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Therapeutic Advances in Chronic Disease 2019The purpose of this systematic review was to summarize the different dysphagia screening and evaluation tools, and to identify their measurement properties in adults... (Review)
Review
BACKGROUND
The purpose of this systematic review was to summarize the different dysphagia screening and evaluation tools, and to identify their measurement properties in adults with neuromuscular diseases (NMDs).
METHODS
A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy was conducted across three databases ( and ). Measurement properties of each tools and the Quality Index, developed by Downs and Black, were considered for the different investigated studies.
RESULTS
The search strategy produced 2221 articles. After removal of duplicates and full-text analysis, 19 studies were included. Most of the publications focused on amyotrophic lateral sclerosis (ALS; = 10) and Duchenne muscular dystrophy (DMD; = 4). A total of 12 tools, listed as instrumental and noninstrumental examinations, were retrieved. A total of five of them used videofluoroscopic swallow study (VFSS). Measurement properties of the tools are not completely described in detail in many studies. The neuromuscular disease swallowing status scale, a noninstrumental tool, is the only one that assessed all measurement properties in ALS patients. The median score reported for the Quality Index was 16.
CONCLUSIONS
This systematic review identified 12 different tools for the screening and evaluation of dysphagia in adults with NMD. Majority of the studies presented VFSS as a valid and reliable examination to assess dysphagia in ALS and DMD. Other tools were mainly evaluated in ALS patients, but further studies are needed to complete their measurement properties. In other NMDs, no firm conclusion can be made because of insufficient data and heterogeneity of NMDs.
PubMed: 30728931
DOI: 10.1177/2040622318821622 -
Dysphagia Feb 2023Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce... (Review)
Review
Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
Topics: Humans; Deglutition Disorders; Quality of Life; Deglutition; Nervous System Diseases; Ultrasonography
PubMed: 35556172
DOI: 10.1007/s00455-022-10459-9 -
Archives of Gerontology and Geriatrics Jul 2023Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the... (Review)
Review
BACKGROUND
Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people.
METHOD
We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers.
RESULTS
Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found.
CONCLUSIONS
There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.
Topics: Humans; Aged; Deglutition Disorders; Risk Factors
PubMed: 36906939
DOI: 10.1016/j.archger.2023.104991 -
Global Spine Journal Feb 2017Systematic review and meta-analysis. (Review)
Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Anterior cervical diskectomy and fusion (ACDF) is an effective surgical option for patients with cervical radiculopathy, myelopathy, or deformity. Although ACDF is generally safe, dysphagia is a common complication. Despite its high incidence, prolonged postoperative dysphagia is poorly understood; its etiology remains relatively unknown, and its risk factors are widely debated.
METHODS
We searched MEDLINE, Scopus, Web of Science, and Embase for studies reporting complications for cervical diskectomy with plating. We recorded dysphagia events from all included studies and calculated effect summary values, 95% confidence intervals (CIs), Q values, and values.
RESULTS
Of the 7,780 retrieved articles, 14 met inclusion criteria. The overall dysphagia rate was 8.5% (95% CI 5.7 to 11.3%). The rate of moderate or severe dysphagia was 4.4% (0.4 to 8.4%). Follow-up times of <12, 12 to 24, and >24 months reported rates of 19.9% (6.0 to 33.7%), 7.0% (5.2 to 8.7%), and 7.6% (1.4 to 13.8%), respectively. Studies utilizing the Bazaz Dysphagia Score resulted in an increase in dysphagia diagnosis relative to studies with no outlined criteria (19.8%, 5.9 to 33.7% and 6.9%, 3.7 to 10.0%, respectively), indicating that the criteria used for dysphagia identification are critical. There was no difference in dysphagia rate with the use of autograft versus allograft.
CONCLUSIONS
This review represents a comprehensive estimation of the actual incidence of dysphagia across a heterogeneous group of surgeons, patients, and criteria. The classification scheme for dysphagia varied significantly within the literature. To ensure its diagnosis and identification, we recommend the use of a standardized, well-outlined method for dysphagia diagnosis.
