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Revista Espanola de Enfermedades... Mar 2024A 73-year-old male patient presented to the Emergency Department with history of weight loss, dysphagia, and recurrent fever. The initial chest radiograph showed a...
A 73-year-old male patient presented to the Emergency Department with history of weight loss, dysphagia, and recurrent fever. The initial chest radiograph showed a mediastinal hypotransparency and to the complaints of dysphagia the patient did a barium swallow test that revealed a giant Zenker diverticulum. Apart from mildly elevated inflammatory markers and despite the extensive investigation of recurrent fever, no other relevant features were found either in blood analysis, microbiological cultures or computerized tomography. He was submitted to surgical intervention, with no recurrence of fever afterwards. It was assumed that food debris and possible microaspirations were responsible for the recurrence of fever and elevation of inflammatory markers. The patient eventually died due to late complications of surgery. Although recurrent fever is frequently linked to systemic disease, the presence of such a giant diverticulum was probably causing an inflammatory response that is usually not seen in these conditions.
Topics: Male; Humans; Aged; Deglutition Disorders; Fever; Diverticulum; Emergency Service, Hospital; Food; Zenker Diverticulum
PubMed: 36426849
DOI: 10.17235/reed.2022.9340/2022 -
Dysphagia Aug 2023Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the...
Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.
Topics: Humans; Deglutition; Deglutition Disorders; Quality of Life; Barium; Fluoroscopy
PubMed: 36229718
DOI: 10.1007/s00455-022-10532-3 -
Nutrients Apr 2024The aim of this study was to examine the frequency of dysphagia in patients with ischaemic stroke. It was crucial to evaluate the relationship between swallowing...
The aim of this study was to examine the frequency of dysphagia in patients with ischaemic stroke. It was crucial to evaluate the relationship between swallowing disorders and selected demographic and clinical indicators. Additionally, the association between various patient feeding methods and selected demographic and clinical factors was assessed. Based on the analysis of medical documentation, we identified the most important clinical parameters, including demographic data, the frequency of stroke risk factors, the location of the ischaemic lesion, cortical involvement, stroke severity as measured by the NIHSS (Nationale Institutes of Health Stroke Scale), and the methods of feeding post-stroke patients. Dysphagia was observed in 65.9% of the patients in the study group. Hypertension was the most common chronic illness in the studied population of ischemic stroke patients (91.8% of patients). Diet modification (35.7%) and PEG (25%) were the frequent methods of feeding in patients with confirmed dysphagia. Age played a significant role in determining the feeding methods in patients with dysphagia. Patients with a PEG (Percutaneous Endoscopic Gastrostomy) tube were the oldest (79.37 ± 10.80) and 75% of them had pneumonia. Early identification of swallowing difficulties in stroke patients is critical in determining an appropriate and safe feeding plan, as well as initiating logopedics therapy to improve swallowing efficacy and minimize pulmonary complications.
Topics: Humans; Deglutition Disorders; Male; Aged; Female; Retrospective Studies; Ischemic Stroke; Aged, 80 and over; Middle Aged; Risk Factors; Gastrostomy; Enteral Nutrition; Stroke; Age Factors
PubMed: 38674886
DOI: 10.3390/nu16081196 -
Medicine Mar 2024Dysphagia, or swallowing dysfunction, is a commonly observed complication among stroke patients, which has been associated with increased mortality rates. The treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dysphagia, or swallowing dysfunction, is a commonly observed complication among stroke patients, which has been associated with increased mortality rates. The treatment of post-stroke dysphagia encompasses various therapeutic approaches, and Kinesio taping has recently emerged as a potentially effective intervention. This study aims to evaluate the potential benefits of Kinesio Tape in improving dysphagia symptoms in individuals who have experienced a stroke.
METHODS
his study searched PubMed, Embase, The Cochrane Library, Web of Science, Wanfang Medical Database, CBM, CNKI, and Wipro VIP databases. Randomised controlled trials on the effect of intraosseous patches on the recovery of swallowing function in stroke patients were collected according to the inclusion and exclusion criteria. The search was conducted from from the date of database construction to June 2, 2023. Included trials were assessed using the Cochrane Risk of Bias tool. Meta-analyses were performed using ReviewerManager 5.4.1, and publication bias tests were performed using stata17.
RESULTS
A total of 12 randomized controlled trials consisting of 724 patients were included in the analysis. The results showed that the effective rate of Kinesio taping [RR = 1.27, 95% CI (1.16, 1.39), P < .00001], swallowing function score [MD = 0.78, 95% CI (0.45, 1.11), P < .00001], and quality of life score for patients with swallowing disorders [MD = 21.68, 95% CI (8.47, 36.90), P = .001] were all superior to those of the controls.
CONCLUSION
Kinesio taping have been shown to improve swallowing function and nutritional status in patients with dysphagia in the pharyngeal phase.
Topics: Humans; Deglutition Disorders; Athletic Tape; Quality of Life; Stroke; Deglutition; Randomized Controlled Trials as Topic
PubMed: 38489742
DOI: 10.1097/MD.0000000000037491 -
Radiation Protection Dosimetry Jul 2023Videofluoroscopic swallowing studies (VFSSs) are fluoroscopic examinations performed by speech and language pathologists (SLPs), for the evaluation of the oral and...
