[Importance of hydration in people with dysphagia and its consequences]. / Importancia de la hidratación en personas con disfagia y sus consecuencias.

Introduction: Introduction: dysphagia is a difficulty in moving food or drink from the mouth to the stomach, which may consist of a delay or an impossibility of transit or an-error in the direction, with the consequent passage into the airways. Dysphagia increases the risk of malnutrition and dehydration in the patient. However, although dehydration is one of the most common complications of dysphagia and is associated with significant risks, including hospitalization and mortality, it has been little studied in terms of its relationship and associated risk factors. Methods: a review of the scientific literature on the hydration of people with dysphagia and the dangers of inadequate hydration in them was carried out. Results and discussion: the dietary and nutritional approach in patients with dysphagia requires a multidisciplinary and personalized approach and is essential to improve the quality of life of patients with dysphagia. Dehydration is a frequent and serious complication in patients with dysphagia, which can lead to problems such as urinary tract infections, constipation, confusion, and worsening of chronic diseases. Therefore, it is crucial to carefully evaluate and monitor the fluid intake in these patients, and strategies to improve hydration include the use of thickened liquids, stimulating appetite, and adapting the texture and presentation of foods. Conclusión: adequate and protocolized management, from a dietary and nutritional point of view, can have a significant impact on the quality of life of patients, improving their well-being and preventing complications associated with this condition. A comprehensive approach to dysphagia, which includes adequate assessment and management of hydration, is essential to prevent serious complications.

Introducción: Introducción: la disfagia supone una dificultad en el desplazamiento del alimento o de la bebida desde la boca hasta al estómago, que puede consistir en un retraso o una imposibilidad de tránsito o en un error en la dirección, con el consiguiente paso a la vía aérea. La disfagia aumenta el riesgo de desnutrición y deshidratación en el paciente. Pero aunque la deshidratación es una de las complicaciones más comunes de la disfagia y se asocia con riesgos importantes, incluyendo hospitalización y mortalidad, su relación y los factores de riesgo asociados han sido poco estudiados. Métodos: se llevó a cabo una revisión de la literatura científica sobre la hidratación de las personas con disfagia y los peligros de una inadecuada hidratación en ellas. Resultados y discusión: el abordaje dietético y nutricional en pacientes con disfagia requiere un enfoque multidisciplinar y personalizado y es fundamental para mejorar su calidad de vida. La deshidratación es una complicación frecuente y grave en pacientes con disfagia, que puede llevar a problemas como infecciones urinarias, estreñimiento, confusión y empeoramiento de enfermedades crónicas. Por ello, es crucial evaluar y monitorizar cuidadosamente la ingesta hídrica de estos pacientes y establecer estrategias para mejorar la hidratación, incluyendo el uso de líquidos espesados, la estimulación del apetito y la adaptación de la textura y presentación de los alimentos. Conclusión: un manejo adecuado y protocolizado, desde el punto de vista dietético y nutricional, puede llegar a tener un impacto significativo en la calidad de vida de los pacientes, mejorando su bienestar y previniendo complicaciones asociadas a esta condición. El abordaje integral de la disfagia, que incluye una adecuada evaluación y manejo de la hidratación, es fundamental para prevenir complicaciones graves.

Dysphagia management by nurses in Spanish intensive care units.

INTRODUCTION/PURPOSE: Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses. METHOD: Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis. OUTCOMES: 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%). CONCLUSION: The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.

Intervenções do enfermeiro especialista em enfermagem de reabilitação em pacientes com deglutição comprometida: uma scoping review / Interventions by nurses specialising in rehabilitation nursing for patients with impaired swallowing: a Scoping Review

Introdução: A deglutição é um processo dinâmico e complexo, que desempenha um papel fundamental na nutrição e na proteção da via aérea e que quando comprometida tem um impacto biopsicossocial. Na deglutição comprometida, também denominada disfagia ocorre um condicionamento da normal passagem do bolo alimentar em qualquer fase e/ou entre as fases da dinâmica da deglutição, que pode ser congénita ou adquirida, após comprometimento neurológico, mecânico ou psicogénico. Esta, possui uma elevada prevalência em adultos/idosos institucionalizados e, surge associada a patologias neurológicas, bem como, a patologias localizadas na cabeça e pescoço. O EEER possui o conhecimento e as competências necessárias, para intervir nesta problemática, uma vez que, está presente durante todo o período de internamento, desempenhando um papel crucial no planeamento antecipado do regresso a casa. Objetivo: Mapear a evidência científica, mais atualizada, sobre a intervenção dos EEER em pacientes com deglutição comprometida, em contexto hospitalar; Objetivos específicos: Identificar intervenções do EEER em adultos com deglutição comprometida, em contexto hospitalar; Descrever as intervenções do EEER identificadas, no paciente adulto com deglutição comprometida, em contexto hospitalar. Metodologia: Foi realizada uma scoping review segundo a metodologia JBI. Tratando-se de um estudo de revisão, obedece a critérios de elegibilidade com base na População, Conceito e Contexto. A pesquisa foi concretizada nas seguintes bases de dados, aplicando a frase booleana definida: EBSCOhost, Cochrane Database, Scopus, Scielo, PubMed, RCAAP e RENATES. Foram incluídos dez estudos: quatro estudos de caso, três estudos quantitativos, duas revisões sistemáticas da literatura e um estudo controlado randomizado. Resultados: A análise dos dez estudos selecionados de acordo com os critérios de inclusão, permitiu identificar um conjunto de intervenções do EEER, na deglutição comprometida em pacientes hospitalizados. Dos resultados destacou-se que a avaliação da deglutição prévia à administração de alimentos por via oral, a modificação da dieta, a higiene oral, a intervenção psicológica, a educação para a saúde, assim como a reabilitação funcional motora e a reabilitação funcional respiratória são fundamentais para a promoção da funcionalidade e independência e para a qualidade de vida, em pacientes com deglutição comprometida. Por outro lado, permitiu-nos verificar que a intervenção do EEER contribuiu para a diminuição de complicações associadas, nomeadamente, redução do risco de pneumonia e melhor custo-efetividade, resultando na redução do número de dias de internamento hospitalar. Conclusão: O papel do EEER é fundamental na obtenção de ganhos em saúde no paciente com deglutição comprometida. No entanto, existe uma lacuna na exploração das intervenções do EEER na deglutição comprometida, sendo fundamental o desenvolvimento de novas pesquisas, com amostras mais alargadas, com o objetivo de orientar uma prática mais sistematizada.

