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Tamura S, Kamo T, Kobayashi S, Saito H, Igarashi T, Kaizu Y, Miyata K, Kubo H, Ogihara H, Momosaki R. Impact of post-hospitalization dysphagia on dependence in activities of daily living at discharge in older adults with hip fracture: A nationwide inpatient database study. Clin Nutr ESPEN 2025; 67:355-361. [PMID: 40127767 DOI: 10.1016/j.clnesp.2025.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/18/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Older adults with hip fractures of the femur have a higher probability of developing dysphagia after surgery. Dysphagia affects older patients with hip fractures in multiple ways, thus clinicians need to understand the impact of dysphagia on the effectiveness of treatment. AIMS The aim of this study is to clarify the impact of dysphagia on dependence in activities of daily living in older adults with hip fractures. METHODS This retrospective observational study utilized a nationwide inpatient database, encompassing acute inpatient care from 2017 to 2022. Older adults (≥60 years) with hip fractures who underwent surgery and survived to discharge were included. Dysphagia was analyzed as a factor affecting dependence in activities of daily living at discharge using binomial logistic regression and the inverse probability of treatment weighting (IPTW) method, which was based on propensity scores. RESULTS The analysis included 88,809 older adults with hip fractures. Binomial logistic regression analysis showed that dysphagia was significantly associated with dependence in activities of daily living, with an odds ratio of 3.24 (95 % confidence interval [CI], 2.72-3.85; p < 0.01). Furthermore, sensitivity analysis confirmed these findings. After adjusting for IPTW, dysphagia remained a significant factor for dependence in activities of daily living at discharge, with an odds ratio of 2.55 (95 % CI, 2.45-2.64; p < 0.01). CONCLUSIONS In older adults with hip fractures, dysphagia negatively affects the activities of daily living at discharge. These results are useful for clinicians for understanding the significance of preventing dysphagia development.
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Affiliation(s)
- Shuntaro Tamura
- Department of Physical Therapy, Ota College of Medical Technology, 1373 Higashi-nagaoka-cho, Ota, Gunma 373-0812, Japan.
| | - Tomohiko Kamo
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, 1-7-1 Tonyamachi, Takasaki-shi, Gunma 370-0006, Japan.
| | - Sota Kobayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan.
| | - Hiroyuki Saito
- Department of Rehabilitation, Geriatrics Research Institute and Hospital, 3-26-8 Ootomo-cho, Maebashi-shi, Gunma 371-0847, Japan.
| | - Tatsuya Igarashi
- Department of Physical Therapy, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino-shi, Saitama 356-8533, Japan.
| | - Yoichi Kaizu
- Rehabilitation Center, Hidaka Rehabilitation Hospital, 2204 Maniwa Yoshii-machi, Takasaki, Gunma 370-2104, Japan.
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Inashiki-gun, Ami-Machi, Ibaraki 300-0394, Japan.
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, 6-2-23, Morikita-machi, Higashinada-ku, Kobe City, Hyogo 658-0001, Japan.
| | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-machi, Nagano-City, Nagano 381-2227, Japan.
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507, Japan.
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Revoredo ECV, Ximenes CRC, Bezerra TFP, de Oliveira KGSC, da Silva HJ, Gomes ADOC, Leão JC. Transsurgical Palatal Obturator for Maxillectomy Patients: A Preliminary Study of Swallowing and Oropharyngeal Geometry. Dysphagia 2025:10.1007/s00455-025-10831-5. [PMID: 40397166 DOI: 10.1007/s00455-025-10831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/21/2025] [Indexed: 05/22/2025]
Abstract
INTRODUCTION Resection of malignancy through maxillectomy and subsequent maxillofacial prosthetics provides adequate swallowing function and rehabilitation. The aim of this study was to verify whether there is association between changes in swallowing and the oropharyngeal geometry in maxillectomy patients with and without using transsurgical palatal obturators (TPO). METHODS The study includes 7 maxillectomy patients, TPO users who underwent complementary radiotherapy. Outcome variables were investigated by acoustic pharyngometry (APh) and fiberoptic endoscopic evaluation of swallowing (FEES) to assess the oropharyngeal geometry and swallowing, respectively with and without TPO. Sociodemographic and clinical characteristics (postoperative radiotherapy, type of surgery, type of obturator, time elapsed between adaptation and the swallowing test) were evaluated. To compare with and without TPO conditions, Mann-Whitney test and Spearman's correlation coefficient were used. RESULTS Swallowing variables: early escape and nasopharyngeal reflux showed better results with TPO (p = 0.021 and p = 0.029, respectively) compared to swallowing without TPO. The oropharyngeal geometry was not statistically associated with swallowing changes. CONCLUSION Oropharyngeal measures by APh compared to the swallowing evaluation by FEES showed a correlation between early escape and longer length of the vocal tract in individuals with TPO. Swallowing in maxillectomy patients showed significant improvement with the use of transsurgical palatal obturator, related to the lack of early escape and absence of nasopharyngeal reflux.
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Affiliation(s)
| | - Coeli Regina Carneiro Ximenes
- Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil
| | - Thiago Freire Pinto Bezerra
- Graduate Program in surgery, Federal University of Pernambuco. Medical Sciences Center. Recife, Pernambuco, Brazil
| | - Kelly Greyce Sukar Cavalcanti de Oliveira
- Graduate Program in Human Communication Health, Federal University of Pernambuco, Health Sciences Center. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde). Recife, Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE, Pernambuco, 50670-420, Brazil
| | - Hilton Justino da Silva
- Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil
- Graduate Program in Human Communication Health, Federal University of Pernambuco, Health Sciences Center. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde). Recife, Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE, Pernambuco, 50670-420, Brazil
| | - Adriana de Oliveira Camargo Gomes
- Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil.
- Graduate Program in Human Communication Health, Federal University of Pernambuco, Health Sciences Center. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde). Recife, Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE, Pernambuco, 50670-420, Brazil.
| | - Jair Carneiro Leão
- Graduate Program in Dentistry, Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil
- Department of Clinical and Preventive Dentistry. Health Sciences Center. Recife, Federal University of Pernambuco, Pernambuco, Brazil
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Muglia L, Beccacece A, Soraci L, Caloiero R, Arturi F, Fabbietti P, Di Rosa M, Sabbatinelli J, Greco GI, Filicetti E, Volpentesta M, Montesanto A, Paparazzo E, Cherubini A, Fedecostante M, Chinigò C, Capalbo M, Corsonello A, Lattanzio F. Anticholinergic drug exposure is associated with prevalence, worsening and incidence of dysphagia among hospitalized older adults. J Nutr Health Aging 2025; 29:100507. [PMID: 39951931 DOI: 10.1016/j.jnha.2025.100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 01/28/2025] [Accepted: 02/06/2025] [Indexed: 02/17/2025]
Abstract
OBJECTIVES In this study, we aimed at evaluating the association between anticholinergic drug exposure and prevalence, worsening, and incidence of dysphagia among hospitalized older individuals. DESIGN AND SETTING We used data from the REPORT-Age project, a multicenter cohort study including patients aged 65 years or more, admitted to acute care hospitals of the Italian National Institute for Health and Sciences on Aging (INRCA-IRCCS) between 2011 and 2019. PARTICIPANTS 4,005 older patients aged 84.7 (SD = 6.6) years underwent comprehensive geriatric examination according to the interRAI minimum dataset for acute care (MDS-AC), at both hospital admission and discharge. MEASUREMENTS Both prevalence and severity of dysphagia were assessed through items of subjective evaluation included in the section K3 of MDS-AC questionnaire; the anticholinergic drug exposure was measured by means of CRIDECO Anticholinergic Load Scale (CALS) and Anticholinergic Cognitive Burden (ACB) scales. Next, we used logistic regression models to evaluate the association between anticholinergic burden and prevalence of dysphagia at hospital admission; Kaplan Meier cumulative probability curves and cox proportional hazard models were used to analyze the association between anticholinergic burden at hospital admission and worsening or incidence of dysphagia during hospital stay. RESULTS Out of 4,005 patients included, 1,070 (30%) presented dysphagia at hospital admission. High anticholinergic burden was associated with increased prevalence of dysphagia at hospital admission (p < 0.001). Moreover, patients with high anticholinergic burden (ACB and CALS ≥ 2) were at increased risk of dysphagia worsening during hospital stay (HR, 95%CI: 1.14, 1.06-1.22 and 1.12, 1.03-1.23 for ACB and CALS respectively). Among the 2,935 patients with normal swallowing function at hospital admission, high anticholinergic burden was associated with the incidence of dysphagia at hospital discharge (HR, 95% CI: 1.89, 1.21-2.96 and 1.86, 1.14-3.06 for ACB and CALS respectively). Development of dysphagia during hospital stay was associated with a reduced prescription of anticholinergic medications (ORs, 95% CI 1.13 (1.07-1.20) and 1.08 (1.01-1.15) for ACB and CALS, respectively). CONCLUSIONS Increased anticholinergic burden was associated with the prevalence, worsening, and incidence of dysphagia among older hospitalized patients.