Videofluoroscopic swallowing studies (VFSSs) are fluoroscopic examinations performed by speech and language pathologists (SLPs), for the evaluation of the oral and pharyngeal phases of swallowing, in patients who are diagnosed with symptoms like dysphagia and speech impairment. The study was focused on the evaluation of the patient doses from VFSS performed at Hamad Medical Corporation hospitals. Data on the patient exposure and examination parameters were extracted from the Radiation Dose Monitoring system, statistically analysed and compared with literature. For adult patients, the mean (median) values for fluoroscopy time and kerma-air product were 2.8 (2.7) min and 181 (144) cGycm2, respectively. For children, the respective mean (median) values were 2.6 (2.4) min and 15.3 (9.2) cGycm2. The results of the study indicate that the VFSS are performed by well-trained health professionals, and as a result, image quality sufficient for a confident diagnosis is obtained at relatively low dose levels.
Topics: Adult; Child; Humans; Deglutition; Pathologists; Speech; Fluoroscopy; Deglutition Disorders
PubMed: 37345688
DOI: 10.1093/rpd/ncad181 -
Gut Feb 2024To assess the effect of long-term dupilumab on histological, symptomatic and endoscopic aspects of eosinophilic oesophagitis (EoE) in adolescent and adult patients with...
Dupilumab demonstrated efficacy and was well tolerated regardless of prior use of swallowed topical corticosteroids in adolescent and adult patients with eosinophilic oesophagitis: a subgroup analysis of the phase 3 LIBERTY EoE TREET study.
OBJECTIVE
To assess the effect of long-term dupilumab on histological, symptomatic and endoscopic aspects of eosinophilic oesophagitis (EoE) in adolescent and adult patients with and without prior use of swallowed topical corticosteroids (STC) or prior inadequate response, intolerance or contraindication to STC.
DESIGN
Pre-specified analysis of data from the phase 3 LIBERTY EoE TREET study on patients who received dupilumab 300 mg once a week or placebo for 24 weeks (W24) in parts A and B, and an additional 28 weeks (W52) in part C. Patients were categorised as with/without prior STC use and with/without inadequate/intolerance/contraindication to STC. The proportion of patients achieving ≤6 eosinophils per high-power field (eos/hpf), absolute change in Dysphagia Symptom Questionnaire (DSQ) score, mean change in Endoscopic Reference Score and Histologic Scoring System grade/stage scores were assessed for each subgroup.
RESULTS
Regardless of prior STC use, dupilumab increased the proportion of patients achieving ≤6 eos/hpf and improved DSQ score versus placebo at W24, with improvements maintained or improved at W52. The DSQ score and the proportion of patients achieving ≤6 eos/hpf after switching from placebo to dupilumab at W24 were similar to those observed in the dupilumab group at W24, regardless of prior STC use or inadequate/intolerance/contraindication to STC. Improvements in other outcomes with dupilumab were similar in patients with/without prior STC use or inadequate/intolerance/contraindication to STC.
CONCLUSION
Dupilumab 300 mg once a week demonstrated efficacy and was well tolerated in patients with EoE regardless of prior STC use or inadequate response, intolerance and/or contraindication to STC.
TRIAL REGISTRATION NUMBER
NCT03633617.
Topics: Adolescent; Adult; Humans; Antibodies, Monoclonal, Humanized; Deglutition Disorders; Double-Blind Method; Endoscopy; Eosinophilic Esophagitis; Glucocorticoids; Treatment Outcome
PubMed: 38050037
DOI: 10.1136/gutjnl-2023-330220 -
Medicina (Kaunas, Lithuania) Aug 2023(1) : The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic...
(1) : The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) : A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) : There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) : The combined therapy proved to be more effective than single OMT therapy.
Topics: Humans; Deglutition; Patients; Cervical Vertebrae; Neck; Posture
PubMed: 37763700
DOI: 10.3390/medicina59091580 -
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 -
Journal of Speech, Language, and... Oct 2023Swallowing efficiency impairments are the most prevalent and earliest manifestation of dysphagia in people with amyotrophic lateral sclerosis (pALS). We aimed to profile...
PURPOSE
Swallowing efficiency impairments are the most prevalent and earliest manifestation of dysphagia in people with amyotrophic lateral sclerosis (pALS). We aimed to profile number of swallows elicited in pALS across thin liquid, moderately thick liquid, extremely thick liquid, and crackers compared to expected healthy reference data and to determine relationships between degree of pharyngeal residue, number of elicited swallows, and swallowing safety.
METHOD
pALS underwent standardized videofluoroscopic swallowing studies of 10 bolus trials. Trained raters performed duplicate, independent, and blinded ratings to derive Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) efficiency and safety grades and Analysis of Swallowing Physiology: Events, Kinematics, and Timing (ASPEKT) percent total pharyngeal residue. Number of swallows per bolus was quantified (1 = typical, 2 = atypically high, 3 = extremely high). Kruskal-Wallis, Pearson chi-square, and odds ratio analyses were performed at bolus and participant levels.
KEY RESULTS
At the bolus level ( = 2,523), number of swallows per bolus was observed to be, in rank order, as follows: atypically high (49.1%), extremely high (28.5%), and typical (22.4%). Mean number of swallows significantly differed by International Dysphagia Diet Standardisation Initiative level ( < .0001), with a higher number of swallows elicited in pALS for moderately thick versus thin liquids, extremely thick liquids, and crackers, < .0001. Number of swallows per bolus increased with increasing DIGEST efficiency grades ( < .0001). Positive correlations were observed between ASPEKT percent residue and number of swallows for thin ( = .24) and moderately thick ( = .16) liquids, < .05. DIGEST efficiency and safety grades were not significantly associated ( > .05).
CONCLUSION AND INFERENCES
pALS demonstrated a higher number of swallows per bolus compared to healthy reference data that may represent a compensation for reductions in swallowing efficiency to clear pharyngeal residue.
Topics: Humans; Deglutition Disorders; Amyotrophic Lateral Sclerosis; Deglutition; Fluoroscopy; Food; Pharynx
PubMed: 37591233
DOI: 10.1044/2023_JSLHR-23-00209