed by V-VST or GUSS tests of 47.18% (95% CI: 38.30% to 56.14%, I = 0%).
CONCLUSIONS
Dysphagia is prevalent in the elderly, affecting approximately one in three community-dwelling elderly, almost half of the geriatric patients, and even more than half of elderly nursing home residents. The use of non-validated screening tools to report dysphagia underestimates its actual prevalence.
PubMed: 35566731
DOI: 10.3390/jcm11092605 -
Intensive Care Medicine Jul 2020To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care.
METHODS
We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.
RESULTS
We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I = 78%, P = 0.07) (very low certainty).
CONCLUSION
There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
Topics: Adult; Critical Care; Deglutition Disorders; Humans; Pneumonia; Quality of Life; Stroke
PubMed: 32514597
DOI: 10.1007/s00134-020-06126-y