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Systematic Reviews May 2024Oropharyngeal dysphagia (OPD) can be functionally debilitating in persons with multiple sclerosis (pwMS). OPD induces alterations in safety and efficiency of food and/or...
BACKGROUND
Oropharyngeal dysphagia (OPD) can be functionally debilitating in persons with multiple sclerosis (pwMS). OPD induces alterations in safety and efficiency of food and/or liquid ingestion and may incur negative sequalae such as aspiration pneumonia or malnutrition/dehydration. Early detection and timely management of OPD in pwMS could prevent such complications and reduce mortality rates. Identifying risk factors of OPD relative to its onset or repeat manifestation will enable the development of care pathways that target early assessment and sustained management. The aims of this systematic review are to compile, evaluate, and summarize the existing literature reporting potential risk factors and associated long-term outcomes (e.g., aspiration pneumonia, malnutrition, dehydration, and/or death) of OPD in pwMS.
METHODS
We will undertake a systematic review to identify studies that describe patterns and complications of OPD in pwMS. Variables of interest include predictors of OPD along with long-term outcomes. We will search MEDLINE, Embase, CINAHL, AMED, the Cochrane Library, Web of Science, and Scopus. We will consider studies for inclusion if they involve at least 30 adult participants with MS and report risk factors for OPD and/or its long-term outcomes. Studies will be excluded if they refer to esophageal or oropharyngeal dysphagia induced by causes other than multiple sclerosis. Study selection and data extraction will be performed by two independent assessors for abstract and full article review. We will present study characteristics in tables and document research findings for dysphagia-related risk factors or its complications via a narrative format or meta-analysis if warranted (e.g., mean difference and/or risk ratio measurements). All included studies will undergo risk-of-bias assessment conducted independently by two authors with consensus on quality ratings.
DISCUSSION
There is a lacune for systematic reviews involving risk factors and long-term outcomes of dysphagia in pwMS to date. Our systematic review will provide the means to develop accurate and efficient management protocols for careful monitoring and evaluation of dysphagia in pwMS. The results of this systematic review will be published in a peer-reviewed journal.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42022340625.
Topics: Humans; Deglutition Disorders; Systematic Reviews as Topic; Risk Factors; Multiple Sclerosis; Pneumonia, Aspiration; Malnutrition
PubMed: 38698450
DOI: 10.1186/s13643-024-02530-3 -
BMJ Case Reports May 2024A man in his late 50s presented with severe dysphagia caused by a complex refractory benign stenosis that was completely obstructing the middle oesophagus. The patient...
A man in his late 50s presented with severe dysphagia caused by a complex refractory benign stenosis that was completely obstructing the middle oesophagus. The patient was unsatisfied with the gastrostomy tube placed via laparotomy as a long-term solution. Therefore, we performed robot-assisted minimally invasive oesophagectomy (video). Mobilisation of the stomach and gastric conduit preparation were more difficult due to the previously inserted gastrostomy tube; thus, the conduit blood supply was assessed using indocyanine green fluorescence. After an uncomplicated course, the patient was referred directly to inpatient rehabilitation on the 16th postoperative day. At 9 months after surgery, the motivated patient returned to full-time work and achieved level 7 on the functional oral intake scale (total oral diet, with no restrictions). At the 1-year follow-up, he positively confirmed all nine key elements of a good quality of life after oesophagectomy.
Topics: Humans; Male; Esophagectomy; Gastrostomy; Robotic Surgical Procedures; Middle Aged; Esophageal Stenosis; Deglutition Disorders; Quality of Life; Treatment Outcome
PubMed: 38697681
DOI: 10.1136/bcr-2023-256455 -
Pediatric Surgery International May 2024Existing guidelines provide weak recommendations on the surgical management of nutritional problems in children. The objective was to design a management pathway to...
PURPOSE
Existing guidelines provide weak recommendations on the surgical management of nutritional problems in children. The objective was to design a management pathway to address the best nutritional surgery (NS) procedure in a given patient.
