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Esophagus : Official Journal of the... Jul 2020Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of...
Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of gastroesophageal junction (GEJ). Our aim was to systematically review and present all available data on demographics, clinical features, and diagnostic modalities involved in patients with pseudoachalasia. A systematic search of literature published during the period 1978-2019 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (end-of-search date: June 25th, 2019). Two independent reviewers extracted data with regards of study design, interventions, participants, and outcomes. Thirty-five studies met our inclusion criteria and were selected in the present review. Overall, 140 patients with pseudoachalasia were identified, of whom 83 were males. Mean patient age was 60.13 years and the mean weight loss was 13.91 kg. A total of 33 (23.6%) patients were wrongly 'treated' at first for achalasia. The most common presenting symptoms were dysphagia, food regurgitation, and weight loss. The median time from symptoms' onset to hospital admission was 5 months. Most common etiology was gastric cancer (19%). Diagnostic modalities included manometry, barium esophagram, endoscopy, and computed tomography (CT). Pseudoachalasia is a serious medical condition that is difficult to be distinguished from primary achalasia. Clinical feature assessment along with the correct interpretation of diagnostic tests is nowadays essential steps to differentiate pseudoachalasia from idiopathic achalasia.
Topics: Adult; Aged; Aged, 80 and over; Animals; Child; Deglutition; Deglutition Disorders; Diagnosis, Differential; Diagnostic Errors; Endoscopy; Esophageal Achalasia; Esophagogastric Junction; Female; Humans; Male; Manometry; Middle Aged; Rumination, Digestive; Stomach Neoplasms; Time Factors; Tomography, X-Ray Computed; Weight Loss
PubMed: 31989338
DOI: 10.1007/s10388-020-00720-1 -
Journal of Voice : Official Journal of... Mar 2023Bilateral vocal fold paralysis is a condition accounting for great mortality and significant worsening in patients' quality of life. Treatment applied to these patients... (Review)
Review
INTRODUCTION
Bilateral vocal fold paralysis is a condition accounting for great mortality and significant worsening in patients' quality of life. Treatment applied to these patients seek balance among breathing, airway protection and voice quality.
AIM
Critically and systematically reviewing the current literature on the topic in order to set the best technique to restore breathing comfort, without the need of tracheostomy, in patients with bilateral vocal fold paralysis. Furthermore, it seeks the surgical type technique accounting for the best breathing rate and for the smallest changes in voice parameters.
MATERIALS AND METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses method methodology and population, interventions, comparatives, outcomes and study design criteria were used as systematic search in the biggest databases and in the grey literature. The following meshes were used for the search: surgical interventions, surgical treatment, bilateral vocal cord paralysis, bilateral vocal fold paralysis, tracheostomy, decannulation, voice, and dysphonia. The selected studies should have followed the randomized clinical-trial type or be longitudinal observational controlled prospective studies (cohort studies).
RESULTS
In total, 3,548 articles were found. After duplicate studies were removed from the selection, the inclusion and exclusion criteria were applied and 06 articles were selected for qualitative analysis.
CONCLUSIONS
The assessed surgical procedures showed good cost-benefit to treat bilateral vocal fold paralysis, either because they improved the breathing function in most patients and allowed decannulation in patients with tracheostomy, or because they accounted for small changes to both voice parameters or deglutition. However, none of the described techniques has shown respiratory and functional outcomes better than those recorded for the other ones. The decision on what surgery to perform still must be made based on the judgement of an experienced surgeon.
Topics: Humans; Adult; Vocal Cord Paralysis; Vocal Cords; Treatment Outcome; Prospective Studies; Quality of Life
PubMed: 33468368
DOI: 10.1016/j.jvoice.2020.11.018 -
European Journal of Pediatrics May 2023to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11-63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11-63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%). Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae.
WHAT IS KNOWN
• Survival rates of esophageal atresia patients is now more than 90% thanks to the improvements in surgical techniques and intensive care, therefore patients' needs throughout adolescence and adulthood must be taken into account.
WHAT IS NEW
• This review, by summarizing recent literature concerning long term sequelae of esophageal atresia, may contribute to raise awareness on the importance of defining standardized protocols of transitional and adulthood care for esophageal atresia patients.
Topics: Adolescent; Adult; Child; Humans; Middle Aged; Young Adult; Barrett Esophagus; Deglutition Disorders; Disease Progression; Esophageal Atresia; Follow-Up Studies; Gastroesophageal Reflux; Quality of Life; Transitional Care
PubMed: 36905437
DOI: 10.1007/s00431-023-04893-6 -
International Journal of Environmental... May 2021Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of... (Review)
Review
Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia.
Topics: Animals; Deglutition; Deglutition Disorders; Mice; Mouth; Pharynx; Rats; Rodentia
PubMed: 34067192
DOI: 10.3390/ijerph18094987 -
American Journal of Speech-language... Jan 2022This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India.
METHOD
We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle-Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the index.
RESULTS
A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented.
CONCLUSIONS
Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022.
Topics: Deglutition Disorders; Humans; Incidence; Pneumonia; Prevalence; Stroke
PubMed: 34982940
DOI: 10.1044/2021_AJSLP-21-00175 -
Sleep & Breathing = Schlaf & Atmung Mar 2023Recently, the use of barbed pharyngoplasty (BP) has become widespread in snoring and obstructive sleep apnoea (OSA) palatal surgery, but there are no studies regarding... (Review)
Review
BACKGROUND
Recently, the use of barbed pharyngoplasty (BP) has become widespread in snoring and obstructive sleep apnoea (OSA) palatal surgery, but there are no studies regarding the short- and long-term complications resulting from these different techniques. This systematic review aimed to report the complications and side effects of different BP techniques.