Introduction: Deglutition is a dynamic and complex process that plays a fundamental role in nutrition and airway protection, and when compromised, it has a biopsychosocial impact. In deglutition disorders, also known as dysphagia, there is impairment in the normal passage of food bolus at any phase and/or between phases of deglutition dynamics, which can be congenital or acquired, following neurological, mechanical, or psychogenic impairment. It has a high prevalence in institutionalized adults/elderly and is associated with neurological pathologies as well as pathologies localized in the head and neck. The rehabilitation specialist nurses possess the knowledge and skills necessary to intervene in this issue, as they are present throughout the hospitalization period, playing a crucial role in the early planning of discharge to return home. Objectives: Mapping the most current scientific evidence on the intervention of rehabilitation specialist nurses in adult patients with deglutition disorders, in a hospital setting. Specific objectives: Identify rehabilitation nursing interventions in adult patients with deglutition disorders, in a hospital setting; Describe the identified rehabilitation nursing interventions in adult patients with deglutition disorders, in a hospital setting. Method: A scoping review was conducted following the JBI methodology. As a review study, it adheres to eligibility criteria based on Population, Concept, and Context. A boolean phrase was formulated, and the search was conducted in the following databases: EBSCOhost, Cochrane Database, Scopus, Scielo, PubMed, RCAAP, and RENATES. Ten studies were included: four case studies, three quantitative studies, two systematic literature reviews, and one randomized controlled trial. Results: The analysis of the ten selected studies according to the criteria allowed us to identify a set of interventions by the rehabilitation specialist nurses in adult patients with deglutition disorders, in a hospital setting. The results highlighted that the evaluation of deglutition prior to oral food administration, diet modification, oral hygiene, psychological intervention, health education, as well as motor functional rehabilitation and respiratory functional rehabilitation, are fundamental for promoting functionality, independence, and quality of life in patients with deglutition disorders. On the other hand, it allowed us to verify that the intervention by the rehabilitation specialist nurses contributes to the reduction of associated complications, namely, reducing the risk of pneumonia and improved cost-effectiveness resulting from the reduction of hospitalization days. Conclusion: The role of the rehabilitation specialist nurses is fundamental in achieving health gains to the patient with deglutition disorders. However, there is a gap in exploring rehabilitation specialist nurses interventions in deglutition disorders, and it is essential to develop new research with larger samples to guide a more systematic practice.

Disfagia no Transtorno do Espectro Autista (TEA): uma revisão integrativa / Dysphagia in Autism Spectrum Disorder (ASD): An integrative review / Disfagia en el trastorno del espectro autista (TEA): una revisión integradora

Introdução: O Transtorno do Espectro Autista (TEA) é um distúrbio do neurodesenvolvimento caracterizado por déficits na comunicação social, alterações de sensibilidade e dificuldades alimentares.Objetivo: Realizar uma revisão integrativa das alterações de deglutição em indivíduos com TEA.Métodos: A pesquisa foi realizada por meio de uma busca por artigos nacionais e internacionais, utilizando descritores para a pesquisa, bem como critérios de inclusão e exclusão para a seleção da amostra final. A estratégia PPOT foi utilizada para definir critérios de elegibilidade, incluindo população (crianças e adultos), preditor (diagnóstico de TEA), desfecho (relato ou diagnóstico de disfagia oral, faríngea ou esofágica) e tipo de estudo (estudos observatórios). A busca foi realizada no período de junho a agosto de 2023, nas bases de dados: Pubmed, Scopus, Embase e Google Scholar. Resultados: Foram selecionados dez estudos com pacientes diagnosticados com TEA que relataram sintomas de disfagia orofaríngea e esofágica, além de queixas sobre ingestão alimentar. Os estudos sugerem que crianças com TEA podem apresentar algum problema de disfunções motoras orais, frequência alimentar inadequada, padrões alimentares obsessivos, apresentação específica de determinados alimentos, seletividade alimentar e dificuldades de processamento sensorial. Conclusão: Conclui-se que não há evidências científicas robustas sobre a presença de disfagia em pacientes com TEA. (AU)

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, changes in sensitivity and eating difficulties. Objective: To carry out an integrative review of swallowing changes in individuals with ASD. Methods: The research was carried out through a search for national and international articles, using descriptors for the research, as well as inclusion and exclusion criteria for selecting the final sample. The PPOT strategy was used to define eligibility criteria, including population (children and adults), predictor (ASD diagnosis), outcome (report or diagnosis of dysphagia oral, pharyngeal or esophageal), and study type (observatory studies). The search was carried out from June to August 2023, in the databases: Pubmed, Scopus, Embase and Google Scholar. Results: Ten studies were selected with patients diagnosed with ASD who reported symptoms of oropharyngeal and esophageal dysphagia, in addition to complaints about food intake. Studies suggest that children with ASD may present problems with oral motor dysfunction, inadequate eating frequency, obsessive eating patterns, specific presentation of certain foods, food selectivity and sensory processing difficulties. Conclusion: It is concluded that there is no robust scientific evidence about the presence of dysphagia in patients with ASD. (AU)