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Affiliation(s)
- Lucia Muglia
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Alessia Beccacece
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
| | - Luca Soraci
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Ramona Caloiero
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University "Magna Graecia" Medical School, Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "R. Dulbecco", 88100 Catanzaro, Italy.
| | - Paolo Fabbietti
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
| | - Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
| | - Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy; Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy.
| | - Giada Ida Greco
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Elvira Filicetti
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Mara Volpentesta
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Arcavacata di Rende, Italy.
| | - Ersilia Paparazzo
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy; Department of Biology, Ecology and Earth Sciences, University of Calabria, Arcavacata di Rende, Italy.
| | - Antonio Cherubini
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy; Geriatria, Accettazione Geriatrica e Centro di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy.
| | | | - Chiara Chinigò
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.
| | | | - Andrea Corsonello
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy; Department of Pharmacy, Health and Nutritional Sciences, School of Medicine and Digital Technologies, University of Calabria, Arcavacata di Rende, Italy.
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Mendes I, Vara-Luiz F, Palma C, Nunes G, Lima MJ, Oliveira C, Brito M, Santos AP, Santos CA, Meira T, Mascarenhas P, Fonseca J. Percutaneous Endoscopic Gastrostomy in the 21st Century-An Overview of 1415 Consecutive Dysphagic Adult Patients. Nutrients 2025; 17:747. [PMID: 40077616 PMCID: PMC11902068 DOI: 10.3390/nu17050747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/17/2025] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
Background/Objectives: Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition in dysphagic patients. This study aims to characterize conditions motivating PEG, assess nutritional status on the gastrostomy day, evaluate survival and search for survival predictors. Methods: Retrospective study of adult patients who underwent PEG in a tertiary hospital from 2001 to 2023. Data collected included demographics, underlying disorders, nutritional status (anthropometry/laboratory evaluation) on the day of PEG and survival recorded until death or December 2023. Multivariable analysis was performed with Cox regression to search for survival predictors. Results: A total of 1415 patients were included (61.8% males, mean age 66.9 years); 66.4% presented a neurological disorder and 31.3% head and neck or esophageal cancers (HNC/EC). The mean BMI was 20.9 kg/m2, with 49.8% underweight. Albumin, transferrin and total cholesterol were low at 43.2%, 62.2% and 50%, respectively. Median overall survival was 11.1 months; 14.1% of deaths occurred within 4 weeks. HNC/EC patients showed lower survival than neurological patients. Potentially regressive neurological conditions presented longer survival than progressive ones. Predictors of increased survival included female gender, younger age, higher albumin and higher BMI. The protective effect of BMI and albumin was more pronounced in males than in females. Conclusions: Neurological disorders were the most frequent underlying conditions. Nearly half of the patients displayed malnutrition before PEG feeding. Although PEG-fed patients displayed a considerable median survival time, some died early without benefit from PEG. Patients with potentially regressive neurological conditions presented better outcomes. Female gender, younger age, higher albumin and higher BMI were associated with longer survival.
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Affiliation(s)
- Ivo Mendes
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Francisco Vara-Luiz
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Carolina Palma
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Gonçalo Nunes
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Maria João Lima
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Cátia Oliveira
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Marta Brito
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Ana Paula Santos
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Carla Adriana Santos
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Tânia Meira
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Paulo Mascarenhas
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Jorge Fonseca
- GENE—Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
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Guo X, Ke T, Liu Y, Liao C, Li M. Compressed Sensing-Based Cine-MRI for Location of Dysphagia and Swallowing Function assessment in Patients with Head and Neck Cancer: A Comparative Study. Dysphagia 2025:10.1007/s00455-024-10794-z. [PMID: 39847074 DOI: 10.1007/s00455-024-10794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/06/2024] [Indexed: 01/24/2025]
Abstract
Cine magnetic resonance imaging (Cine-MRI) may evaluate the swallowing function and locations of patients with dysphagia, which requires very fast imaging speed. Compressed sensing is a technique that allows for faster MRI imaging by sampling fewer data points and reconstructing the image via optimization techniques, crucial for capturing the rapid movements involved in swallowing. This study aimed to analyze swallowing function and locations in patients with head and neck cancer and healthy individuals using Cine-MRI based on compressed sensing. This comparative study enrolled 36 patients with dysphagia and 10 healthy controls at the Department of Radiology, Yunnan Cancer Hospital between June 2020 and January 2021. Significant correlations were found between primary tumor location and Cine-MRI parameters, and between swallowing function and Cine-MRI parameters. The areas under the receiver operating characteristic curve for the combined Cine-MRI-related parameters in predicting mild and severe dysphagia were 0.806 (95% CI: 0.662-0.949). Cine-MRI with compressed sensing may identify swallowing function and abnormal stages of the physiologic swallowing process in patients with dysphagia after treatment.
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Affiliation(s)
- Xiaobin Guo
- Department of Radiology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
- Department of Radiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 451460, China
| | - Tengfei Ke
- Department of Radiology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Yifan Liu
- Department of Radiology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China.
| | - Chengde Liao
- Department of Radiology, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, 650051, China
| | - Manzhu Li
- Department of Radiology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
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Chang YC, Wu MS, Siao SF, Wang MJ, Xu YJ, Chen CCH. Identifying High-Quality Non-Instrumental Dysphagia Screening Tools for Detection of Adult Dysphagia Case in Acute-Care Settings: A Systematic Review. Clin Otolaryngol 2024; 49:687-698. [PMID: 38940226 DOI: 10.1111/coa.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/01/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high-quality, non-instrumental dysphagia screening tools used for the detection of adult dysphagia cases in all disease categories in acute-care settings. METHOD A literature search was conducted in five databases from each database's earliest inception to 31 July 2021 and guided by five keywords: 'dysphagia', 'deglutition', 'screening', 'test' and 'measure'. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass-fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self-report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). RESULT Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS-2 review. We found six high-quality, non-instrumental screening tools for detecting adult dysphagia cases in acute-care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two-Step Thickened Water Test. These high-quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head-and-neck cancer. CONCLUSIONS The results highlight the gap in the unavailability of high-quality dysphagia screening tool in several emerged high-risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high-risk populations in acute-care settings to screen for cases finding.
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Affiliation(s)
- Yu-Chun Chang
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Meng-Shan Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, Buddhist Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Shu-Fen Siao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Jhuan Wang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Juan Xu
- Green Rice Home Health Care Center, New Taipei City, Taiwan
| | - Cheryl Chia-Hui Chen
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Wen B, Li Y, Zhang M, Xu H. Association of dysphagia and loneliness and their interaction with sleep quality among older adults in nursing homes: A cross-sectional study. PLoS One 2024; 19:e0311024. [PMID: 39325814 PMCID: PMC11426441 DOI: 10.1371/journal.pone.0311024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE Poor sleep quality is a risk factor for many adverse health outcomes and has become a widespread and serious public health problem, especially among older adults. This study aimed to explore the association between dysphagia, loneliness, and their interaction with sleep quality among older Chinese adults living in nursing homes. METHODS This cross-sectional study used multistage cluster random sampling to select 56 nursing homes in Hunan Province, China. Data on sociodemographic characteristics, health-related status, lifestyle, and behavioral and social psychological factors were collected. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. The 30 mL Water Swallowing Test and Eating Assessment Tool-10 items were used to screen for dysphagia, and the 14th item of the Center for Epidemiologic Studies Depression Scale was used to measure loneliness. Binary logistic regression models were used to analyze the relationship between poor sleep quality, dysphagia, and loneliness. The interaction between these variables was evaluated using multiplicative and additive interaction models. RESULTS This study included 3,356 older adults aged 60 and above. The mean Pittsburgh Sleep Quality Index score was 6.31 ± 3.11, and the incidence of poor sleep quality was 30.8%. A total of 642 (19.1%) older adults had dysphagia, and 1,358 (40.5%) experienced loneliness. After adjusting for all covariates, dysphagia and loneliness were associated with an increased risk of poor sleep quality. The interaction analysis demonstrated that the risk of poor sleep quality among older adults with dysphagia and loneliness was 3.476 times higher than that in those without dysphagia and loneliness. Dysphagia and loneliness had an additive interaction effect on poor sleep quality in older adults living in nursing homes. CONCLUSIONS Poor sleep quality can be effectively prevented by focusing on older adults in nursing homes experiencing dysphagia, loneliness, or both and implementing targeted health interventions.
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Affiliation(s)
- Bihan Wen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yao Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengyao Zhang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Liu M, Chen X, Ma P, Deng M. Summary of the best evidence for the management of dysphagia in elderly patients. Eur Arch Otorhinolaryngol 2024; 281:3893-3901. [PMID: 38459985 DOI: 10.1007/s00405-024-08530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. METHODS Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. RESULTS A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. CONCLUSION The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing.