METHODS
Retrospective analysis of children treated at our department from January 2015 to December 2019. The sample was divided into two groups according to presence or absence of neurological impairment (NI). Patients with NI (Group 1) were classified in three subgroups based on presenting symptoms: A-Dysphagia without gastroesophageal reflux (GER); B-GER with or without dysphagia; C-Symptoms associated with a delayed gastric emptying.
RESULTS
A total of 154 patients were included, 111 with NI. One-hundred-twenty-eight patients underwent only one procedure. Complications and mortality were superior in Group 1. In subgroup A, isolated gastrostomy was the first NS in all patients. In subgroup B most of patients were subjected to a Nissen fundoplication, while in 5 cases total esophagogastric dissociation (TEGD) was the first intervention. Considering the entire sample, 92.3% patients who underwent a TEGD did not require further procedures.
CONCLUSION
NS encompasses various procedures depending on presenting symptoms and neurological status. A management flowchart for these patients is proposed.
Topics: Humans; Retrospective Studies; Female; Male; Child; Child, Preschool; Infant; Deglutition Disorders; Gastroesophageal Reflux; Gastrostomy; Adolescent; Nervous System Diseases; Fundoplication; Postoperative Complications
PubMed: 38695977
DOI: 10.1007/s00383-024-05700-5 -
Journal of Physical Therapy Science May 2024[Purpose] In older adults, the risk of aspiration pneumonia increases because of coexisting factors such as age-related decline in swallowing function, inefficient...
Differences in cough strength, respiratory function, and physical performance in older adults with and without low swallowing function in the repetitive saliva swallowing test.
[Purpose] In older adults, the risk of aspiration pneumonia increases because of coexisting factors such as age-related decline in swallowing function, inefficient cough, reduced respiratory function, and poor physical performance. This study aimed to investigate the differences in cough strength, respiratory function, and physical performance in community-dwelling ambulatory older adults with and without low swallowing function. [Participants and Methods] In 225 community-dwelling ambulatory older adults, swallowing function (the repetitive saliva swallowing test, RSST), cough strength (peak cough flow), lung function (forced vital capacity, forced expiratory volume in 1 second/forced vital capacity), respiratory muscle strength (maximum inspiratory and expiratory pressures), and physical performance (30-second chair stand test and Timed Up and Go test) were evaluated. Participants with low swallowing function in RSST (low RSST group) were compared to age- and sex-matched participants without low swallowing function (control group). [Results] Peak cough flow and maximum inspiratory and expiratory pressures were significantly lower in the low RSST group (n=14) than the control group (n=14). [Conclusion] These preliminary results suggest that community-dwelling ambulatory older adults with low swallowing function in RSST might have lower cough and respiratory muscle strength, even if they have relatively preserved lung function and physical performance.
PubMed: 38694018
DOI: 10.1589/jpts.36.273 -
JTCVS Open Apr 2024The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the...
OBJECTIVE
The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs).
METHODS
This retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale.
RESULTS
MPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively ( = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was <10 seconds.
CONCLUSIONS
These findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.
PubMed: 38690425
DOI: 10.1016/j.xjon.2024.02.002 -
The Saudi Dental Journal Apr 2024The association between the visceral swallowing pattern (VSP) and dentofacial abnormalities remains controversial. This cross-sectional study aimed to investigate the...
INTRODUCTION
The association between the visceral swallowing pattern (VSP) and dentofacial abnormalities remains controversial. This cross-sectional study aimed to investigate the association between the VSP and various factors including type of birth, gender, tongue posture, lip incompetence, eruption of primary molars, habits and the presence of malocclusions in children with primary and early mixed dentition.
MATERIAL AND METHOD
A total of 219 children (102 boys and 117 girls) were evaluated using a combination of a questionnaire and a structured clinical examination by one pediatric specialist dentist. Kittel's method of tongue posture evaluation and the Payne technique for assessment of swallowing pattern were included in the clinical examination of myofunctional status. After checking for normality, normal and non-normal distributed data were analyzed using two-sample -test and Mann-Whitney test, respectively. Analysis of categorical variables was done using a chi-square test, and Bonferroni correction was used as correction for multiple comparisons.
