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World Journal of Gastroenterology Jun 2024The peroral endoscopic myotomy (POEM) procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally... (Review)
Review
The peroral endoscopic myotomy (POEM) procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally invasive endoscopic solution to their dysphagia caused by achalasia. Alongside its success in alleviating dysphagia, concerns regarding postoperative gastroesophageal reflux disease have emerged as a pertinent issue which are not fully resolved. In this study, Nabi have comprehensively reviewed the topic of the prediction, prevention and management of gastroesophageal reflux after POEM. POEM is a purely endoscopic procedure which is usually performed without any anti-reflux procedure. Certain patients may be better served by a laparoscopic Heller's myotomy and fundoplication and it is important that gastroenterologists and surgeons provide comprehensive risks and benefits of each achalasia treatment option so that patients can decide what treatment is best for them. This article by Nabi provides a comprehensive review of the current status of this issue to allow these discussions to occur.
Topics: Esophageal Achalasia; Humans; Gastroesophageal Reflux; Fundoplication; Risk Assessment; Heller Myotomy; Postoperative Complications; Treatment Outcome; Deglutition Disorders; Laparoscopy; Natural Orifice Endoscopic Surgery; Risk Factors
PubMed: 38899334
DOI: 10.3748/wjg.v30.i21.2740 -
Nutrients Aug 2023Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol...
Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the rheological and textural properties of ten thick purees (Texture C, British Dietetic Association), (b) understand the effect of oral processing, and (c) measure the properties of the ready-to-swallow bolus after oral processing in healthy adults. Shear viscosity at 50 s and 300 s and textural properties (maximum force, cohesiveness, and adhesiveness) of boluses of ten thick purees were analyzed with a rheometer and a texture analyzer before and after oral processing (ready-to-swallow) in five healthy volunteers. Viscosity varied by 81.78% at 50 s (900-4800 mPa·s) among purees before oral processing. Maximum force varied by 60% (0.47-1.2 N); cohesiveness, 18% (0.66-0.82), and adhesiveness, 32% (0.74-1.1 N·s). The high variability of viscosity was also present in ready-to-swallow boluses, 70.32% among purees. Oral processing significantly reduced viscosity in most purees (French omelet, zucchini omelet, turkey stew, red lentils, noodles, and hake fish) and also significantly reduced maximum force (7-36%) and adhesiveness (17-51%) but hardly affected cohesiveness (<5%). All thick purees met the qualitative textural descriptors for Level C texture. However, all ten purees showed significant differences in all parameters measured instrumentally and were affected differently by oral processing. This study demonstrates the need to use instrumental quality control using standardized protocols and SI units to narrow the variability and provide the optimal values for patients with dysphagia who require texture-modified diets.
Topics: Animals; Deglutition Disorders; Deglutition; Body Fluids; Dietetics; Eggs
PubMed: 37686799
DOI: 10.3390/nu15173767 -
BMC Geriatrics Dec 2023Community-based exercise programs have demonstrated potential for implementation in older adults; however, it remains imperative to ascertain whether this strategy will... (Randomized Controlled Trial)
Randomized Controlled Trial
Community-based group rehabilitation program for stroke patients with dysphagia on quality of life, depression symptoms, and swallowing function: a randomized controlled trial.
BACKGROUND
Community-based exercise programs have demonstrated potential for implementation in older adults; however, it remains imperative to ascertain whether this strategy will yield comparable benefit in stroke patients with dysphagia.
METHODS
This was a single blinded, randomized, matched pairs clinical trial. Sixty-four stroke patients with dysphagia were recruited from patients who had been discharged the Rehabilitation Department of the Third Affiliated Hospital of Sun Yat-sen University. A single blinded, randomized and controlled trial was conducted. Participants were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Patients in the intervention group received health education followed by swallowing function training in community public spaces for 5 days every week over an eight-week period (60 minutes per day). Patients in the control group received swallowing rehabilitation training, and booster educational information about dysphagia, as well as instructions on how to improve quality of life. Swallowing function (Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA)), depressive symptoms (Geriatric Depression Scale-15), and quality of life (Swallowing-Quality of Life, SWAL-QOL) were assessed before and after all the treatment.