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Affiliation(s)
- Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Peng Ma
- Intensive Care Unit, Longquanyi District Hospital of Chengdu University of Traditional Chinese Medicine, 783, Xindu Dadao, Xindu District, Chengdu, 610000, Sichuan, China
| | - Min Deng
- The Publicity Division, Neijiang First People's Hospital, Neijiang, 641000, Sichuan, China.
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9
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Goyal S, Jitender, Garg M, Bala R. Etiological and clinical profiles of patients with dysphagia: A teaching institution experience. J Family Med Prim Care 2024; 13:1881-1886. [PMID: 38948572 PMCID: PMC11213375 DOI: 10.4103/jfmpc.jfmpc_1226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 07/02/2024] Open
Abstract
Background Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population. Methods A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED. Results The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56-65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia. Conclusion Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.
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Affiliation(s)
- Sandeep Goyal
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Jitender
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Manjri Garg
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Renu Bala
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
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10
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Ihara Y, Kato H, Sunakawa A, Murakami K, Minoura A, Hirano K, Watanabe Y, Yoshida M, Kokaze A, Ito Y. Comparison of Two Types of Electrodes for Measuring Submental Muscle Activity During Swallowing. Cureus 2024; 16:e59726. [PMID: 38841025 PMCID: PMC11151711 DOI: 10.7759/cureus.59726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE This study aimed to investigate the potential of a newly developed small electrode to accurately record muscle activity during swallowing. MATERIAL AND METHODS This study included 31 healthy participants. The participants underwent swallowing trials with three types of material. The recordings involved the following conditions: 1) swallowing saliva, 2) swallowing 3 mL water, and 3) swallowing 5 mL water. Two types of electrodes, a conventional electrode (CE) and a newly developed small electrode (NE), were symmetrically positioned on the skin over the suprahyoid muscle group, starting from the center. From the surface electromyography data, the swallowing duration (s), peak amplitude, and rising time (duration from swallowing onset to peak amplitude: s) were measured. Additionally, the equivalence of characteristics of the waveform of muscle activities was calculated by using the variance in both the upper and lower confidence limits in duration and rising time. RESULTS No significant differences in baseline, swallowing duration or rising time between the CE and NE were observed for any swallowing material. The peak amplitude was significantly higher for the NE than for the CE for all swallowing materials. The CE and NE displayed no significant difference in the equivalence of characteristics of the waveform of muscle activities for any swallowing material. CONCLUSIONS The gold-plated small electrodes utilized in this study indicated the ability to record the same characteristics of muscle activity as conventional electrodes. Moreover, it was able to capture the muscle activity of each muscle group with improved sensitivity in a narrow area, such as under the submandibular region, with more precision than that of conventional electrodes.
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Affiliation(s)
- Yoshiaki Ihara
- Department of Oral Health Management, Division of Oral Functional Rehabilitation Medicine, Showa University School of Dentistry, Tokyo, JPN
| | - Hirotaka Kato
- Department of Oral Rehabilitation Medicine, Showa University Graduate School of Dentistry, Tokyo, JPN
| | - Atsumi Sunakawa
- Department of Oral Rehabilitation Medicine, Showa University Graduate School of Dentistry, Tokyo, JPN
| | - Kouzou Murakami
- Department of Radiology, Division of Radiation Oncology, Showa University School of Medicine, Tokyo, JPN
| | - Akira Minoura
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, JPN
| | - Kojiro Hirano
- Department of Otorhinolaryngology Head and Neck Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Yoshio Watanabe
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Masaki Yoshida
- Faculty of Health Sciences, Osaka Electro-Communication University, Osaka, JPN
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, JPN
| | - Yoshinori Ito
- Department of Radiology, Division of Radiation Oncology, Showa University School of Medicine, Tokyo, JPN
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11
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Ross CF, Laurence-Chasen JD, Li P, Orsbon C, Hatsopoulos NG. Biomechanical and Cortical Control of Tongue Movements During Chewing and Swallowing. Dysphagia 2024; 39:1-32. [PMID: 37326668 PMCID: PMC10781858 DOI: 10.1007/s00455-023-10596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better understanding of hyolingual morphology, biomechanics, and neural control in humans and animal models. Recent research has revealed significant variation among animal models in morphology of the hyoid chain and suprahyoid muscles which may be associated with variation in swallowing mechanisms. The recent deployment of XROMM (X-ray Reconstruction of Moving Morphology) to quantify 3D hyolingual kinematics has revealed new details on flexion and roll of the tongue during chewing in animal models, movements similar to those used by humans. XROMM-based studies of swallowing in macaques have falsified traditional hypotheses of mechanisms of tongue base retraction during swallowing, and literature review suggests that other animal models may employ a diversity of mechanisms of tongue base retraction. There is variation among animal models in distribution of hyolingual proprioceptors but how that might be related to lingual mechanics is unknown. In macaque monkeys, tongue kinematics-shape and movement-are strongly encoded in neural activity in orofacial primary motor cortex, giving optimism for development of brain-machine interfaces for assisting recovery of lingual function after stroke. However, more research on hyolingual biomechanics and control is needed for technologies interfacing the nervous system with the hyolingual apparatus to become a reality.
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Affiliation(s)
- Callum F Ross
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA.
| | - J D Laurence-Chasen
- National Renewable Energy Laboratory, National Renewable Energy Laboratory, Golden, Colorado, USA
| | - Peishu Li
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
| | - Courtney Orsbon
- Department of Radiology, University of Vermont Medical Center, Burlington, USA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
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12
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Peñalva-Arigita A, Lecha M, Sansano A, Prats R, Vásquez A, Bascuñana H, Vila L. Adherence to commercial food thickener in patients with oropharyngeal dysphagia. BMC Geriatr 2024; 24:67. [PMID: 38229009 PMCID: PMC10792797 DOI: 10.1186/s12877-023-04589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance. AIM Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants. METHODS Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year). VARIABLES Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons. RESULTS One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%. CONCLUSIONS Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.
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Affiliation(s)
- Amaya Peñalva-Arigita
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain.
| | - Maria Lecha
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Anna Sansano
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Rosa Prats
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, C. d'Oriol Martorell 12., Sant Joan Despí, Barcelona, 08970, Spain
| | - Aida Vásquez
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Helena Bascuñana
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
- Physical Medicine and Rehabilitation Department Sant Pau University Hospital, Sant Quintí, 89, Barcelona, 08041, Spain
| | - Lluis Vila
- Endocrinology and Nutrition Department, Hospital Moisès Broggi, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
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13
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Bascuñana-Ambrós H, Renom-Guiteras M, Nadal-Castells MJ, Beranuy-Rodríguez M, Perrot-González JC, Ramirez-Mirabal E, Trejo-Omeñaca A, Monguet-Fierro JM. Swallowing muscle training for oropharyngeal dysphagia: A non-inferiority study of online versus face-to-face therapy. J Telemed Telecare 2024; 30:116-120. [PMID: 34355589 DOI: 10.1177/1357633x211035033] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study is to show the non-inferiority of the telemedicine therapy versus face-to-face using the exercise therapy of oropharyngeal muscles in 183 patients treated consecutively from 2010 to 2020. METHOD We conducted a retrospective study comparing two dysphagia treatment groups: online versus face-to-face. Patients were distributed in a non-random way but according to patient's preferences. All patients followed the same pathway and were evaluated at the beginning and at the end of the study using the dysphagia outcome and severity scale and the functional oral intake scale. A non-inferiority analysis approximation was done with delta = 1 in both variables. RESULTS Within a total of 183 patients, 114 (62.3%) used the online treatment and 69 (37.7%) the face-to-face one. The main cause of dysphagia was neurological in the total sample (60.7%) and within both groups. When we evaluate the clinical response, we find that both groups improved regardless of the type of therapy. The confidence interval of the difference between the beginning and the end of treatment did not reach the inferior limit of the delta defined, therefore supporting the no inferiority of online versus presential. DISCUSSION This study shows the no inferiority of the online therapy versus the face-to-face one for the oropharyngeal training of the swallow muscles.