Introducción: El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo caracterizado por déficits en la comunicación social, cambios en la sensibilidad y dificultades alimentarias. Objetivo: Realizar una revisión integradora de los cambios en la deglución en individuos con TEA. Métodos: La investigación se realizó mediante una búsqueda de artículos nacionales e internacionales, utilizando descriptores para la investigación, así como criterios de inclusión y exclusión para la selección de la muestra final. La estrategia PPOT se utilizó para definir los criterios de elegibilidad, incluida la población (niños y adultos), el predictor (diagnóstico de TEA), el resultado (informe o diagnóstico de enfermedad oral, faríngea o esofágica) y el tipo de estudio (estudios observatorios). La búsqueda se realizó de junio a agosto de 2023, en las bases de datos: Pubmed, Scopus, Embase y Google Scholar. Resultados: Se seleccionaron diez estudios con pacientes diagnosticados de TEA que refirieron síntomas de disfagia orofaríngea y esofágica, además de quejas sobre la ingesta de alimentos. Los estudios sugieren que los niños con TEA pueden presentar problemas de disfunción motora oral, frecuencia inadecuada de alimentación, patrones alimentarios obsesivos, presentación específica de ciertos alimentos, selectividad alimentaria y dificultades en el procesamiento sensorial. Conclusión: Se concluye que no existe evidencia científica robusta sobre la presencia de disfagia en pacientes con TEA. (AU)

Upper airway manifestations of anti-IgLON5 disease: Otorhinolaryngological point of view.

INTRODUCTION: Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm. METHODS: In this study, we present a series of 9 patients with anti-IgLON5 disease and otolaryngological manifestations. Patients were evaluated between July 2012 and March 2022 by video-polysomnography, fiber-optic laryngoscopy, and functional endoscopic evaluation of swallowing. RESULTS: The median age was 71 years, and 5 (56%) were female. Video-polysomnography showed a NREM/REM parasomnia in 6 patients (67%), obstructive sleep apnea in 8 (88%), stridor during sleep in 7 (78%) and central apneas in 1 (11%). Six out of the 9 patients (67%) presented episodes of acute respiratory failure that required mechanical ventilation, 6 had vocal fold palsy with 4 of them requiring tracheostomy (3 had to be performed on an emergency basis). Dysphagia occurred in 8 patients (89%). Prominent upper airway secretion and sialorrhea was also present in 3 cases. CONCLUSION: The anti-IgLON5 disease exhibits extensive otolaryngological symptoms, mainly affecting the upper airway. These symptoms affect the quality of life and can be life-threatening. Prompt acute management is essential for stridor, dyspnea, and dysphagia. Given the potential severity of the symptoms and rarity of the disease, it is important for otolaryngologists to be familiar with anti-IgLON5 disease. LEVEL OF EVIDENCE: Level 4.

The evolution of the treatment of esophageal achalasia. Chronicle of a 35-year journey.

Over the last few decades, significant improvement has been made in both the evaluation and treatment of esophageal achalasia. The Chicago classification, today in version 4.0, is now the standard for diagnosis of achalasia, providing a classification into 3 subtypes with important therapeutic and prognostic implications. Therapy, which was at first mostly limited to pneumatic dilatation, today includes minimally invasive surgery and peroral endoscopic myotomy, allowing for a more tailored approach to patients and better treatment of recurrent symptoms. This review chronicles my personal experience with achalasia over the last 35 years, describing the progress made in the treatment of patients with achalasia.

The Thyrohyoid Muscle: A Crucial Player in Deglutition and Vocalization / El Músculo Tirohioideo: Un Actor Crucial en la Deglución y la Vocalización

SUMMARY: The thyrohyoid muscle is one of the four infrahyoid muscles. Its role in vocalization and deglutition could be often overlooked, despite its crucial participation in these processes. Unlike other infrahyoid muscles, the thyrohyoid muscle receives innervation from the first cervical spinal nerves which contributes to its unique function. Its primary action involves hyolaryngeal elevation during swallowing, contributing to the opening of the upper esophageal sphincter. In conjunction with other muscles, it also protects the airway and facilitates the passage of food into the esophagus. Variations in the muscle's thickness may exist, and its function can be influenced by chewing habits. Weakened muscles involved in swallowing are often associated with dysphagia, a common complication in stroke and brain-injured patients. Advanced imaging techniques and sleep studies have provided insights into the dynamics and frequency of swallowing. This review explores the anatomic structures, function in action, diagnosis and clinical implications of this muscle. Overall, understanding the significance of the thyrohyoid muscle enhances our comprehension of the intricate interplay of laryngeal muscles during vocalization and deglutition.

El músculo tirohioideo es uno de los cuatro músculos infrahioideos. A menudo podría pasarse por alto su papel en la vocalización y la deglución, a pesar de su participación crucial en estos procesos. A diferencia de otros músculos infrahioideos, el músculo tirohioideo recibe inervación de los primeros nervios espinales cervicales, lo que contribuye a su función única. Su acción principal implica la elevación hiolaríngea durante la deglución, contribuyendo a la apertura del esfínter esofágico superior. Junto con otros músculos, también protege las vías respiratorias y facilita el paso de los alimentos al esófago. Pueden existir variaciones en el grosor del músculo y su función puede verse influenciada por los hábitos de masticación. Los músculos debilitados involucrados en la deglución a menudo se asocian con disfagia, una complicación común en pacientes con accidente cerebrovascular y lesión cerebral. Las técnicas de imagen avanzadas y los estudios del sueño han proporcionado información sobre la dinámica y la frecuencia de la deglución. Esta revisión explora las estructuras anatómicas, la función en acción, el diagnóstico y las implicaciones clínicas de este músculo. En general, comprender la importancia del músculo tirohioideo mejora nuestra comprensión de la intrincada interacción de los músculos laríngeos durante la vocalización y la deglución.