METHODS
An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September 2, 2021.
RESULTS
We included 14 prospective clinical studies consisting of 769 patients aged 23 to 81 years. The associated intra-operative complications of BP were as follows: partial thread extrusion (2.9%), self-limited bleeding (2.9%), broken needle (1.0%), and suture rupture (1.0%). Short-term complications were as follows: thread/knot extrusion (12.4%), dysphagia (5.6%), bleeding (1.5%), velopharyngeal insufficiency (1.5%), anterior pharyngoplasty dehiscence (1.2%), tonsillar haemorrhage (1.0%), excessive postnasal discharge (1.0%), barbed suture failure (0.5%), acute infection (0.2%), mucosal granulomas (0.2%), chipped tooth caused by mouth gag displacement (0.2%), and fibrous scar (0.2%). Long-term complications were as follows: foreign body sensation (7.8%), sticky mucus in throat (5.9%), dysphagia (3.6%), rhinolalia (3.1%), throat phlegm (1.1%), nose regurgitation (0.8%), dry throat (0.6%), and throat lump (0.3%).
CONCLUSION
BP is a safe technique free of significant side effects and major complications. However, in this review, patients undergoing BP were very heterogeneous in terms of characteristics of patients chosen and severity of diseases, surgical technique used (myoresective vs non-myoresective), time of follow-up, and mono level vs multilevel surgery. More studies on a larger scale with long-term follow-up are needed to confirm these promising results.
Topics: Humans; Pharynx; Deglutition Disorders; Prospective Studies; Neck
PubMed: 35217931
DOI: 10.1007/s11325-022-02585-3 -
Aging Clinical and Experimental Research Dec 2022Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact.
METHODS
The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]).
RESULTS
The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0).
CONCLUSION
One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.
Topics: Humans; Aged; Aged, 80 and over; Independent Living; Deglutition; Deglutition Disorders; Prevalence; Xerostomia
PubMed: 36207669
DOI: 10.1007/s40520-022-02258-x -
Japan Journal of Nursing Science : JJNS Apr 2021To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. (Meta-Analysis)
Meta-Analysis Review
AIM
To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia.
METHODS
A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology.
RESULTS
Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively.
CONCLUSION
Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.
Topics: Cohort Studies; Cross-Sectional Studies; Deglutition Disorders; Humans; Sensitivity and Specificity; Ultrasonography
PubMed: 33843140
DOI: 10.1111/jjns.12396 -
Journal of Clinical Medicine Apr 2022Dysphagia is one of the most common symptoms in patients after stroke onset, which has multiple unfavorable effects on quality of life and functional recovery.... (Review)
Review
UNLABELLED
Dysphagia is one of the most common symptoms in patients after stroke onset, which has multiple unfavorable effects on quality of life and functional recovery. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation that is widely used to improve deglutition function. Recently, some studies have confirmed that tDCS enhances deglutition function after stroke. However, the number of evaluation indexes used in those studies was small, and the number of trials included was limited. Most importantly, the optimal stimulation protocol is still uncertain and the safety of tDCS has not been reviewed. Therefore, we conducted a systematic review and meta-analysis to address these shortcomings.
METHODS
Seven databases were searched entirely, including Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. Two reviewers independently evaluated the eligibility of retrieved data according to the selection criteria and assessed the methodological quality of the studies using the Cochrane risk of bias tool. Outcomes, measures, and indicators used in this study included the dysphagia outcome and severity scale (DOSS), modified Mann assessment of swallowing ability (MMASA), functional oral intake scale (FOIS), functional dysphagia scale (FDS), and Kubota's water-drinking test (KWDT). Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically.
RESULTS
Fifteen trials with a total of 787 participants (394 subjects in the tDCS groups were treated with true tDCS, and 393 subjects in the control groups were wait-listed or treated with sham tDCS) involving tDCS for dysphagia after stroke and were included in the meta-analysis. Results of this meta-analysis confirmed that tDCS had a positive effect on post-stroke dysphagia. Subgroup analyses revealed that bilateral and high-intensity stimulation with tDCS had a more significant impact on post-stroke dysphagia. Furthermore, no adverse events occurred during the application of tDCS for post-stroke dysphagia.
CONCLUSION
tDCS can promote the recovery of deglutition function in patients with dysphagia after stroke. In addition, bilateral stimulation and high-intensity stimulation may have better effects. However, the safety evidence for tDCS and post-stroke dysphagia is insufficient.
PubMed: 35566421
DOI: 10.3390/jcm11092297 -
Neural Plasticity 2021Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.
OBJECTIVE
To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.
METHODS
Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the . A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).
RESULTS
Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS ( = 0.52) > tDCS ( = 0.48), the best probabilistic ranking of the SSA score is rTMS ( = 0.72) > tDCS ( = 0.28), and the best probabilistic ranking of the PAS score is rTMS ( = 0.68) > tDCS ( = 0.32).
CONCLUSION
Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.
Topics: Deglutition Disorders; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic; Stroke; Transcranial Direct Current Stimulation
PubMed: 34777497
DOI: 10.1155/2021/3831472