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Affiliation(s)
| | - Marta Renom-Guiteras
- Physical Medicine and Rehabilitation Department, Sant Pau University Hospital, Spain
| | | | | | | | - Eliot Ramirez-Mirabal
- Physical Medicine and Rehabilitation Department, Sant Pau University Hospital, Spain
| | - Alex Trejo-Omeñaca
- Department of Engineering and Information Systems, Universitat Politècnica de Catalunya, Barcelona Tech, Spain
| | - Josep Maria Monguet-Fierro
- Department of Engineering and Information Systems, Universitat Politècnica de Catalunya, Barcelona Tech, Spain
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14
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Mahamid R, Said Ahmad H, Azzam N, Omari A, Abu Baker F, Mari A. The yield of solid swallows in high resolution esophageal manometry among patients with dysphagia and gastro-esophageal reflux symptoms. Minerva Gastroenterol (Torino) 2023; 69:511-516. [PMID: 35388665 DOI: 10.23736/s2724-5985.22.03180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Swallowing disorders are frequently reported esophageal symptoms and represent a common cause for referrals to gastroenterology consultations. Esophageal high-resolution manometry (HRM) is considered the gold standard modality for the evaluation of esophageal peristalsis and esophageal sphincter. The standard protocol of HRM includes water swallows only, that may not assess appropriately esophageal function and symptoms. Hence, we investigated the diagnostic yield of combining solid food swallows (SFS) to standard HRM. METHODS We conducted a retrospective study at the Unit of Gastroenterology of EMMS Nazareth Hospital, Israel. Patients who underwent manometry mainly due to dysphagia or reflux symptoms between November 2019 and November 2020 were enrolled. All patients underwent routine HRM and completed ten 5 mL water swallows and 5 bread swallows. Analysis and reports were done by an expert gastroenterologist, based on the Chicago Classification version 3. RESULTS Overall, 99 patients (45.5% men, mean age 52.1±16 years) who underwent HRM were included. The addition of solid swallows to the test changed manometry results in 43 patients (43.4%) (P<0.005). Furthermore, SFS improved the contractility in 26/42 cases of ineffective and/or absent motility (61%) (P<0.005). Finally, SFS aggravated symptoms in 44 patients (44.6% more aggravation than in liquid only) (P<0.005). CONCLUSIONS Combining SFS to HRM can improve the diagnostic yield of the study. Adding solid swallows is of special value in cases of ineffective esophageal motility but induces a high rate of symptoms aggravation.
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Affiliation(s)
- Rawan Mahamid
- Pediatrics Department, Haeemk Hospital, Afula, Israel
| | - Helal Said Ahmad
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Narjes Azzam
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Ali Omari
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel -
| | - Amir Mari
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
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15
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Song G, Trujillo S, Fu Y, Shibi F, Chen J, Fass R. Transcutaneous electrical stimulation for gastrointestinal motility disorders. Neurogastroenterol Motil 2023; 35:e14618. [PMID: 37288650 DOI: 10.1111/nmo.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND/PURPOSE Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory function. Symptoms may vary depending on the organ affected and can be debilitating. Treatment usually involves diet and lifestyle changes. Pharmacotherapy is limited in effectiveness with various side effects. Transcutaneous electrical stimulation (TES), a noninvasive, needleless technique that provides electrical stimulation using cutaneous non-needle electrodes, has become increasingly popular. It has been shown to be beneficial in treating GI motility disorders. METHODS This review paper navigates through the different TES techniques, including transcutaneous peripheral nerve (vagal/sacral/tibial nerves) electrical stimulation, transcutaneous electrical acustimulation (stimulation via acupuncture point), transcutaneous interferential current therapy, and transcutaneous electrical nerve stimulation. KEY RESULTS As we delve deeper, we explore the promising effects of TES on dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, postoperative ileus, constipation, and irritable bowel syndrome. The literature at hand speaks volumes about the therapeutic prowess of this noninvasive technique. CONCLUSION & INFERENCES The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders.
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Affiliation(s)
- Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sophie Trujillo
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuhan Fu
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fahmi Shibi
- Department of Gastroenterology and Hepatology, HaEmek Medical Center, Afula, Israel
| | - Jiande Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Chen X, Xia Y, Shen S, Wang C, Zan R, Yu H, Yang S, Zheng X, Yang J, Suo T, Gu Y, Zhang X. Research on the Current Application Status of Magnesium Metal Stents in Human Luminal Cavities. J Funct Biomater 2023; 14:462. [PMID: 37754876 PMCID: PMC10532415 DOI: 10.3390/jfb14090462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
The human body comprises various tubular structures that have essential functions in different bodily systems. These structures are responsible for transporting food, liquids, waste, and other substances throughout the body. However, factors such as inflammation, tumors, stones, infections, or the accumulation of substances can lead to the narrowing or blockage of these tubular structures, which can impair the normal function of the corresponding organs or tissues. To address luminal obstructions, stenting is a commonly used treatment. However, to minimize complications associated with the long-term implantation of permanent stents, there is an increasing demand for biodegradable stents (BDS). Magnesium (Mg) metal is an exceptional choice for creating BDS due to its degradability, good mechanical properties, and biocompatibility. Currently, the Magmaris® coronary stents and UNITY-BTM biliary stent have obtained Conformité Européene (CE) certification. Moreover, there are several other types of stents undergoing research and development as well as clinical trials. In this review, we discuss the required degradation cycle and the specific properties (anti-inflammatory effect, antibacterial effect, etc.) of BDS in different lumen areas based on the biocompatibility and degradability of currently available magnesium-based scaffolds. We also offer potential insights into the future development of BDS.
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Affiliation(s)
- Xiang Chen
- School of Medicine, Anhui University of Science and Technology, Huainan 232000, China;
| | - Yan Xia
- School of Stomatology, Anhui Medical College, Hefei 230601, China;
| | - Sheng Shen
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Chunyan Wang
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
- Department of General Surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Rui Zan
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Han Yu
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
| | - Shi Yang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
| | - Xiaohong Zheng
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Jiankang Yang
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Tao Suo
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Yaqi Gu
- School of Medicine, Anhui University of Science and Technology, Huainan 232000, China;
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Xiaonong Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
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17
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Venchiarutti RL, Charters EK, Dunn M, Clark JR. Construct and discriminant validity testing of the FACE-Q Head and Neck Cancer Module for assessing speech and swallowing outcomes for patients undergoing maxillectomy or mandibulectomy. Head Neck 2023; 45:1519-1529. [PMID: 37052459 DOI: 10.1002/hed.27366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The FACE-Q H&N is a patient reported outcome measure covering multiple constructs for patients with head and neck tumors. Additional testing is needed to determine suitability in assessing speech- and swallowing-related quality of life and function. METHODS FACE-Q H&N, The M. D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) scores were collected from two patient cohorts who had undergone jaw reconstruction. Construct validity was assessed using convergent validity testing and known groups testing to assess discriminant validity. RESULTS A priori hypotheses testing demonstrated strong correlations (ρ > 0.6, p < 0.05) between FACE-Q H&N eating and drinking, swallowing and eating distress scales with MDADI subscales, and between FACE-Q H&N speech function and distress scales and the SHI. Known groups testing demonstrated all instruments could delineate outcomes among patients who had radiation, advanced tumors, and tracheostomy. CONCLUSION The FACE-Q H&N may be an alternative for the SHI and MDADI in this patient cohort.
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Affiliation(s)
- Rebecca L Venchiarutti
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Emma K Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Camperdown, New South Wales, Australia
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20
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The effect of acupuncture on the correction of post-stroke dysphagia compared to methods of physical influence. ACTA BIOMEDICA SCIENTIFICA 2023. [DOI: 10.29413/abs.2023-8.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background. Dysphagia is a problematic field in the clinical work of neurologists, resuscitation experts and therapists due to the high percentage of secondary complications caused by aspiration pneumonia, nutritional deficiency, which affect the recovery process. This ultimately affects the main socio-medical indicators such as mortality, lethality, disability in structure of cerebrovascular diseases. Neurogenic dysphagia occurs in 25–65 % of patients with stroke, while mortality among patients with post-stroke dysphagia receiving tube feeding varies from 20 to 24 %.The aim. To evaluate the impact of reflexology in the treatment of post-stroke dysphagia in comparison with the methods of physical impact. Materials and methods. An open clinical comparative study was conducted in two clinical bases: Republican Hospital named after N.A. Semashko (Ulan-Ude) and Bokhan District Hospital.In this clinical trial, 53 patients with swallowing disorders during the acute period of ischemic stroke were tested. When diagnosing dysphagia, a point scale of the Clinic of the Institute of the Brain was used, which assesses the degree of swallowing disorders before and after treatment. The comparative group receiving standard therapy in combination with physiotherapy (VOCASTIM) included 27 patients, the study group was comprised of 26 patients, who underwent basic therapy in combination with acupuncture (1 course – 10 sessions). In the course of the comparative clinical trial, statistical data were obtained that indicate the positive role of acupuncture in restoring the function of swallowing in patients with acute impairment of cerebral circulation.Results. During the current clinical study, on the background of a 10-day course of reflexology with an exposure of 10–15 minutes and VOCASTIM physiotherapy for 10–15 minutes, the majority of patients experienced regression of post-stroke dysphagia.Conclusion. According to the results of this study, the method of reflexology as a result of physiotherapy showed a faster recovery of swallowing function in the correction of neurogenic swallowing diseases, which causes cerebral infarction.