Autopercepción del conocimiento de disfagia por profesionales de la salud oral / Self-perception of knowledge of dysphagia by oral health professionals

Introducción: la disfagia es la alteración en los mecanismos de la deglución que coexiste con múltiples enfermedades y condiciones. El conocimiento amplio de esta alteración generará mejores diagnósticos y tratamientos para el mejoramiento de la calidad de vida de estos pacientes. Aunque esta alteración podría ser del dominio común por especialistas en el área de la salud, principalmente la oral, no existe información reciente del nivel de conocimiento sobre la disfagia en el personal odontológico. Objetivo: determinar el nivel de conocimiento sobre la disfagia en un grupo de profesionales de la salud oral de Ciudad Juárez, Chihuahua. Material y método: se realizó un estudio trasversal descriptivo en un grupo de 241 odontólogos (pasantes de servicio social, odontólogos generales, periodoncistas, endodoncistas, rehabilitadores, odontopediatras y ortodoncistas) a través de una encuesta, los reactivos utilizados fueron sobre conocimiento de la disfagia, métodos de diagnóstico, signos y síntomas, tratamiento y complicaciones. Resultados: la mitad de la población encuestada refirió conocer los trastornos de la deglución (64.7%). Contrastantemente, al utilizar el término «disfagia¼, la postura del conocimiento disminuyó considerablemente (40.7%). Finalmente, los valores más bajos de la encuesta se mostraron en la falta de conocimiento sobre identificación de signos y síntomas de la disfagia (36.1%), métodos de diagnóstico (20.7%), tratamientos (18.7%) y complicaciones (23.2%). Conclusión: existe un bajo conocimiento de los trastornos de la deglución autopercibido por los profesionales de la odontología, lo que sugiere la búsqueda de los factores que ocasionan la falta del conocimiento de los profesionales del área odontológica (AU)

Introduction: dysphagia is the alteration in swallowing mechanisms that coexists with multiple diseases and conditions. The broad knowledge of this alteration will generate better diagnoses and treatments for the improvement of the quality of life of these patients. Although this alteration could be common domain by specialists in the area of health, mainly oral, there is no recent information on the level of knowledge about dysphagia in dental personnel. Objective: to determine the level of knowledge about dysphagia in a group of oral health professionals from Ciudad Juárez, Chihuahua. Material and methods: a descriptive cross-sectional study was carried out in a group of 241 dentists (social service intern, general dentists, periodontists, endodontists, rehabilitators, pediatric dentists and orthodontists) through a survey, the reagents used were on knowledge of dysphagia, diagnostic methods, signs and symptoms, treatment and complications. Results: half of the surveyed population reported knowing swallowing disorders (64.7%). In contrast, when using the term «dysphagia¼ the posture of knowledge decreased considerably (40.7%). Finally, the lowest values in the survey were found in the lack of knowledge about identification of signs and symptoms of dysphagia (36.1%), diagnostic methods (20.7%), treatments (18.7%) and complications (23.2%). Conclusion: there is a low knowledge of self-perceived swallowing disorders by dentists, which suggests the search for the factors that cause the lack of knowledge of dental professionals (AU)

Dysphagia as a primary manifestation of basilar impression: A case report.

Secondary basilar invagination or basilar impression is an anomaly at the craniovertebral junction where the odontoid process prolapses into the foramen magnum with the risk of compressing adjacent structures and obstructing the proper flow of cerebrospinal fluid (CSF). The incidence is less than 1% in the general population and occurs mainly in the first three decades of life when it is associated with malformations of the neuroaxis. In older age, the main aetiologies are diseases that alter bone mineral density. The clinical course is usually progressive and the most common symptoms are asthenia, cervical pain and restricted movement, but also dysphonia, dyspnoea and dysphagia. It is a progressive disease which, if left untreated, can cause severe neurological damage and death. We report the case of a 79-year-old woman with osteoporosis and progressive dysphagia leading to severe malnutrition, which conditioned the decision not to intervene due to the high perioperative risk.

Clinical outcomes and manometry results of peroral endoscopic myotomy in patients with achalasia: experience in a Latin American referral centre. / Resultados clínicos y manométricos de la miotomía endoscópica peroral en pacientes con acalasia: experiencia en un centro de referencia latinoamericano.

INTRODUCTION: Currently there is little information in Latin America on the clinical outcome and manometric evolution of patients with Achalasia undergoing peroral endoscopic myotomy (POEM). PRIMARY OUTCOME: Evaluate the manometric and clinical changes in adult patients with achalasia after peroral endoscopic myotomy at a referral center in Bogotá, Colombia. METHODS: Observational, analytical, longitudinal study. Adult patients with achalasia according to the Chicago 4.0 criteria were included. Sociodemographic, clinical and manometric variables were described. To compare the pre- and post-surgical variables, the Student's or Wilcoxon's t test was used for the quantitative variables according to their normality, and McNemar's chi-square for the qualitative variables. RESULTS: 29 patients were included, 55.17% (n=16) women, with a mean age at the time of surgery of 48.2 years (±11.33). The mean post-procedure evaluation time was 1.88±0.81 years. After the procedure, there was a significant decrease in the proportion of patients with weight loss (37.93% vs 21.43% p 0.0063), chest pain (48.28% vs 21.43, p 0.0225) and the median Eckardt score (8 (IQR 8 -9) vs 2(IQR 1-2), p <0.0001). In addition, in fourteen patients with post-surgical manometry, significant differences were found between IRP values (23.05±14.83mmHg vs 7.69±6.06mmHg, p 0.026) and in the mean lower esophageal sphincter tone (9.63±7.2mmHg vs 28.8±18.60mmHg, p 0.0238). CONCLUSION: Peroral endoscopic myotomy has a positive impact on the improvement of symptoms and of some manometric variables (IRP and LES tone) in patients with achalasia.