PubMed: 28451514
DOI: 10.1055/s-0036-1583944 -
Acta Bio-medica : Atenei Parmensis Aug 2022We performed a systematic review on the early assessment of swallowing function after cerebrovascular stroke.
PURPOSE
We performed a systematic review on the early assessment of swallowing function after cerebrovascular stroke.
MATERIALS AND METHODS
A systematic review of the English language literature of the past 20 years was performed regarding swallowing function and cerebrovascular stroke. All articles reporting swallowing evaluation through clinical examination validated scores, and diagnostic tools were included in the summary.
RESULTS
The systematic review of the literature identified 1,768 potentially relevant studies with 7 papers retrieved with a total of 589 stroke dysphagic patients. While at the clinical neurological assessment, The National Institutes of Health Stroke Scale was more frequently used as a clinical outcome predictor. The Bedside screening approach was carried out in 6 papers to assess patients with probable swallowing disorders. Among the diagnostic tools, seven studies performed the Flexible Fiberoptic Endoscopic evaluation assessing scoring validated system while two papers reported early swallowing outcomes Videofluoroscopic Swallow Study.
CONCLUSIONS
Our systematic review revealed the findings significantly associated with dysphagia in post-cerebrovascular patients. Endoscopic evaluation of swallowing proved to be the most used method in the literature, effective in identifying early predictors of dysphagia. Given the presence of different assessing scores employed and reduced study samples enrolled, further studies with large courts are necessary for a greater significance.
Topics: Deglutition; Deglutition Disorders; Endoscopy; Humans; Stroke
PubMed: 36043981
DOI: 10.23750/abm.v93i4.12135 -
Developmental Medicine and Child... Jun 2017Dysphagia is frequent in paediatric patients with neuromuscular diseases (pNMD). Its detection is important for initiating early diagnosis and treatment as well as for... (Review)
Review
AIM
Dysphagia is frequent in paediatric patients with neuromuscular diseases (pNMD). Its detection is important for initiating early diagnosis and treatment as well as for minimizing related complications. The aim of this study was to review the literature on dysphagia screening and evaluation tools in pNMD.
METHOD
A systematic review was performed on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed, CINAHL, and ScienceDirect) were searched. Measurement properties of tools and the quality index developed by Downs and Black were considered.
RESULTS
Our search yielded four studies and four different tools for paediatric patients with Duchenne muscular dystrophy (DMD). The Sydney Swallow Questionnaire, surface electromyography, Neuromuscular Disease Swallowing Status Scale, and videofluoroscopic swallow study showed interesting properties for DMD. No data were available for other NMD and children under 9 years. The mean total score for the quality index was 17.5.
INTERPRETATION
We did not identify any superior validated tools, either for screening or for evaluation of dysphagia, and no widely accepted protocol. Further studies are needed to identify the simplest assessment with the best psychometric properties for pNMD. We recommend establishing a specific tool for pNMD.
Topics: Child; Deglutition Disorders; Humans; Neuromuscular Diseases
PubMed: 27935021
DOI: 10.1111/dmcn.13354 -
Neurogastroenterology and Motility Dec 2022Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD). We performed... (Review)
Review
BACKGROUND
Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD). We performed a systematic review to assess the data on the effectiveness of the currently available interventions for the treatment of nocturnal reflux symptoms.
METHODS
We searched PubMed, EMBASE, and the Cochrane Library. All prospective, controlled, and uncontrolled clinical trials in adult patients describing interventions (lifestyle modifications, surgical and pharmacological) for nocturnal gastroesophageal reflux symptoms were assessed for eligibility. A narrative descriptive summary of findings is presented together with summary tables for study characteristics and quality assessment.