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Atkins M, Burton Murray H, Staller K. Assessment and management of disorders of gut-brain interaction in patients with eating disorders. J Eat Disord 2023; 11:20. [PMID: 36782302 PMCID: PMC9926752 DOI: 10.1186/s40337-022-00731-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
Disorders of gut-brain interaction (DBGI), also known as functional gastrointestinal disorders, are common in individuals with eating disorders, and may precede or perpetuate disordered eating. Understanding the pathophysiology of common gastrointestinal symptoms in DGBI can be important for the care of many patients with eating disorders. In this review, we summarize the literature to date on the complex relationship between DBGI and eating disorders and provide guidance on the assessment and management of the most common symptoms of DBGI by anatomic region: esophageal symptoms (globus and functional dysphagia), gastroduodenal symptoms (functional dyspepsia and nausea), and bowel symptoms (abdominal pain, bloating and constipation).
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Affiliation(s)
- Micaela Atkins
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.
| | - Helen Burton Murray
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, USA
| | - Kyle Staller
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Lim HJ, Lai DKH, So BPH, Yip CCK, Cheung DSK, Cheung JCW, Wong DWC. A Comprehensive Assessment Protocol for Swallowing (CAPS): Paving the Way towards Computer-Aided Dysphagia Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2998. [PMID: 36833691 PMCID: PMC9963613 DOI: 10.3390/ijerph20042998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Dysphagia is one of the most common problems among older adults, which might lead to aspiration pneumonia and eventual death. It calls for a feasible, reliable, and standardized screening or assessment method to prompt rehabilitation measures and mitigate the risks of dysphagia complications. Computer-aided screening using wearable technology could be the solution to the problem but is not clinically applicable because of the heterogeneity of assessment protocols. The aim of this paper is to formulate and unify a swallowing assessment protocol, named the Comprehensive Assessment Protocol for Swallowing (CAPS), by integrating existing protocols and standards. The protocol consists of two phases: the pre-test phase and the assessment phase. The pre-testing phase involves applying different texture or thickness levels of food/liquid and determining the required bolus volume for the subsequent assessment. The assessment phase involves dry (saliva) swallowing, wet swallowing of different food/liquid consistencies, and non-swallowing (e.g., yawning, coughing, speaking, etc.). The protocol is designed to train the swallowing/non-swallowing event classification that facilitates future long-term continuous monitoring and paves the way towards continuous dysphagia screening.
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Affiliation(s)
- Hyo-Jung Lim
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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23
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Keles MN, Ertoy Karagol HI, Serel Arslan S, Egritas Gurkan O, Sari S, Elbasan B, Dalgic B, Bakirtas A. Oropharyngeal Dysphagia in Children with Eosinophilic Esophagitis. Dysphagia 2023; 38:474-482. [PMID: 35781555 DOI: 10.1007/s00455-022-10489-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia is the most troublesome symptom of eosinophilic esophagitis (EoE). This study aimed to investigate oropharyngeal dysphagia in children with EoE and possible related factors. Children with a definite diagnosis of EoE were included in the study. Medical and feeding histories were recorded. A disease control level was determined for each child. An oral structure examination, the Turkish version of the Mastication and Observation Evaluation (T-MOE), the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-oz water swallow test were applied in screening for oropharyngeal dysphagia. Fifty-two children participated in the study. Oropharyngeal dysphagia took the form of abnormal swallowing (PEDI-EAT-10 score ≥ 4) and increased aspiration risk (PEDI- EAT-10 score ≥ 13) in 51.9% and 25.0% of the children, respectively. Seven children failed the 3-oz water swallow test. Abnormal swallowing and aspiration risk were significantly higher in children with prolonged mealtimes, impaired chewing function, and uncontrolled disease (p < 0.05). Chewing function was the most important risk factor for abnormal swallowing and increased aspiration (R2 = 0.36, R2 = 0.52, p < 0.001, respectively). Oropharyngeal dysphagia is common in children with EoE and associated with increased aspiration risk in a subpopulation. Uncontrolled disease, prolonged mealtimes, and impaired chewing function may provide clues for oropharyngeal dysphagia in EoE.
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Affiliation(s)
- Muserrefe Nur Keles
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Cankaya, 06490, Ankara, Turkey.
| | | | - Selen Serel Arslan
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Odul Egritas Gurkan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sinan Sari
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bulent Elbasan
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Cankaya, 06490, Ankara, Turkey
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Arzu Bakirtas
- Department of Pediatric Allergy, Faculty of Medicine, Gazi University, Ankara, Turkey
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Estupiñán Artiles C, Regan J, Donnellan C. Physiological Mechanisms and Associated Pathophysiology of Dysphagia in Older Adults. Gerontol Geriatr Med 2022; 8:23337214221142949. [PMID: 36582660 PMCID: PMC9793049 DOI: 10.1177/23337214221142949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022] Open
Abstract
Dysphagia can be a common secondary sequela of neurological and neurodegenerative disorders in older adults. Early screening, identification, and management of dysphagia is essential to avoid serious complications, including malnutrition, dehydration, aspiration pneumonia; and promote quality of life. Although individuals of all ages may experience swallowing difficulties, dysphagia and its complications are more common in older adults. This literature review aims to provide an overview of the physiological mechanisms of normal swallowing in healthy individuals and age-related changes to swallowing function, the pathophysiology of dysphagia associated with three common neurological disorders affecting older adults (stroke, Parkinson's disease, and dementia), and implications for interdisciplinary clinical practice. Increased awareness of these issues may contribute to a more timely and efficient identification of older adults with dysphagia and to improve overall dysphagia management.
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Affiliation(s)
- Constantino Estupiñán Artiles
- Trinity College Dublin, Ireland,Constantino Estupiñán Artiles, School of
Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24
D’Ollier Street, Dublin D02 T283, Ireland.
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Hollinghurst J, Smithard DG. Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008-2018. Dysphagia 2022; 37:1612-1622. [PMID: 35212847 PMCID: PMC9643178 DOI: 10.1007/s00455-022-10425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65-74: aged 75-84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
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Affiliation(s)
| | - David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, Woolwich, London, SE18 4QH UK
- University of Greenwich, Avery Hill Campus, Bexley Rd, London, SE9 2PQ UK
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26
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Waters AM, Patterson J, Bhat P, Phillips AW. Investigating dysphagia in adults: symptoms and tests. BMJ 2022; 379:e067347. [PMID: 36252961 DOI: 10.1136/bmj-2021-067347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A M Waters
- Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
| | - J Patterson
- School of Health Sciences, Institute of Population Heath, University of Liverpool, UK
| | | | - A W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
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27
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Proactive Swallowing Rehabilitation in Patients with Recurrent Oral Cancer Receiving Salvage Treatment: Long-Term Swallowing-Related Outcomes. Dysphagia 2022; 38:954-964. [PMID: 36127448 DOI: 10.1007/s00455-022-10521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 09/11/2022] [Indexed: 11/03/2022]
Abstract
The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life in patients with recurrent oral cancer in the first 2 years after salvage treatment. Consecutive adult patients with recurrent oral cancer who received salvage surgery and free flap reconstruction were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, 18 and 24 months were evaluated. A total of 50 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in BW and FOIS from one month, and in MDADI from three months. All patients were free of tube feeding at 18-24 months and tolerated diet with special preparations or compensation. Safe swallowing could be achieved in approximately 80% participants after 12 months of diet modification or compensatory maneuvers. Proactive swallowing therapy was feasible in patients with recurrent oral cancer receiving salvage treatment. Although this patient population might have pre-existing dysphagia from previous treatments, rehabilitation could facilitate safe per oral intake and maintain adequate nutrition with adaptive maneuvers or compensatory strategies. Patients who underwent proactive swallowing rehabilitation had better recovery in the functional oral intake level.
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Yao L, Liang W, Du X, Chen Y, Huang X. Effect of acupuncture on long-term outcomes in patients with post-stroke dysphagia. NeuroRehabilitation 2022; 51:433-441. [PMID: 35871375 DOI: 10.3233/nre-220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acupuncture has been used to treat patients with post-stroke neurological dysfunction. OBJECTIVE The purpose of our observational study was to observe the long-term efficacy of acupuncture and investigate whether the acupuncture treatment could short the recovery time of patients with post-stroke dysphagia. METHODS Medical records were reviewed to select patients who met the inclusion criteria for post-stroke dysphagia. Exposure factor was defined as received acupuncture during inpatient. Clinical data were obtained at the 6-month follow-up. The primary outcome was the time to improve the score of Food Intake Level Scale (FILS, 0-10) by 3 grades. Cox regression models were used to assess the relationship between acupuncture and recovery of dysphagia. RESULTS In acupuncture group, the median time to achieve clinical improvement of dysphagia was 97 days (95% CI, 93-124) compared with 119 days (95% CI, 108-145) in control group, with a statistically significant difference between the two groups (HR = 1.48; 95% CI 1.14-1.92; P = 0.003). At 6 months, 78 patients (60.5%) in acupuncture group reached excellent function and 61 patients (47.3%) in control group (RR = 1.28; 95% CI, 1.02-1.62; P = 0.045). 106 patients (82.2%) in acupuncture group achieved favorable function and 91 patients (70.5%) in control group (RR = 1.17; 95% CI, 1.02-1.35; P = 0.039). The outcome of adjusted multivariable Cox regression models showed that there was a difference in the recovery time of dysphagia between groups, HR = 1.79, 95% CI 1.34-2.39. The rates of adverse events were similar in both groups. CONCLUSIONS Acupuncture can promote the recovery of post-stroke dysphagia, and has a better long-term efficacy. Besides, it can reduce the degree of disability and improve the quality of life.