RESULTS
Before treatment, the two groups did not differ statistically. After the intervention, the swallowing function (SSA and FOIS) showed a significant improvement in both groups (All p < 0.001). But there was no significant difference in Functional Oral Intake Scale change between groups (P = 0.479). Compared with the control group, the intervention group had a significant improvement in depressive symptoms (P = 0.002), with a greater reduction in the number of depressed patients (13 to 6).The control group showed no significant improvements in depressive symptoms or a reduction in the number of depressed patients before and after treatment (P = 0.265, 14 to 12). The Swallowing-Quality of Life scores showed significant improvement in both the intervention and control group (P < 0.001). Specifically within Swallowing-Quality of Life sub-domains, greater changes were observed in symptoms and frequency (P < 0.001), communication (P = 0.012), and sleep (P = 0.006) for participants in the intervention group. And the cost-effectiveness of group rehabilitation surpasses that of rehabilitation training.
CONCLUSION
Community-based group rehabilitation program is more effective than traditional treatment in improving patients' depressive symptoms and quality of life, as well as being more cost-effective.
Topics: Aged; Humans; Deglutition; Deglutition Disorders; Depression; Quality of Life; Stroke; Stroke Rehabilitation; Treatment Outcome; Single-Blind Method
PubMed: 38124046
DOI: 10.1186/s12877-023-04555-0 -
Use of Muscle Ultrasonography in Morphofunctional Assessment of Amyotrophic Lateral Sclerosis (ALS).Nutrients Mar 2024Amyotrophic lateral sclerosis (ALS) is a progressive disease with a high prevalence of malnutrition that can influence prognosis. The main objective of this study is to... (Observational Study)
Observational Study
UNLABELLED
Amyotrophic lateral sclerosis (ALS) is a progressive disease with a high prevalence of malnutrition that can influence prognosis. The main objective of this study is to compare the validity of muscle ultrasonography in the diagnosis of malnutrition and the prognosis of patients with ALS.
METHODS
This is a prospective observational study that analyzes the nutritional status of patients at the beginning of nutritional monitoring. The morphofunctional assessment included the examination of anthropometric variables such as weight, height, body mass index (BMI), arm circumference, and calf circumference. Additionally, electrical bioimpedanciometry (BIA) was used to measure electrical parameters and estimate other relevant metrics. Muscle ultrasonography (quadriceps rectus femoris (QRF)) assessed muscle mass parameters, including muscle area index (MARAI), anteroposterior diameter of the QRF (-axis) (cm), transverse diameter of the QRF (-axis) (cm), and the sum of the quadriceps thickness (RF+VI) (cm), as well as muscle quality parameters such as echogenicity and the Y-X index.
RESULTS
A total of 37 patients diagnosed with amyotrophic lateral sclerosis (ALS) were included in this study. Of these patients, 51.4% were men. The mean age was 64.27 (12.59) years. A total of 54.1% of the patients had a bulbar onset of amyotrophic lateral sclerosis, and 45.9% had spinal onset. The percentage of subjects with malnutrition diagnosed by the Global Leadership Initiative on Malnutrition (GLIM) criteria was 45.9% of patients. There was a direct correlation between muscle mass parameters assessed by muscle ultrasonography (RF+VI) and active mass markers measured by bioimpedanciometry (body cellular mass index (BCMI) (r = 0.62; < 0.01), fat-free mass index (FFMI) (r = 0.75; < 0.01), and appendicular skeletal mass index (ASMI) (r = 0.69; < 0.01)). There was a direct correlation between echogenicity and resistance (r = 0.44; = 0.02), as well as between the fat-free mass index and the Y-X index (r = 0.36; = 0.14). Additionally, there was a negative correlation between echogenicity and BCMI (r = -0.46; < 0.01) and ASMI (r = 0.34; = 0.06). Patients with low quadriceps thickness (male < 2.49 cm; female < 1.84 cm) showed an increased risk of hospital admission adjusted by age, sex, and presence of dysphagia (OR: 7.84 (CI 95%: 1.09-56.07); -value = 0.04), and patients with low-quality mass (Y-X index < 0.35) had a higher risk of hospital admission adjusted by age, sex, and presence of dysphagia (OR: 19.83 (CI 95%: 1.77-222.46); -value = 0.02).
CONCLUSIONS
In patients with ALS, ultrasonography echogenicity was inversely related to BCMI, FFMI, and ASMI, and the Y-X index was directly related to FFMI. The lowest quartiles of quadriceps thickness and Y-X index are risk factors for hospital admission.
Topics: Female; Humans; Male; Middle Aged; Amyotrophic Lateral Sclerosis; Body Mass Index; Deglutition Disorders; Malnutrition; Quadriceps Muscle; Prospective Studies
PubMed: 38613054
DOI: 10.3390/nu16071021 -
Scientific Reports Dec 2023This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms...