RESULTS
A total of 56.2 % of the study population had a VSP. The chi-square test indicated a statistically significant higher presence of VSP in male gender. Statistically significant associations were seen between the VSP and lip incompetency, pathologic resting tongue position, habits, anterior open bite and increased overjet. On the other hand, no statistically significant associations were found between VSP and children's age within the sample population, type of birth, uni- or bilateral crossbites, increased overbite, edge-to-edge anterior bite or completion of eruption of primary molars and/or permanent incisors.
CONCLUSIONS
The association between VSP and male gender, pathologic tongue posture, lip incompetency and habits and occlusal traits such as anterior open bite and increased anterior overjet is supported by the results of the present study.
PubMed: 38690392
DOI: 10.1016/j.sdentj.2024.01.001 -
Frontiers in Cellular and Infection... 2024The mechanism by which high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) improves swallowing function by regulating intestinal flora remains...
BACKGROUND
The mechanism by which high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) improves swallowing function by regulating intestinal flora remains unexplored. We aimed to evaluate this using fecal metabolomics and 16S rRNA sequencing.
METHODS
A Post-stroke dysphagia (PSD) rat model was established by middle cerebral artery occlusion. The magnetic stimulation group received HF-rTMS from the 7th day post-operation up to 14th day post-surgery. Swallowing function was assessed using a videofluoroscopic swallowing study (VFSS). Hematoxylin-eosin (H&E) staining was used to assess histopathological changes in the intestinal tissue. Intestinal flora levels were evaluated by sequencing the 16S rRNA V3-V4 region. Metabolite changes within the intestinal flora were evaluated by fecal metabolomics using liquid chromatography-tandem mass spectrometry.
RESULTS
VFSS showed that the bolus area and pharyngeal bolus speed were significantly decreased in PSD rats, while the bolus area increased and pharyngeal transit time decreased after HF-rTMS administration (p < 0.05). In the PSD groups, H&E staining revealed damaged surface epithelial cells and disrupted cryptal glands, whereas HF-rTMS reinforced the integrity of the intestinal epithelial cells. 16S rRNA sequencing indicated that PSD can disturb the intestinal flora and its associated metabolites, whereas HF-rTMS can significantly regulate the composition of the intestinal microflora. Firmicutes and Lactobacillus abundances were lower in the PSD group than in the baseline group at the phylum and genus levels, respectively; however, both increased after HF-rTMS administration. Levels of ceramides (Cer), free fatty acids (FA), phosphatidylethanolamine (PE), triacylglycerol (TAG), and sulfoquinovosyl diacylglycerol were increased in the PSD group. The Cer, FA, and DG levels decreased after HF-rTMS treatment, whereas the TAG levels increased. Peptococcaceae was negatively correlated with Cer, Streptococcus was negatively correlated with DG, and Acutalibacter was positively correlated with FA and Cer. However, these changes were effectively restored by HF-rTMS, resulting in recovery from dysphagia.
CONCLUSION
These findings suggest a synergistic role for the gut microbiota and fecal metabolites in the development of PSD and the therapeutic mechanisms underlying HF-rTMS.
Topics: Animals; RNA, Ribosomal, 16S; Feces; Rats; Gastrointestinal Microbiome; Metabolomics; Stroke; Deglutition Disorders; Male; Disease Models, Animal; Transcranial Magnetic Stimulation; Rats, Sprague-Dawley; Bacteria
PubMed: 38686094
DOI: 10.3389/fcimb.2024.1373737 -
BMJ Open Apr 2024To describe the severity and impact of gastrointestinal involvement in patients with systemic sclerosis (SSc) and identify associated factors.
OBJECTIVES
To describe the severity and impact of gastrointestinal involvement in patients with systemic sclerosis (SSc) and identify associated factors.