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Affiliation(s)
- Lulu Yao
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Liang
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Yujing Chen
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaobo Huang
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Biodegradable PTX-PLGA-coated magnesium stent for benign esophageal stricture: An experimental study. Acta Biomater 2022; 146:495-505. [PMID: 35487426 DOI: 10.1016/j.actbio.2022.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/21/2023]
Abstract
Biodegradable stents can degrade step by step and thereby avoid secondary removal by endoscopic procedures in contrast to metal stents. Herein, a biodegradable composite stent, a magnesium (Mg)-based braided stent with a surface coating of poly (lactic-co-glycolic acid) (PLGA) containing paclitaxel (PTX), was designed and tested. By adding this drug-loaded polymer coating, the radial force of the stent increased from 33 Newton (N) to 83 N. PTX was continuously released as the stent degraded, and the in vitro cumulative drug release in phosphate-buffered saline for 28 days was 115 ± 13.5 μg/mL at pH = 7.4 and 176 ± 12 μg/mL at pH = 4.0. There was no statistically significant difference in the viability of fibroblasts of stent extracts with different concentration gradients (P > 0.05), while the PTX-loaded stents effectively promoted fibroblast apoptosis. In the animal experiment, the stents were able to maintain esophageal patency during the 3-week follow-up and to reduce the infiltration of inflammatory cells and the amount of fibrous tissue. These results showed that the PTX-PLGA-coated Mg stent has the potential to be a safe and effective approach for benign esophageal stricture. STATEMENT OF SIGNIFICANCE: We designed a biodegradable composite stent, having poly (lactic-co-glycolic acid) (PLGA) containing paclitaxel (PTX) coated the surface of the magnesium (Mg)-based braided stent. We evaluated in vitro and in vivo characteristics of the Mg esophageal stent having a PLGA coating plus a variable concentration of PTX in comparison with the absence of PTX PLGA coating. The PTX PLGA stents exerted higher radial force than stents without coating, degraded more quickly in an acid medium, and effectively promoted fibroblast apoptosis in vitro experiments. In a rabbit model of caustic-induced esophageal stricture, there was an increased lumen and decreased inflammation of the esophageal wall in the animals stented with PTX-PLGA versus the sham group, indicating a potential approach for benign esophageal stricture.
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Doan TN, Ho WC, Wang LH, Chang FC, Nhu NT, Chou LW. Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:2605. [PMID: 35566731 PMCID: PMC9104951 DOI: 10.3390/jcm11092605] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia assessment methods. METHODS Five major databases were systematically searched through January 2022. A random-effects model for meta-analysis was conducted to obtain the pooled prevalence. RESULTS Prevalence of dysphagia in the community-dwelling elderly screened by water swallow test was 12.14% (95% CI: 6.48% to 19.25%, I2 = 0%), which was significantly lower than the combined prevalence of 30.52% (95% CI: 21.75% to 40.07%, I2 = 68%) assessed by Standardized Swallowing Assessment (SSA) and volume-viscosity swallow test (V-VST). The dysphagia prevalence among elderly nursing home residents evaluated by SSA was 58.69% (95% CI: 47.71% to 69.25%, I2 = 0%) and by the Gugging Swallowing Screen test (GUSS) test was 53.60% (95% CI: 41.20% to 65.79%, I2 = 0%). The prevalence of dysphagia in hospitalized older adults screened by the 10-item Eating Assessment Tool was 24.10% (95% CI: 16.64% to 32.44%, I2 = 0%), which was significantly lower than those assessed by V-VST or GUSS tests of 47.18% (95% CI: 38.30% to 56.14%, I2 = 0%). CONCLUSIONS Dysphagia is prevalent in the elderly, affecting approximately one in three community-dwelling elderly, almost half of the geriatric patients, and even more than half of elderly nursing home residents. The use of non-validated screening tools to report dysphagia underestimates its actual prevalence.
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Affiliation(s)
- Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
| | - Liang-Hui Wang
- Department of Speech Language Pathology and Auditory, HungKuang University, Taichung 433304, Taiwan;
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
| | - Fei-Chun Chang
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
| | - Nguyen Thanh Nhu
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 94117, Vietnam;
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
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Bolgeo T, Di Matteo R, Gallione C, Gatti D, Bertolotti M, Betti M, Roveta A, Maconi A. Intragastric prepyloric enteral nutrition, bolus vs continuous in the adult patient: A systematic review and meta-analysis. Nutr Clin Pract 2022; 37:762-772. [PMID: 35174544 DOI: 10.1002/ncp.10836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bolus and continuous nutrition are commonly used enteral nutrition (EN) administration methodologies. Currently, there is insufficient evidence to establish which is the most effective method for reducing gastrointestinal complications in adult patients. The aim of this review is to evaluate the impact of bolus/intermittent EN compared with continuous EN for the following outcomes: diarrhea, constipation, emesis/vomiting, gastric residual volume, aspiration, and glycemic control in adult patients receiving intragastric prepyloric EN in the hospital setting. Bibliographical research was performed on the following databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. The review included all randomized and nonrandomized controlled trials of patients aged ≥18 years with preserved gastrointestinal function. Meta-analysis was performed by Review Manager V.5.3. Seven studies including 551 patients were included in the meta-analysis. Five of these studies reported that the diarrhea rate was higher in the bolus feeding group (risk ratio [RR] = 2.50; 95% CI, 1.17-5.34; P = 0.02), and another five of these studies indicated that the aspiration rate was higher in the continuous feeding group (RR = 0.55; 95% CI, 0.35-0.87; P = 0.01). There were no significant differences for the other outcomes. In conclusion, intermittent EN appears to reduce the incidence of aspiration in the hospital setting; however, it may increase the risk of diarrhea. For future research, we hypothesize the joint use of continuous nutrition until the patient reaches tolerance and then passing to bolus nutrition, thus reducing the incidence of aspiration and enabling a physiological nutrition intake.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Roberta Di Matteo
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Chiara Gallione
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Denise Gatti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Marinella Bertolotti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Marta Betti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Annalisa Roveta
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Antonio Maconi
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
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Kumar A, Nigam GB, Vasant DH, Dhar A. Twitter debate: controversies in dysphagia. Frontline Gastroenterol 2022; 14:155-157. [PMID: 36818789 PMCID: PMC9933583 DOI: 10.1136/flgastro-2022-102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/08/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Aditi Kumar
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Gaurav B Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Dipesh Harshvadan Vasant
- Neurogastroenterology Department, Wythenshawe Hospital, Manchester, UK,Division of Diabetes, endocrinology and gastroenterology, The University of Manchester, Manchester, Manchester, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Durham, UK
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Liou HH, Tsai SW, Hsieh MHC, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Hung DSY. Evaluation of Objective and Subjective Swallowing Outcomes in Patients with Dysphagia Treated for Head and Neck Cancer. J Clin Med 2022; 11:jcm11030692. [PMID: 35160142 PMCID: PMC8836568 DOI: 10.3390/jcm11030692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
We evaluated objective and subjective swallowing function outcomes in patients with dysphagia treated for head and neck cancer (HNC) and identified risk factors for poor swallowing outcomes. Patients undergoing videofluoroscopic swallowing studies (VFSS) between January 2016 and March 2021 were divided into four groups according to primary tumor sites; post-treatment dysphagia was assessed. The penetration–aspiration scale (PAS) and bolus residue scale (BRS) were used to objectively assess swallowing function through VFSS. The Functional Oral Intake Scale (FOIS) was used for subjective analyses of swallowing statuses. To account for potential confounding, important covariates were adjusted for in logistic regression models. Oropharyngeal tumors were significantly more likely to have poor PAS and BRS scores than oral cavity tumors, and the patients with nasopharyngeal tumors were significantly less likely to have poor FOIS scores. Old age, having multiple HNCs, and a history of radiotherapy were associated with an increased odds of poor PAS scores (for all types of swallows), poor BRS scores (for semiliquid and solid swallows), and poor FOIS scores, respectively. This indicates using only subjective assessments may not allow for accurate evaluations of swallowing function in patients treated for HNC. Using both objective and subjective assessments may allow for comprehensive evaluations.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yi-Jen Chen
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
- Correspondence:
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Qiu X, Yao XJ, Han SN, Wu YY, Ou ZJ, Li TS, Zhang H. Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study. Front Neurosci 2022; 15:791964. [PMID: 35069105 PMCID: PMC8770751 DOI: 10.3389/fnins.2021.791964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown. Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy. Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure. Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37-0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18-39, 40-59, 60-79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000). Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings. Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.