This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms undergoing real-time MRI of the esophagus and esophagogastric junction between 2015 and 2018 were included. A 10 ml bolus of pineapple juice served as an oral contrast agent. Patients performed Valsalva maneuver to provoke reflux and hiatal hernia. Systematic MRI assessment included visual presence of achalasia, fundoplication failure in patients with previous surgical fundoplication, gastroesophageal reflux, and hiatal hernia. A total of 184 patients (n = 92 female [50%], mean age 52.7 ± 15.8 years) completed MRI studies without adverse events at a mean examination time of 15 min. Gastroesophageal reflux was evident in n = 117 (63.6%), hiatal hernia in n = 95 (52.5%), and achalasia in 4 patients (2.2%). Hiatal hernia was observed more frequently in patients with reflux at rest (n = 67 vs. n = 6, p < 0.01) and during Valsalva maneuver (n = 87 vs. n = 8, p < 0.01). Real-time MRI visualized a morphologic correlate for recurring GERD symptoms in 20/22 patients (90%) after fundoplication procedure. In a large-scale single-center cohort of patients with GERD symptoms undergoing real-time MRI, visual correlates for clinical symptoms were evident in most cases. The proposed assessment algorithm could aid in wider-spread utilization of real-time MRI and provides a comprehensive approach to this novel imaging modality.
Topics: Humans; Female; Adult; Middle Aged; Aged; Hernia, Hiatal; Deglutition; Esophageal Achalasia; Gastroesophageal Reflux; Magnetic Resonance Imaging; Laparoscopy; Treatment Outcome
PubMed: 38129469
DOI: 10.1038/s41598-023-49776-w -
BMJ Open Dec 2023To determine change trajectories and predictors of swallowing function and swallowing-related quality of life (QoL) in perioperative patients with oral cancer. (Observational Study)
Observational Study
Perioperative change trajectories and predictors of swallowing function and swallowing-related quality of life in patients with oral cancer: a longitudinal observational study.
OBJECTIVE
To determine change trajectories and predictors of swallowing function and swallowing-related quality of life (QoL) in perioperative patients with oral cancer.
DESIGN
Longitudinal observational study.
SETTING
A tertiary cancer hospital in Hunan Province, China.
PARTICIPANTS
Patients with oral cancer scheduled for surgery were recruited using convenience sampling.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcomes were swallowing function and swallowing-related QoL. The secondary outcomes were the predictors of the swallowing function and swallowing-related QoL.
METHODS
The participants completed the sociodemographic and clinical data questionnaire, Nutritional Risk Screening 2002 and MD Anderson Dysphagia Inventory before surgery, 7 days after operation and 1 month after operation. Data were analysed using t-test, analysis of variance and generalised linear models.
RESULTS
Among 138 participants who completed all the three surveys, 41 (29.71%) had moderate to severe dysphagia before surgery. Swallowing function and swallowing-related QoL changed over time, showing the trend of decline first and then increase. Preoperative swallowing function and swallowing-related QoL were affected by sex, lymphocyte level, preoperative nutritional risk and primary tumour site. At 7 days postoperatively, tracheotomy affected swallowing function. At 1 month postoperatively, age and marital status influenced swallowing function, whereas age, type of job and preoperative nutritional risk influenced swallowing-related QoL.
CONCLUSIONS
Our study demonstrates that perioperative patients with oral cancer generally faced swallowing disorders, especially in the acute phase after surgery. Healthcare providers should pay attention to the swallowing function of perioperative patients with oral cancer, especially those with preoperative nutritional risk, tongue tumour, tracheotomy, age <60 years, and no spouse and the employed patients, and provide available interventions, such as swallowing and nutritional therapy, as early as possible to improve their swallowing function. Meanwhile, doctors should recommend the most evidence-based treatment options, such as reconstruction or not, preoperative chemotherapy or not, to patients.
Topics: Humans; Middle Aged; Deglutition; Deglutition Disorders; Mouth Neoplasms; Quality of Life; Tongue Neoplasms; Male; Female
PubMed: 38086600
DOI: 10.1136/bmjopen-2023-075401 -
Acta Medica Portuguesa Nov 2023Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient's personal and...
INTRODUCTION
Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient's personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population.
MATERIAL AND METHODS
Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity.
RESULTS
The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach's α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity.
CONCLUSION
The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.
Topics: Adult; Humans; Female; Aged; Portugal; Quality of Life; Deglutition Disorders; Reproducibility of Results; Deglutition; Translations; Surveys and Questionnaires; Language; Psychometrics
PubMed: 36961414
DOI: 10.20344/amp.19161 -
Scientific Reports Sep 2023Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment...
Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.