PATIENTS AND METHODS
Non-controlled cross-sectional study of patients with SSc (2013 American College of Rheumatology/European League Against Rheumatism criteria). The main variables were severity of gastrointestinal involvement according to the University of California, Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 instrument (UCLA SCTC GIT 2.0) and dysphagia according to the Eating Assessment Tool-10 (EAT-10). We evaluated reflux, distension, diarrhoea, faecal soilage, constipation, emotional well-being and social functioning, as well as dysphagia. Clinical and epidemiological data were collected using the Mini Nutritional Assessment Short Form (MNA-SF) and the EuroQol-5D-3L. The degree of skin fibrosis was assessed using the modified Rodnan skin score (mRSS). Multivariate models were constructed to analyse factors associated with gastrointestinal involvement and dysphagia.
RESULTS
Of the 75 patients with SSc included, 58.7% had moderate, severe or very severe reflux, 57.4% had constipation according to UCLA SCTC GIT 2.0 and 49.7% had abdominal distension. Gastrointestinal symptoms interfered significantly with social functioning (42.7%) and emotional well-being (40.0%). Dysphagia (EAT-10≥3) was recorded in 52% of patients, and according to MNA-SF poor nutrition in 30.7%, and clear malnutrition requiring a nutritional intervention in 5.3%. Multivariate adjustment revealed an association between severity of gastrointestinal symptoms according to the mRSS (β=0.249; p=0.002) and Visual Analogue Scale 3-Level EuroQol-5D (VAS-EQ-5D-3L) (β=-0.302; p=0.001), whereas presence of dysphagia was associated with the mRSS (OR=2.794; p=0.015), VAS-EQ-5D-3L (OR=0.950; p=0.005) and malnutrition (MNA-SF≤7; OR=3.920; p=0.041).
CONCLUSIONS
Patients with SSc frequently present severe gastrointestinal symptoms. These are associated with poor quality of life, more severe skin involvement and malnutrition.
Topics: Humans; Scleroderma, Systemic; Cross-Sectional Studies; Female; Male; Middle Aged; Severity of Illness Index; Aged; Deglutition Disorders; Quality of Life; Gastrointestinal Diseases; Constipation; Adult
PubMed: 38684244
DOI: 10.1136/bmjopen-2023-083419 -
Endoscopy Dec 2024
Topics: Humans; Male; Deglutition Disorders; Endoscopic Mucosal Resection; Esophageal Neoplasms; Esophagoscopy; Adult
PubMed: 38684196
DOI: 10.1055/a-2302-7690 -
Asian Pacific Journal of Cancer... Apr 2024To identify swallowing-related structures (SRSs) predicting post-radiotherapy dysphagia in oropharyngeal carcinoma patients.
OBJECTIVE
To identify swallowing-related structures (SRSs) predicting post-radiotherapy dysphagia in oropharyngeal carcinoma patients.
MATERIAL AND METHODS
Between September 2020 and October 2022, oropharyngeal cancer patients who had completed radiotherapy at least one year before without recurrence or residuals were selected. They underwent flexible endoscopic evaluation of swallowing (FEES) assessments and dysphagia grading. The mean radiation doses delivered to their SRSs were recalculated. The correlation between radiation doses to each SRS and FEES scores was analysed.
RESULTS
Twenty-nine participants, aged 51-73 years, were enrolled. Six patients had received two-dimensional radiotherapy, eight had undergone three-dimensional conformal radiotherapy, and fifteen had received intensity-modulated radiation therapy. Radiation doses to the inferior pharyngeal constrictor, cricopharyngeus and glottic larynx significantly predicted dysphagia for both semisolids (p = 0.023, 0.030 and 0.001) and liquid diets (p = 0.021, 0.013 and 0.002). The esophageal inlet significantly predicted swallowing outcomes for only the liquid diet (p = 0.007).
CONCLUSIONS
This study supports that SRS-sparing during radiotherapy for oropharyngeal cancers improves swallowing outcomes.
Topics: Humans; Deglutition Disorders; Middle Aged; Male; Oropharyngeal Neoplasms; Female; Aged; Radiotherapy, Intensity-Modulated; Follow-Up Studies; Prognosis; Deglutition; Radiation Injuries; Radiotherapy, Conformal; Radiotherapy Dosage; Organ Sparing Treatments
PubMed: 38680007
DOI: 10.31557/APJCP.2024.25.4.1451