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Affiliation(s)
- Xuan Qiu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Jie Yao
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng-Nan Han
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yun-Yun Wu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeng-Jian Ou
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian-Shi Li
- First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong Zhang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Fakhriani R, Surono A, Rianto BUD. Translation and Validation of the Indonesian MD Anderson Dysphagia Inventory (MDADI) in Head and Neck Cancer Patients with Swallowing Disorders. Int Arch Otorhinolaryngol 2021; 26:e321-e326. [PMID: 35846827 PMCID: PMC9282947 DOI: 10.1055/s-0041-1735566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction
Dysphagia is common in head and neck cancer patients; it is associated with significant morbidity, including quality of life. Several instruments can be used to assess the quality of life of dysphagia patients, including the M.D Anderson dysphagia inventory (MDADI) questionnaire, which is sufficiently valid and reliable to improve the quality of life of patients with neurological disorders and head and neck cancer.
Objective
The purpose of the present study is to perform adaptation, cultural translation, and validation of the MDADI questionnaire for the Indonesian language.
Methods
This cross-sectional study assessed the validity and reliability of the MDADI Indonesian adaptation instrument in head and neck cancer patients with swallowing disorders in the Otorhinolaryngology clinic of the Dr. Sardjito hospital, Yogyakarta, from May to August 2019.
Results
There were 40 study subjects, including 31 men and 9 women. The MDADI instrument adapted to Indonesian is valid and reliable as an instrument for assessing the quality of life of patients with head and neck cancer with swallowing disorders, with r-values ranging from 0.314 to 0.939. Internal consistency shows that Cronbach's α is 0.915, and test-retest reliability (intra-class correlation) ranges from 0.919 to 0.985.
Conclusion
The translation and validation of the Indonesian MDADI instrument were performed as an instrument for assessing the quality of life of head and neck cancer patients with swallowing disorders.
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Affiliation(s)
- Rizka Fakhriani
- Departement of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine and Health Science, University of Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
- Departement of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada, Yogyakarta, Indonesia
| | - Agus Surono
- Departement of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada, Yogyakarta, Indonesia
| | - Bambang Udji Djoko Rianto
- Departement of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada, Yogyakarta, Indonesia
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Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients' Quality of Life-A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111138. [PMID: 34769657 PMCID: PMC8583542 DOI: 10.3390/ijerph182111138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022]
Abstract
Background: Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE). Methods: This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, p ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162). Results: Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia. Conclusion: The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients’ quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis.
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Long-term swallowing-related outcomes in oral cancer patients receiving proactive swallowing therapy. Oral Oncol 2021; 122:105569. [PMID: 34656054 DOI: 10.1016/j.oraloncology.2021.105569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life (QoL) in oral cancer patients in the first two years after definitive treatment. MATERIALS AND METHODS Consecutive adult patients with locally advanced oral cancer who received radical surgery, free flap reconstruction, and adjuvant radiotherapy were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, and 24 months were evaluated. RESULTS A total of 104 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in FOIS from one month, and in BW and MDADI from three months. A total of 94% patients were free of tube feeding at 12 months but with a diet requiring special preparations or compensation. Safe swallowing could be achieved in approximately 90% of the participants after six months with diet modification or compensatory maneuvers. BW at 18 and 24 months did not differ significantly from baseline. CONCLUSION Proactive swallowing therapy is feasible for patients with locally advanced oral cancer receiving definitive treatments. It facilitates safe oral intake and adequate nutrition. Patients who performed swallowing exercises had a faster and better recovery in swallowing function and swallowing-related QoL.
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Sarbinowska J, Wiatrak B, Waśko-Czopnik D. Association between Schatzki ring and eosinophilic esophagitis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2021; 33:1167-1173. [PMID: 33470703 DOI: 10.1097/meg.0000000000002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/OBJECTIVE The involvement of hydrochloric acid in the etiology of eosinophilic esophagitis and numerous reports on its coexistence and interaction with reflux disease, as well as the rings of the esophageal mucosa formed with the advancement of the disease, suggest a potential association of eosinophilic esophagitis with another disorder of esophageal morphology potentially caused by exposure to acid reflux-Schatzki ring. Therefore, it seems reasonable to check the relationship of eosinophilic esophagitis with the coexistence of the Schatzki ring as a potential effect of advanced esophageal trachealization, which is the subject of this systematic review with a meta-analysis. METHODS The protocol of this meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A systematic search of the indexed literature in the MEDLINE and Scopus databases from early to December 2019 was performed to identify all original research articles on the association between the occurrence of the Schatzki ring and eosinophilic esophagitis in adults. RESULTS Out of 68 searched studies, after the analysis and evaluation of the works, only 4 met the criteria set according to the protocol and were included in the meta-analysis. Based on the performed meta-analysis, no relationship was found between the occurrence of Schatzki ring and eosinophilic esophagitis. CONCLUSION The present study did not show a significant relationship between the occurrence of the Schatzki ring and eosinophilic esophagitis in the adult population, which suggests that these are two independent causes of dysphagia in this patient population.
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Affiliation(s)
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, Wroclaw, Poland
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Shajbak AA, Yakovleva AV, Yakovlev AA, Sidorov IB, Pryanikova NI, Raskatova EV, Usoltseva NI, Grechko AV. [Noninvasive magnetic stimulation with endoscopic navigation for the treatment of cricopharyngeal failure in chronic critical illness]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:31-35. [PMID: 34460154 DOI: 10.17116/jnevro202112107131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the efficacy of treatment of cricopharyngeal insufficiency in chronic critical illness caused by severe brain injury using non-invasive magnetic stimulation with endoscopic navigation. MATERIAL AND METHODS Thirty patients (19 men and 11 women, mean age 50±12 years) were studied. The exposure was carried out by a bipolar alternating magnetic field using an inductor located in the projection of the hyoid bone. The study compared the standard therapy and the complex of therapeutic measures, in which the proposed non-invasive magnetic stimulation method with endoscopic navigation was included. The procedure was carried out daily without regime changes, with objective control 1 time in 10 days. The duration of the first course was 10 days, followed by a decision to extend the course for another 10 days, depending on the objective dynamics. Evaluation was performed with the Rosenbek Penetration and Aspiration Scale (PAS), the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), The Mann assessment of swallowing ability (MASA) and the Functional oral intake scale (FOIS). RESULTS AND CONCLUSION Improvements of swallowing function were observed in both groups, but qualitative changes were more pronounced in the main group. The use of the proposed method made it possible to obtain a more stable and predictable result.
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Affiliation(s)
- A A Shajbak
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - A V Yakovleva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - A A Yakovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - I B Sidorov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - N I Pryanikova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - E V Raskatova
- Central City Clinical Hospital of Reutov, Reutov, Russia
| | - N I Usoltseva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - A V Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
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Nigam GB, Vasant DH, Dhar A. Curriculum review : investigation and management of dysphagia. Frontline Gastroenterol 2021; 13:254-261. [PMID: 35493628 PMCID: PMC8996094 DOI: 10.1136/flgastro-2021-101917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023] Open
Abstract
Dysphagia is a common presentation in gastroenterology practice and the diagnosis and management requires a comprehensive knowledge of diverse range of aetiologies, with a systematic approach for assessment of symptoms, selection of investigations and appropriate treatment to relieve symptoms. In this curriculum review, the suggested diagnostic approach highlights the importance of thorough clinical assessment in order to guide the selection of investigations. This article discusses the utility of endoscopic, histopathology, fluoroscopic and motility investigations for dysphagia, and their interpretation, in order to guide targeted treatments ranging from dietary, pharmacological, endoscopic and surgical interventions.