High-resolution manometry with impedance for the study of pharyngeal motility and the upper esophageal sphincter: Keys for its use in the study of the pathophysiology of oropharyngeal dysphagia. / Manometría de alta resolución con impedancia para el estudio de la motilidad faríngea y del esfínter esofágico superior: claves para su utilización en el estudio de la fisiopatología de la disfagia orofaríngea.

Oropharyngeal dysphagia (OD) is a pathology with a high prevalence in different patient phenotypes. High-resolution pharyngoesophageal manometry (HRPM) with impedance (HRPM-I) has become in recent years a fundamental technique for better understanding the pathophysiology of pharynx and upper oesophageal sphincter (UES) dysfunctions in patients with OD. Various groups of experts have proposed a methodology for the practice of the HRPM-I and for the standardization of the different metrics for the study of pharyngeal motility and UES dysfunctions based on the quantification of 3main phenomena: relaxation of the UES, resistance to flow through the UES and propulsion of the bolo through the pharynx into the oesophagus. According to the alterations of these metrics, 3patterns of dysfunction are proposed that allow a specific therapeutic approach: (a) UES flow restriction with normal pharyngeal propulsión; (b) UES flow restriction with ineffective pharyngeal propulsion, and (c) ineffective pharyngeal contraction with normal relaxation of the UES. We present a practical review of the methodology and metrics used by the main working groups together with the description of the main patterns of dysfunction according to our experience to highlight the usefulness of the HRPM-I in the study of the pathophysiology and selection of a specific treatment in patients with OD.

Associação entre risco de disfagia e sinais sugestivos de sarcopenia, estado nutricional e frequência de higiene oral em idosos hospitalizados / Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly

RESUMO Objetivo Identificar o risco de disfagia e sua associação com os sinais sugestivos de sarcopenia, estado nutricional e frequência da higiene oral em idosos hospitalizados. Método Trata-se de um estudo transversal analítico com participação de 52 idosos internados em clínica médica de um hospital público no Distrito Federal. Foram aplicados os instrumentos Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Circunferência da Panturrilha e o Mini Nutritional Assessment shortform além de coleta de dados sociodemográficos e de condições de saúde. Resultados Dos idosos participantes 30,8% apresentaram risco de disfagia autorrelatada. Os fatores associados ao risco de disfagia foram sinais sugestivos sarcopenia (p=0,04), estado nutricional (p<0,001) e frequência da higiene oral (p=0,03). Conclusão Na população geriátrica deste estudo, em sua maioria com Covid-19, o risco de disfagia esteve associado aos sinais sugestivos de sarcopenia, estado nutricional e frequência da higiene oral.

ABSTRACT Purpose To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. Methods This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. Results Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p<0.001) and oral hygiene frequency (p=0.03). Conclusion In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.

Associação entre número de dentes, próteses dentárias e disfagia autorreferida em idosos brasileiros: estudo populacional / Association between number of teeth, dental prostheses, and self-reported dysphagia in brazilian old people: a population-based study

RESUMO Objetivo Verificar a associação entre o número de dentes e uso de prótese dentária removível e a ocorrência de disfagia autorreferida em idosos de 60 anos ou mais. Método Estudo transversal de base populacional com 5.432 idosos, que participaram da linha de base do Estudo Longitudinal da Saúde do Idoso (ELSI-Brasil). O desfecho "disfagia" foi associado ao número de dentes permanentes e ao uso de prótese dentária removível. As variáveis independentes sociodemográficas (idade, sexo e cor/raça) e de histórico clínico (nenhuma morbidade, uma morbidade ou mais de duas morbidades) utilizando Regressão de Poisson com variância robusta e seus respectivos intervalos de confiança (IC) de 95% foram analisados. Resultados A prevalência de disfagia autorreferida nos idosos não institucionalizados foi de 30%. O grupo de idosos com 10 - 19 dentes permanentes apresentou um risco de 52% de queixa de disfagia autorreferida (RPaj 1,565 IC95% 1,34;1,826) se comparado com seus pares com mais dentes. Conclusão foi encontrada associação entre o menor número de dentes e próteses removíveis com a ocorrência de disfagia.

ABSTRACT Purpose To investigate the association between the number of permanent teeth and the use of removable dental prostheses with self-reported dysphagia occurrence in individuals aged 60 years or older. Methods A population-based cross-sectional study was conducted with 5,432 old individuals who participated in the baseline of the Brazilian Longitudinal Study of Elderly Health (ELSI-Brazil). The outcome "dysphagia" was associated with the number of permanent teeth and the use of removable dental prostheses. Sociodemographic independent variables (age, sex, and race/ethnicity) and clinical history variables (no morbidity, one morbidity, or more than two morbidities) were analyzed using Poisson Regression with robust variance and their respective 95% confidence intervals (CI). Results The prevalence of self-reported dysphagia in non-institutionalized old individuals was 30%. The group of old individuals with 10 - 19 natural teeth showed a 52% increased risk of self-reported dysphagia complaint (PRadj 1,565 IC95% 1,34;1,826) compared to their counterparts with more teeth. Conclusion An association was found between a lower number of teeth and removable prostheses with the occurrence of dysphagia.