Topics: Humans; Deglutition Disorders; Surgeons; Diskectomy; Bone Plates; Bone Screws
PubMed: 37737299
DOI: 10.1038/s41598-023-43086-x -
Curationis Mar 2024Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in... (Review)
Review
BACKGROUND
Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in identifying symptoms of post-stroke dysphagia.
OBJECTIVE
To explore existing literature regarding nurses' practices and knowledge in the identification and management of post-stroke oropharyngeal dysphagia (OPD) in low- and middle income countries (LMICs).
METHOD
A scoping review was conducted according to the PRISMA-ScR guidelines. Studies were retrieved from PubMed, Scopus, EBSCOhost (CINAHL and Health source: Nursing and Academic edition), Web of Science Core collection, and Cochrane libraries. No time frame was applied, and all included studies were screened according to predefined eligibility criteria.
RESULTS
Eight studies were included from 1 792 initial hits. Studies described nursing practices in acute care pertaining to identification and management of stroke-related dysphagia in LMICs. Increased knowledge was reported in nurses who had greater clinical experience in managing patients with dysphagia. Needs for training relating to dysphagia management and opportunities for interprofessional collaboration with speech-language therapists (SLTs) were identified. Contextual barriers specific to LMICs impacting on optimal nursing management of dysphagia included heavy workloads, staff-shortages and time constraints.Conclusion and contribution: Eight studies described nurses' practices and identified needs for the improvement of nurses' dysphagia care in LMICs. This scoping review highlighted the urgency for further research in dysphagia management that provides creative, contextually relevant solutions for improved protocols and training of health care professionals. Findings may be valuable for the multidisciplinary team involved in post-stroke dysphagia care.
Topics: Humans; Developing Countries; Deglutition Disorders; Health Personnel; Allied Health Personnel; Nurses
PubMed: 38572844
DOI: 10.4102/curationis.v47i1.2499 -
Journal of Neuroengineering and... Mar 2024Conventional diagnostic methods for dysphagia have limitations such as long wait times, radiation risks, and restricted evaluation. Therefore, voice-based diagnostic and...
BACKGROUND
Conventional diagnostic methods for dysphagia have limitations such as long wait times, radiation risks, and restricted evaluation. Therefore, voice-based diagnostic and monitoring technologies are required to overcome these limitations. Based on our hypothesis regarding the impact of weakened muscle strength and the presence of aspiration on vocal characteristics, this single-center, prospective study aimed to develop a machine-learning algorithm for predicting dysphagia status (normal, and aspiration) by analyzing postprandial voice limiting intake to 3 cc.
METHODS
Conducted from September 2021 to February 2023 at Seoul National University Bundang Hospital, this single center, prospective cohort study included 198 participants aged 40 or older, with 128 without suspected dysphagia and 70 with dysphagia-aspiration. Voice data from participants were collected and used to develop dysphagia prediction models using the Multi-Layer Perceptron (MLP) with MobileNet V3. Male-only, female-only, and combined models were constructed using 10-fold cross-validation. Through the inference process, we established a model capable of probabilistically categorizing a new patient's voice as either normal or indicating the possibility of aspiration.
RESULTS
The pre-trained models (mn40_as and mn30_as) exhibited superior performance compared to the non-pre-trained models (mn4.0 and mn3.0). Overall, the best-performing model, mn30_as, which is a pre-trained model, demonstrated an average AUC across 10 folds as follows: combined model 0.8361 (95% CI 0.7667-0.9056; max 0.9541), male model 0.8010 (95% CI 0.6589-0.9432; max 1.000), and female model 0.7572 (95% CI 0.6578-0.8567; max 0.9779). However, for the female model, a slightly higher result was observed with the mn4.0, which scored 0.7679 (95% CI 0.6426-0.8931; max 0.9722). Additionally, the other models (pre-trained; mn40_as, non-pre-trained; mn4.0 and mn3.0) also achieved performance above 0.7 in most cases, and the highest fold-level performance for most models was approximately around 0.9. The 'mn' in model names refers to MobileNet and the following number indicates the 'width_mult' parameter.
CONCLUSIONS
In this study, we used mel-spectrogram analysis and a MobileNetV3 model for predicting dysphagia aspiration. Our research highlights voice analysis potential in dysphagia screening, diagnosis, and monitoring, aiming for non-invasive safer, and more effective interventions.
TRIAL REGISTRATION
This study was approved by the IRB (No. B-2109-707-303) and registered on clinicaltrials.gov (ID: NCT05149976).
Topics: Female; Humans; Male; Algorithms; Deglutition Disorders; Machine Learning; Prospective Studies; Respiratory Aspiration; Adult
PubMed: 38555417
DOI: 10.1186/s12984-024-01329-6