KEY RESULTS
The initial reference search yielded 3067 citations; 66 citations were screened in full text, of which 31 articles were included. Studies on lifestyle modifications include head of bed elevation (n = 5), prolonging dinner-to-bed time (n = 2), and promoting left lateral decubitus position (n = 2). Placebo-controlled clinical trials investigating proton pump inhibitors (PPIs) (n = 11) show success rates ranging from 34.4% to 80.8% in the PPI group versus 10.4%-51.7% in the placebo group. Laparoscopic fundoplication is reserved for severe disease only. There is insufficient evidence for a recommendation on the use of nasal continuous positive airway pressure (nCPAP), hypnotics, baclofen and adding bedtime H2 receptor antagonists for reducing nocturnal reflux. CONCLUSION INFERENCES: A sequential treatment strategy, including head of bed elevation, prolonging dinner-to-bed time, promoting left lateral decubitus position and treatment with acid-suppressive medication is recommended for nocturnal gastroesophageal reflux symptoms. Currently, there is insufficient evidence for the use of nCPAP, hypnotics, baclofen and adding bedtime H2 receptor antagonists.
Topics: Adult; Humans; Histamine H2 Antagonists; Baclofen; Prospective Studies; Gastroesophageal Reflux; Proton Pump Inhibitors; Treatment Outcome; Hypnotics and Sedatives
PubMed: 35445777
DOI: 10.1111/nmo.14385 -
The Cochrane Database of Systematic... Oct 2014Most patients with oesophageal and gastro-oesophageal carcinoma are diagnosed at an advanced stage and require palliative intervention. Although there are many kinds of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most patients with oesophageal and gastro-oesophageal carcinoma are diagnosed at an advanced stage and require palliative intervention. Although there are many kinds of interventions, the optimal one for the palliation of dysphagia remains unclear. This review updates the previous version published in 2009.
OBJECTIVES
The aim of this review was to systematically analyse and summarise the efficacy of different interventions used in the palliation of dysphagia in primary oesophageal and gastro-oesophageal carcinoma.
SEARCH METHODS
To find new studies for this updated review, in January 2014 we searched, according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases model, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and CINAHL; and major conference proceedings (up to January 2014).
SELECTION CRITERIA
Only randomised controlled trials (RCTs) were included in which patients with inoperable or unresectable primary oesophageal cancer underwent palliative treatment. Different interventions like rigid plastic intubation, self-expanding metallic stent (SEMS) insertion, brachytherapy, external beam radiotherapy, chemotherapy, oesophageal bypass surgery, chemical and thermal ablation therapy, either head-to-head or in combination, were included. The primary outcome was dysphagia improvement. Secondary outcomes included recurrent dysphagia, technical success, procedure related mortality, 30-day mortality, adverse effects and quality of life.
DATA COLLECTION AND ANALYSIS
Data collection and analysis were performed in accordance with the methods of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group.
MAIN RESULTS
We included 3684 patients from 53 studies. SEMS insertion was safer and more effective than plastic tube insertion. Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and for adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Some anti-reflux stents might have reduced gastro-oesophageal reflux and complications. Newly-designed double-layered nitinol (Niti-S) stents were preferable due to longer survival time and fewer complications compared to simple Niti-S stents. Brachytherapy might be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life, and might provide better results when combined with argon plasma coagulation or external beam radiation therapy.
AUTHORS' CONCLUSIONS
Self-expanding metal stent insertion is safe, effective and quicker in palliating dysphagia compared to other modalities. However, high-dose intraluminal brachytherapy is a suitable alternative and might provide additional survival benefit with a better quality of life. Some anti-reflux stents and newly-designed stents lead to longer survival and fewer complications compared to conventional stents. Combinations of brachytherapy with self-expanding metal stent insertion or radiotherapy are preferable due to the reduced requirement for re-interventions. Rigid plastic tube insertion, dilatation alone or in combination with other modalities, and chemotherapy alone are not recommended for palliation of dysphagia due to a high incidence of delayed complications and recurrent dysphagia.