Traqueostomía y disfagia en pacientes con COVID-19. Su impacto en el proceso de decanulación / Tracheostomy and Dysphagia in Patients with COVID-19. Its Impact on the Decannulation Process

RESUMEN Introducción: Los pacientes con neumonía grave por COVID-19 pueden requerir in tubación orotraqueal, ventilación mecánica prolongada, y traqueostomía. La presencia de una cánula de traqueostomía no implica por sí misma el desarrollo de disfagia, pero la frecuencia de disfagia en estos pacientes es alta con riesgo de aspiración. Objetivo: Describir la prevalencia disfagia orofaríngea en pacientes que requirieron traqueostomía luego de ventilación mecánica prolongada secundaria a COVID-19, valorada mediante un método instrumental. Como objetivo secundario, evaluar la asociación entre la presencia de disfagia y variables clínico-demográficas, duración de la ventilación mecánica invasiva, días de vía aérea artificial, presencia de lesiones laríngeas y días de estadía en terapia intensiva. Material y métodos: Estudio observacional, longitudinal y retrospectivo, realizado en el hospital Juan A. Fernández, CABA, Argentina. Se incluyeron de manera consecutiva pacientes con diagnóstico de COVID-19 traqueostomizados. La presencia de disfagia se valoró mediante estudio endoscópico de la deglución al momento de la decanulación. Resultados: Un total de 69 pacientes traqueostomizados en proceso de decanulación ingresaron al estudio. De ellos, 65 pacientes fueron analizados y evaluados mediante endoscopía de la deglución y cincuenta se diagnosticaron con disfagia (76,9 %). La me diana de días de traqueostomía fue de 32; al comparar los días de traqueostomía entre el grupo sin disfagia (mediana veintiún días) y el grupo con disfagia (mediana 36), se observaron diferencias estadísticamente significativas entre ambos grupos (p = 0,015). Conclusión: La disfagia orofaríngea fue prevalente en esta cohorte de pacientes con COVID 19. Los pacientes que tuvieron más días de traqueostomía hasta la decanulación se asociaron significativamente con el desarrollo de disfagia.

ABSTRACT Introduction: Patients with severe COVID-19 pneumonia may require orotracheal intubation, prolonged mechanical ventilation, and tracheostomy. The presence of a tracheostomy cannula does not contribute by itself to the development of dysphagia, but the frequency of dysphagia in these patients is high and with risk of aspiration. Objective: To describe the prevalence of oropharyngeal dysphagia in patients who required tracheostomy after prolonged mechanical ventilation secondary to COVID-19, assessed by an instrumental method. As a secondary objective, to evaluate the as sociation between the presence of dysphagia and clinical-demographic variables, the duration of invasive mechanical ventilation, days of artificial airway, presence of laryngeal injuries, and length of stay in the Intensive Care. Methods: Observational, longitudinal, retrospective study conducted at the Hospital Juan A. Fernández, Autonomous City of Buenos Aires (CABA), Argentina. Tracheos tomized patients diagnosed with COVID-19 were consecutively included in the study. The presence of dysphagia was assessed by an endoscopic study of swallowing at the time of decannulation. Results: A total of 69 tracheostomized patients undergoing decannulation were included in the study. 65 of these patients were evaluated through swallowing endoscopy, and 50 were diagnosed with dysphagia (76.9%). The median number of tracheostomy days was 32. When comparing tracheostomy days between the group without dysphagia (median of 21 days) and the group with dysphagia (median of 36 days), statistically significant differences were reported between both groups (p=0.015). Conclusion: Oropharyngeal dysphagia was prevalent in this cohort of COVID-19 pa tients. A significant association was found between patients with more tracheostomy days until decannulation and the development of dysphagia.

Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study

Objectives: This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods: A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results: Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations: The study had a modest sample size and relied solely on clinical screening tools. Value: This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings. Conclusion: While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.

Objetivos: Este estudio piloto tuvo como objetivo identificar y probar una batería de herramientas de detección de problemas de voz y deglución que fueran eficientes en cuanto a tiempo y costo para pacientes chilenos postextubados. Métodos: Un panel de cuatro expertos seleccionó y evaluó herramientas de detección de voz y deglución. Se seleccionaron siete medidas: prominencia de pico cepstral suavizado (CPPS) y tiempo máximo de fonación (TMF) para la evaluación de la voz, prueba de volumen-viscosidad (V-VST) para la deglución, flujo máximo voluntario y reflejo de la tos para evaluar la tos, Eating Assessment Tool-10 (EAT-10) y la Escala de Sintomas Vocales (ESV) para los resultados informados por los pacientes. Estas herramientas se aplicaron a cuatro pacientes postextubados (48-72 horas), junto con la evaluación de 17 controles pareados. Resultados: Los pacientes postextubados mostraron un TMF y CPPS significativamente más bajos, aumento de los indicios de disfagia en la V-VST, reducción del flujo máximo de la tos y síntomas más pronunciados tanto en la ESV como en la EAT-10 en comparación con los controles. Limitaciones: El estudio tuvo un tamaño de muestra reducida y se basó únicamente en herramientas de detección clínica. Valor: Este estudio piloto sugiere un enfoque factible y rentable para la detección de problemas de voz y deglución en pacientes postextubados, valioso en entornos con recursos limitados. Conclusión: Aunque ese abordaje no sustituye a las evaluaciones de referencia, ofrece información valiosa y puede guiar futuras investigaciones que busquen facilitar la detección temprana de los trastornos de la voz-deglución en pacientes postextubados.