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Affiliation(s)
- Gaurav B Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK,National Institute of Health Research, Oxford, UK
| | - Dipesh Harshvadan Vasant
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Anjan Dhar
- Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health and Life Sciences, Teesside University, Middlesborough, UK
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Chiu YH, Tseng WH, Ko JY, Wang TG. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2021; 121:3-13. [PMID: 34246510 DOI: 10.1016/j.jfma.2021.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states. Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Yang L, Zhang Z, Gao H, Wu Y, Wei H, Kong J, Wang R, Cheng J, Tian J. Cultural Adaptation and Validation of Questionnaires for Evaluation of Health-Related Quality of Life with Dysphagia in Different Countries: A Systematic Review. Dysphagia 2021; 37:812-823. [PMID: 34181064 DOI: 10.1007/s00455-021-10330-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Dysphagia can have devastating and long-lasting effects on the patient's health-related quality of life (HRQoL). In recent years, a number of questionnaires for the evaluation of the HRQoL of patients with dysphagia have been developed and have been adapted for use in different countries and cultures. However, problems may arise in the process of cultural adaptation and validation, which can affect the quality of the questionnaires and their measurements. This study was conducted to systematically summarize the cultural adaptation and validation of questionnaires for the evaluation of dysphagia-related HRQoL in different countries, assessing the varieties, measurement properties, and qualities of these questionnaires, with the aim of identifying the status of their adaptation and validation and ways in which they might be improved. Four databases were searched, and relevant articles were screened, with data from eligible reports extracted and reviewed. The methodological quality of the included articles was evaluated using the QualSyst critical appraisal tool. The HRQoL questionnaires for patients with dysphagia were assessed using the quality criteria for the measurement properties of health status questionnaires proposed by Terwee et al. and Timmerman et al. 29 studies published between 2008 and 2020 were included. The questionnaires described in these 29 studies were translated into 19 languages and culturally adapted to 21 countries. The adapted questionnaires were based on the Swallowing quality of life questionnaire (SWAL-QOL) by Mchorney et al., the Dysphagia Handicap Index (DHI) by Silbergleit et al., the M.D. Anderson Dysphagia Inventory (MDADI) by Chen et al., and the Eating Assessment Tool-10 (EAT-10) by Belafsky et al. It was found that the questionnaires were reliable and valid instruments for the assessment of dysphagia-related HRQoL, but the quality criteria for cultural adaptation and validation were not strictly followed, especially in the categories of criterion validity, agreement, responsiveness, and interpretability. In conclusion, although the questionnaires were found to be both reliable and valid, the quality criteria should be considered and strictly followed in the cultural adaptation and validation process in the future.
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Affiliation(s)
- Lin Yang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- The First Hospital of Lanzhou University, Lanzhou, China.
- School of Nursing, Lanzhou University, Lanzhou, China.
| | - Huiya Gao
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuchen Wu
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Huaping Wei
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiajia Kong
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Rui Wang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jie Cheng
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
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Ciarambino T, Sansone G, Para O, Giordano M. Dysphagia: what we know? A minireview. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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SEREL ARSLAN S, DEMIR N, KARADUMAN AA. Deglutition disorders from the perspective of healthcare professionals in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up. Dysphagia 2021; 37:217-236. [PMID: 33687558 DOI: 10.1007/s00455-021-10273-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.
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Park MI. [Approach of Dysphagia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:57-63. [PMID: 33632995 DOI: 10.4166/kjg.2021.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia. In patients with swallowing difficulties, it is important to determine whether the dysphagia is oropharyngeal or esophageal. Patients with orophayngeal dysphagia are likely to develop aspiration and aspiration pneumonia, so accurate diagnosis should be made in the early stages of complaining of swallowing difficulties. Patients with orophayngeal dysphagia complained difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Patients with esophageal dysphagia complained difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck in the esophagus. Esophageal dysphagia should be characterized by analyzing whether foods that cause swallowing difficulties are solid, liquids or both, whether symptoms are progressive or intermittent, how severe, and associated symptoms, such as weight loss, heartburn, or regurgitation. The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history. If esophageal motility disorder is suspected, barium esophagogram is performed first, and upper endoscopy is performed first if structural abnormalities are suspected. If an upper endoscopy shows normal findings, but the esophagus is still suspected of mechanical obstruction, a barium esophagogram is performed. Esophageal manometry should be performed in patients with swallowing difficulties who are suspected of esophageal motility disorder or have normal findings in upper endoscopy.
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Affiliation(s)
- Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Estupiñán Artiles C, Regan J, Donnellan C. Dysphagia screening in residential care settings: A scoping review. Int J Nurs Stud 2021; 114:103813. [PMID: 33220569 DOI: 10.1016/j.ijnurstu.2020.103813] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adults with dysphagia are at a higher risk of experiencing serious complications where dysphagia is not identified and adequately managed. Nursing personnel are critical for timely identification and management of dysphagia and prevention of these subsequent serious complications in residential care settings. OBJECTIVES To identify dysphagia screening tools used in residential care and to establish whether validated and used as per guidelines, their diagnostic accuracy and reliability and to identify the prevalence rate of dysphagia in this setting. DESIGN A scoping review based on Arksey & O'Malley (2005) methodological framework. DATA SOURCES An electronic search of databases CINAHL, Pubmed and Scopus was conducted. Reference lists were checked in all identified articles for additional studies. Peer-reviewed publications describing the process of identifying dysphagia and using a screening protocol in residential care settings were considered for inclusion. REVIEW METHODS All identified studies were screened by reading of titles, keywords and abstracts. Those articles that were deemed eligible for inclusion were read in full. RESULTS Nineteen quantitative studies and one mixed-methods study out of 1,674 articles were included in the review. Thirteen different instruments for dysphagia screening were identified, with the Modified Water Swallow Test being the most commonly used. Other diagnostic procedures, such as fiberoptic endoscopic evaluation of swallowing, pulse oximetry or cervical auscultation, were implemented along with the administration of a dysphagia screening tool in six studies. The 3-Ounce Water Swallow Test, the Yale Swallow Protocol and the Gugging Swallowing Screen were identified as the instruments with the best clinical accuracy values. The reported prevalence of dysphagia in this setting ranged from 15% to 70%. CONCLUSIONS Formal dysphagia screening in residential care settings is not common practice. The dysphagia screening tools identified in this review are not validated for use in this setting. The implementation of dysphagia screening protocols specific to this population may facilitate identification of dysphagia and avoid complications.
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Affiliation(s)
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Faculty of Arts, Humanities and Social Sciences, Trinity College Dublin, Ireland
| | - Claire Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Ireland
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 2021; 36:800-820. [PMID: 33399995 DOI: 10.1007/s00455-020-10218-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).
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Silva PB, Ramos GHA, Petterle RR, Borba VZC. Sarcopenia as an early complication of patients with head and neck cancer with dysphagia. Eur J Cancer Care (Engl) 2020; 30:e13343. [PMID: 33043532 DOI: 10.1111/ecc.13343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/20/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the relationship between dysphagia and sarcopenia in patients with head and neck cancer (HNC). METHODS A cross-sectional, prospective study, sample by convenience, including men with HNC during their initial oncologic evaluation. Patients answered questionnaires (demographic data, lifestyle habits, disease characteristics and the Short International Physical Activity Questionnaire). Swallowing capacity, bioelectrical impedance (BIA), handgrip strength (HGS) and physical performance test (Timed Up and Go test) were evaluated. Sarcopenia was diagnosed following the European Working Group on Sarcopenia and Foundation for the National Institute of Health criterion. RESULTS 71 men, elderly (66.9 ± 6.25 years) and adults (53.17 ± 3.66 years), were divided into the dysphagic group (DG, 44) and the non-dysphagic group (NDG, 27). The DG presented lower body mass index (BMI), lower skeletal muscle mass and a higher number of sarcopenic individuals than the NDG (p < 0.05). The degree of dysphagia was associated with weight loss (p = 0.006) but not with sarcopenia (p = 0.084) in the DG. The multivariate analysis showed that age, percentage of weight loss and BMI interfered with pre-sarcopenia, and only age influenced sarcopenia (p < 0.005). CONCLUSION Patients with dysphagia had a high prevalence of sarcopenia in the pre-treatment phase, related to age.
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Affiliation(s)
- Patricia Blasco Silva
- Department of Internal Medicine, Universidade Federal do Paraná, Curitiba, Brazil.,Head and Neck Surgery Service, Hospital Erasto Gaertner, Curitiba, Brazil
| | | | | | - Victória Zeghbi Cochenski Borba
- Department of Internal Medicine, Universidade Federal do Paraná, Curitiba, Brazil.,Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, Brazil
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Lazarescu A, Chan WW, Gyawali CP, Lee YY, Xiao Y, Wu P. Updates on diagnostic modalities for esophageal dysphagia. Ann N Y Acad Sci 2020; 1481:108-116. [PMID: 32875574 DOI: 10.1111/nyas.14453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
Esophageal dysphagia is a common symptom in adults. Fluoroscopic contrast studies, endoscopy, and esophageal manometry have been used in the diagnosis of esophageal dysphagia for many years. The diagnostic yield has been improved with new test protocols that highlight abnormal bolus transit in the esophagus and outflow obstruction, as well as new high-definition and high-resolution technical advances in equipment. Functional luminal impedance planimetry and the addition of impedance to high-resolution esophageal manometry have also allowed the assessment of new parameters to better understand esophageal structure and function. In this concise review, we describe the role and utility of various diagnostic modalities in the assessment of patients with esophageal dysphagia.
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Affiliation(s)
- Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Yinglian Xiao
- Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Peter Wu
- Department of Gastroenterology and Hepatology, St. George Hospital, Kogarah, New South Wales, Australia
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