Topics: Adenocarcinoma; Brachytherapy; Carcinoma, Squamous Cell; Deglutition Disorders; Esophageal Neoplasms; Gastroesophageal Reflux; Humans; Laser Therapy; Palliative Care; Photochemotherapy; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Stents
PubMed: 25354795
DOI: 10.1002/14651858.CD005048.pub4 -
Przeglad Gastroenterologiczny 2018Knowledge about oesophageal carcinoids is based primarily on case reports, and therefore information about them is incomplete. (Review)
Review
INTRODUCTION
Knowledge about oesophageal carcinoids is based primarily on case reports, and therefore information about them is incomplete.
AIM
To collect information on oesophageal carcinoid tumours in a systematic review study.
MATERIAL AND METHODS
Databases including PubMed, Scopus, and Web of Science were searched for the characteristics of oesophageal carcinoid tumour. Studies included original articles, case series, or case reports, reporting at least one of the characteristics of benign carcinoid tumour or carcinoid tumour.
RESULTS
Out of 670 studies searched, after evaluation and excluding non-relevant studies, 14 studies were included and analysed in the systematic review. These studies included 19 patients with carcinoid tumour of whom 57.9% were males with a mean age of 55.5 years. Dysphagia and weight loss were the most prevalent symptoms and signs in the patients. Lower oesophagus was the most prevalent site of tumour.
CONCLUSIONS
This meta-analysis showed that the mean age at diagnosis of oesophageal carcinoid was around 55 years, with 1.4 times greater prevalence among males, and located mainly in the distal oesophagus. The mean tumour size was 2.4 cm. The main symptoms and signs of this disease were dysphagia, weight loss, and reflux. The tumour behaviour was mainly non-aggressive except for cases associated with adenocarcinoma.
PubMed: 30302162
DOI: 10.5114/pg.2018.78285 -
Frontiers in Neurology 2023Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is...
BACKGROUND
Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is widely used in the treatment of post-stroke dysphagia, but the evidence-based medical evidence of NMES is limited. Therefore, this study aimed to evaluate the clinical efficacy of NMES in patients with post-stroke dysphagia by systematic review and meta-analysis.
METHODS
We searched the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases for all randomized controlled trials (RCTs) of NMES in the treatment of post-stroke dysphagia from the establishment of the database to 9 June 2022. The risk of bias assessment tool recommended by Cochrane and the GRADE method was used to assess the risk of bias and the quality of evidence. RevMan 5.3 was used for statistical analysis. Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically.
RESULTS
A total of 46 RCTs and 3,346 patients with post-stroke dysphagia were included in this study. Our meta-analysis showed that NMES combined with routine swallowing therapy (ST) could effectively improve swallowing function in Penetration-Aspiration Scale (MD = -0.63, 95% CI [-1.15, -0.12], = 0.01), Functional Oral Intake Scale (MD = 1.32, 95% CI [0.81, 1.83], < 0.00001), Functional Dysphagia Scale (MD = - 8.81, 95% CI [-16.48, -1.15], = 0.02), the Standardized Swallowing Assessment (MD = -6.39, 95% CI [-6.56, -6.22], < 0.00001), the Videofluoroscopic Swallow Study (MD = 1.42, 95% CI [1.28, 1.57], < 0.00001) and the Water swallow test (MD = -0.78, 95% CI [-0.84, -0.73], < 0.00001). Furthermore, it could improve the quality of life (MD = 11.90, 95% CI [11.10, 12.70], < 0.00001), increase the upward movement distance of hyoid bone (MD = 2.84, 95% CI [2.28, 3.40], < 0.00001) and the forward movement distance of hyoid bone (MD = 4.28, 95% CI [3.93, 4.64], < 0.00001), reduce the rate of complications (OR = 0.37, 95%CI [0.24, 0.57], < 0.00001). Subgroup analyses showed that NMES+ST was more effective at 25 Hz, 7 mA or 0-15 mA, and at courses ( ≤ 4 weeks). Moreover, patients with an onset of fewer than 20 days and those older than 60 years appear to have more positive effects after treatment.
CONCLUSION
NMES combined with ST could effectively increase the forward and upward movement distance of the hyoid bone, improve the quality of life, reduce the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022368416.
PubMed: 37228409
DOI: 10.3389/fneur.2023.1163045