Acalasia o hipertrofia del músculo Cricofaríngeo: opciones de tratamiento

La disfagia alta es un síntoma frecuente de consulta al otorrinolaringólogo o gastroenteròlogo. Los diagnósticos diferenciales son trastornos de la deglución por daño neurològico, anillos esofágicos superiores, globus faríngeo, neoplasia, disfagia lusoria y trastornos motores inespecífico y otras más raras aún. Hay escasa literatura actualizada en pacientes adultos. El diagnóstico se basa en el estudio radiológico baritado, endoscopia y complementariamente con manometría. Las opciones de tratamiento son motivo de discusión, dada la poca evidencia disponible. En este artículo se presentan los resultados observados en una cohorte de 10 pacientes con diagnóstico confirmado de acalasia del cricofaríngeo sometidos a dilatación endoscópica (7 pacientes) o miotomía quirúrgica por cervicotomía (3 pacientes). Se evaluó evolución de la disfagia, complicaciones post procedimiento y resultados a largo plazo. No hubo complicaciones mayores, la disfagia mejoro en ambos grupos, en el grupo de dilatación se complementó el tratamiento con dilataciones periódicas en 2 pacientes. No hubo diferencias significativas en los 2 grupos estudiados. Conclusión: ambas opciones terapéuticas presentan buenos resultados en el tratamiento de estos pacientes.

Dysphagia at cervical level is a frequent symptom causing visit to otolaryngologist or gastroenterologist. The differential diagnoses are swallowing disorders due to neurological damage, upper esophageal rings, pharyngeal globus, neoplasia, non-specific motor disorders and other even rarer ones. There is little updated literature in adult patients. The diagnosis is based on the barium radiological study, endoscopy and complementary manometry. Treatment options are a matter of discussion, given the little evidence available. This paper presents the results observed in a cohort of 10 patients with a confirmed diagnosis of cricopharyngeal achalasia who underwent endoscopic dilation (7 patients) or surgical myotomy by cervicotomy (3 patients). The evolution of dysphagia, post-procedure complications and long-term results were evaluated. There were no major complications, dysphagia improved in both groups, in the dilation group the treatment was supplemented with periodic dilations in 2 patients. There were no significant differences in the 2 groups studied. Conclusion: both therapeutic options present good results in the treatment of these patients.

Self-expanding Metal Stents in Malignant Obstruction of the Esophagus: A 25-Year Multicentric Study

Background: Self-expanding metal prostheses improve dysphagia in patients with incurable esophageal cancer (EC). New stents have been introduced, and chemoradiotherapy has been implemented for EC, changing patients' risk profiles. It is unknown whether this has affected palliation with stents. Patients and methods: Retrospective study in three centers in Medellín-Colombia; patients undergoing placement of palliative esophageal prostheses for malignant dysphagia (1997-2022). Major and minor complications after implantation, the influence of oncological therapies, and survival were evaluated for 1997-2009 (n = 289) and 2010-2022 (n = 318). Results: 607 patients underwent esophageal prostheses; 296 (48.8%) became complicated. It was higher in the second period (52.5% vs. 48.1%), as were major complications (20.8% vs. 14.2%, p = 0.033), with no differences in minor complications (33.9% vs 31.8%, p = 0.765). Also, 190 (31.3%) patients presented with recurrent dysphagia, stable in both periods. Migration increased over time (from 13.1% to 18.2%, p = 0.09). The most common minor adverse event was pain, increasing over time (from 24.9% to 33.95%, p < 0.01), and associated factors were chemoradiotherapy, absence of fistula, and squamous cell carcinoma. Acid reflux decreased in the second group (p = 0.038). Twelve percent of patients required another intervention for feeding. Survival was not impacted by time and use of stents. Conclusions: Stents are an alternative in non-surgical malignant dysphagia, although recurrent dysphagia has not decreased over time. Minor stent-related complications are increasing in association with the implementation of chemoradiotherapy.

Antecedentes: Las prótesis metálicas autoexpandibles mejoran la disfagia en pacientes con cáncer esofágico (CE) incurable. En las últimas décadas se han introducido nuevos tipos de stents y se ha implementado la quimiorradioterapia para el CE, generando cambios en los perfiles de riesgo de los pacientes. Se desconoce si estos cambios han afectado la paliación con stents. Pacientes y métodos: Estudio retrospectivo en tres centros de Medellín-Colombia; pacientes sometidos a colocación de prótesis esofágicas paliativas para disfagia maligna (1997-2022). Se evaluaron en dos períodos: 1997-2009 (n = 289) y 2010-2022 (n = 318), complicaciones mayores y menores después del implante, la influencia de las terapias oncológicas y la sobrevida. Resultados: Se evaluaron 607 pacientes sometidos a prótesis esofágicas. 296 (48,8%) se complicaron, y fue mayor en el segundo periodo (52,5% frente a 48,1%), al igual que las complicaciones mayores (20,8% frente a 14,2%, p = 0,033), sin diferencias en complicaciones menores (33,9% frente a 31,8%, p = 0,765). 190 (31,3%) pacientes presentaron disfagia recurrente, estable en ambos períodos. La migración aumentó con el tiempo (de 13,1% a 18,2%, p = 0,09). El evento adverso menor más frecuente fue dolor, que aumentó con el tiempo (de 24,9% a 33,95%, p < 0,01), y los factores asociados fueron quimiorradioterapia, ausencia de fístula y carcinoma de células escamosas. El reflujo ácido disminuyó en el segundo grupo (p = 0,038). El 12% de pacientes requirieron otra intervención para alimentarse. No se impactó la sobrevida con el tiempo y uso de stents. Conclusiones: Los stents son una alternativa en la disfagia maligna no quirúrgica, aunque la disfagia recurrente no ha disminuido con el tiempo. Las complicaciones menores relacionadas con el stent van en aumento, asociadas a la implementación de la quimiorradioterapia.

Por que indivíduos saudáveis podem ter escores do Eating Assessment Tool (EAT-10) indicativos de disfagia? / Why healthy individuals may have Eating scores Assessment Tool (EAT-10) indicative of dysphagia?

Contexto: Eating Assessment Tool (EAT-10) é um método clínico de detecção de disfagia, entendida como dificuldade na deglutição. Em pesquisa realizada no Brasil, foi observado que 9,5% de indivíduos saudáveis assintomáticos têm resultados do teste compatível com disfagia. Objetivo: Avaliar os possíveis fatores que influenciam o resultado anormal do teste em indivíduos saudáveis. Método: Estudo transversal realizado na Faculdade de Medicina de Ribeirão Preto (FMRP-USP) em 358 voluntários sem doenças e sem sintomas, nos quais foi aplicado o teste EAT-10. Resultados: Em 316 o resultado nos 10 itens do teste foi zero, e em 42 os resultados da somatória dos 10 itens foi igual ou superior a 3, considerado indicativo de disfagia. O resultado ≥ 3 ocorreu em 10 homens entre 144 (7%) e 32 mulheres entre 214 (15%), (P = 0,01). A mediana (limites) de idades daqueles com resultado zero foi de 39 (20-84) anos, e com resultado ≥ 3 foi de 32 (20-83) anos (P = 0,04). O índice de massa corporal (IMC) não apresentou diferença entre pessoas com e sem indicação de disfagia. O máximo escore possível para o item 5 (dificuldade na ingestão de medicamentos) foi o que obteve o maior percentual (43,9%) de máximo escore possível, sendo o fator mais importante para o resultado anormal. Discussão: Em indivíduos saudáveis, a dificuldade em ingerir medicamentos foi o fator que mais influenciou a ocorrência de resultado do teste EAT-10 indicativo de disfagia. Conclusão: Dificuldade na ingestão de medicamentos sólidos deve ser considerada quando da interpretação do teste.

[Protocol of action in the dietary and nutritional approach in patients with dysphagia]. / Protocolo de actuación en el abordaje dietético y nutricional en pacientes con disfagia.

Introduction: Introduction: dysphagia is classified under "symptoms and signs involving the digestive system and abdomen" in the International Classification of Diseases (ICD-10, code R13). It is defined as obstruction in the region of the pharynx, sternum or xiphoid because of obstruction of the passage of food from the mouth to the stomach or cardia, and has become one of the most important causes affecting the adequate intake of energy and nutrients. An optimal dietary and nutritional approach plays a crucial role in the management of dysphagia. The main goal of such an approach is to ensure safe and sufficient nutrition to prevent malnutrition and complications associated with dysphagia. Objectives: to establish an action protocol for an effective dietary and nutritional approach in patients with dysphagia based on the existing scientific evidence. Methods: a review of the scientific literature on the dietary-nutritional approach to dysphagia was carried out. Results: the dietary and nutritional approach in patients with dysphagia requires a multidisciplinary and personalized approach and is essential to improve the quality of life of patients with dysphagia. Through the implementation of an evidence-based action protocol, it is possible to guarantee preventing aspiration and ensuring safe swallowing and modification of textures of different foods (thus promoting adequate intake of nutrients and fluids to avoid malnutrition and dehydration). Conclusion: adequate and protocolized management, from a dietary and nutritional point of view, can have a significant impact on the quality of life of patients, improving their well-being and preventing complications associated with this condition.

Introducción: Introducción: la disfagia se clasifica dentro de los "síntomas y signos que involucran el sistema digestivo y el abdomen" en la Clasificación Internacional de Enfermedades (CIE-10, código R13). Dicho síntoma produce en la región de la faringe, el esternón o el xifoides como resultado de la obstrucción del paso de alimentos de la boca al estómago o al cardias, y se ha convertido en una de las causas más importantes que afecta a la ingesta adecuada de energía y nutrientes. Un abordaje dietético y nutricional óptimo desempeña un papel crucial en el manejo de la disfagia. El objetivo principal de dicho abordaje es garantizar una alimentación segura y suficiente para prevenir la desnutrición y las complicaciones asociadas a la disfagia. Objetivos: establecer un protocolo de actuación para realizar, de forma eficaz, el abordaje dietético y nutricional en pacientes con disfagia en base a la evidencia científica existente. Métodos: se llevó a cabo una revisión de la literatura científica sobre el abordaje dietético-nutricional de la disfagia. Resultados: el abordaje dietético y nutricional en pacientes con disfagia requiere un enfoque multidisciplinar y personalizado, y es fundamental para mejorar la calidad de vida de los pacientes con disfagia. A través de la implementación del protocolo de actuación basado en la evidencia, se puede garantizar: prevenir la aspiración y asegurar una deglución segura y, modificación de texturas de los diferentes alimentos (promoviendo de esta forma la ingesta adecuada de nutrientes y líquidos para evitar la desnutrición y la deshidratación). Conclusión: un manejo adecuado y protocolizado, desde el punto de vista dietético y nutricional, puede llegar a tener un impacto significativo en la calidad de vida de los pacientes, mejorando su bienestar y previniendo complicaciones asociadas a esta condición.

[Translated article] Deglufarm: Mobile application with recommendations for the safe administration of drugs in patients with dysphagia or swallowing disorders.

OBJECTIVE: Develop an App to use in healthcare practice, with updated and accurate information on the handling of medications in patients with dysphagia or deglution disorders, as well as their compatibility with food and thickeners. METHODS: The development of the Deglufarm® App was based on the CRONOS, Nutrition and Techno working groups of the Sociedad Española de Farmacia Hospitalaria. A group of specialist pharmacists was created from different care areas for patients with dysphagia. The creation of Deglufarm® consisted of several stages: selection of active drugs, literature review, content development, design (an expert company in App design was contacted), testing, launch, content update and follow-up. RESULTS: Deglufarm® is available for Android and IOS free of charge from July 2022. It has been tested among the members of the research group and collaborators, Currently, 540 monographs of active drugs have been reviewed and registered in Deglufarm. The first version is aimed at healthcare professionals. CONCLUSIONS: Deglufarm® is an easy tool to consult, with the most current evidence on handling the medicines it contains.