Outcomes of Serum Food-Specific Immunoglobulin G 4 to Guide Elimination Diet in Patients With Eosinophilic Esophagitis.

INTRODUCTION: Eosinophilic esophagitis (EoE) is associated with atopy; however, recent studies have identified an association with food-specific immunoglobulin G 4 (FS-IgG 4 ) rather than immunoglobulin E antibodies. This study aimed to evaluate the role of serum FS-IgG 4 in guiding an elimination diet and its outcomes. METHODS: Patients with and without EoE were enrolled in a prospective, controlled, single tertiary center trial. Serum FS-IgG 4 titers, esophageal eosinophil counts, and dysphagia symptom questionnaire scores were assessed, and participants with elevated FS-IgG 4 (ImmunoCAP, cutoff of 10 mgA/L) commenced 6-week targeted elimination diet. Repeat serum FS-IgG 4 and endoscopic and histologic examination were performed at 6-week follow-up. RESULTS: Twenty-two patients with active EoE and 13 controls were recruited. Serum FS-IgG 4 to milk, wheat, soy, eggs, and nuts was significantly higher in EoE ( P = 0.0002, P = 0.002, P = 0.003, P = 0.012, and P < 0.001, respectively). Elevated serum FS-IgG 4 to 1 or more food groups (median 2) was identified in 21/22 (95.4%) patients with EoE; 20/21 underwent 6-week dietary elimination. Median reductions in dysphagia symptom questionnaire score and EoE endoscopic reference score after elimination were 8 ( P = 0.0007) and 1 ( P = 0.002), respectively. Nine (45%) patients had histological remission (<15 eosinophils per high-power field). Fall in median esophageal eosinophil count was not statistically significant (50 vs 23; P = 0.068). Serum FS-IgG 4 did not decline by 6-week follow-up. DISCUSSION: Serum FS-IgG 4 to milk, wheat, soy, egg, and nuts was present at higher levels in EoE, with targeted elimination resulting in 45% histologic remission rate. Serum FS-IgG 4 has potential as a noninvasive biomarker in EoE. When successful, FS-IgG 4 -led elimination diet can negate need for medications and be viewed more favorably by patients because of its smaller endoscopic burden compared with empirical elimination diets.

Disfagia en tiempos de COVID-19 / Dysphagia in COVID-19 times

Resumen Los pacientes con COVID-19 pueden presentar dificultades en la alimentación por distintos factores, entre los que destacan el aumento del esfuerzo respiratorio, uso de dispositivos de apoyo ventilatorio, compromiso neurológico y disfagia postextubación. La evaluación clínica es fundamental, pero debe ser realizada con precaución y con elementos de protección personal, ya que es un procedimiento generador de aerosoles, al igual que la evaluación instrumental mediante videofluoroscopía y evaluación fibroendoscópica de la deglución. Las recomendaciones de manejo deben basarse en la evaluación clínica adaptada, tanto para pacientes ambulatorios como hospitalizados, y debe incluir el manejo nutricional, compensatorio y el seguimiento clínico periódico para evitar las consecuencias de la disfagia orofaríngea, y así disminuir la tasa de neumonía aspirativa, causa importante de morbimortalidad.

Abstract Patients with COVID-19 may present feeding difficulties due to different factors, like the increase in respiratory effort, use of ventilatory support devices, neurological compromise and post-extubation dysphagia. Clinical evaluation is essential, but it must be carried out with caution and using personal protection elements, since it is an aerosol-generating procedure, as well as the instrumental evaluation by videofluoroscopy and fiberoptic endoscopic evaluation of swallowing. Treatment should be based on adapted clinical evaluation, for both outpatients and hospitalized patients, and should include nutritional treatment, compensatory management and periodic clinical follow-up to avoid the consequences of oropharyngeal dysphagia and decrease the rate of aspiration pneumonia major cause of morbidity and mortality.

Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia.

Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener® (FCT)] on four phenotypes of OD patients: G1) 36 older; G2) 31 head/neck cancer (HNC); G3) 30 Parkinson's disease; and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5/20 mL boluses, at four levels of shear-viscosity (<50, 250, 1000 and 2000 mPa·s). The effect of α-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 ± 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 250-1000 mPa·s (74.19-96.67%, safe swallows in G1, G3, G4, and 58.06% in G2), without increasing pharyngeal residue. Viscosity was unaffected by α-amylase. Increasing shear-viscosity with FCT causes a strong viscosity-dependent therapeutic effect on the safety of swallow. This effect depends on the phenotype and is similar among older, Parkinson's and post-stroke patients.

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review.

OBJECTIVES: This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. DESIGN: Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. SETTING: OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. RESULTS: This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. CONCLUSION: There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

"Eat to Live"-Piloting a Culinary Medicine Program for Head & Neck Radiotherapy Patients.

BACKGROUND: Head and neck radiotherapy (H&N RT) patients are at risk for malnutrition following treatment due to dysphagia and alterations in taste quality. This project studied feasibility of a food skills intervention strategy support food preparation, cooking confidence, and individualized dietary choices to support nutritional status in this patient population. METHODS: We piloted a monthly cooking class (called "Eat to Live") from November 2018 to January 2019. Every class included cooking and nutrition domains, organized around a specific meal of the day (i.e., breakfast, lunch, or dinner). Seven participants (4 patients, 3 caregivers) attended at least one class, with four participants (3 patients, 1 caregiver) completing all three classes. Pre- and post-study measures (self-administered questionnaires) assessed changes in cooking behavior, dietary choices, and taste sensation before and after the intervention. RESULTS: Healthful eating scores increased modestly from start to finish of the class (1.5 to 1.7 on a 3-point scale), with averaged patient preference scores for healthy foods increasing incrementally. This took place despite physical taste scores declining across the 3-month study. After completing the class, participants were more likely to select fresh fruits and vegetables, grains, lean cuts of meat, and dairy products. Patients also adopted positive behavioral modifications to their diets, such as eating out at restaurants less often and baking/grilling foods instead of frying. CONCLUSIONS: To our knowledge, this is the first published report on feasibility and patient acceptance of an evidence-based culinary medicine intervention in H&N RT patients. We observed objective improvements in dietary choices and cooking confidence in a small cohort of patient/caregiver dyads. This pilot work justifies follow-on development of a more comprehensive intervention optimized for patient convenience and longitudinal support.

Parental care for infants with feeding tube: psychosocial repercussions / Cuidado de los padres para lactantes con sondas de alimentación: repercusiones psicosociales / O cuidado prestado por pais a lactentes com sonda alimentadora: repercussões psicossociais

ABSTRACT Objectives: to understand the psychosocial repercussions experienced by caregiving parents, resulting from care for the child with dysphagic cleft lip and palate. Methods: qualitative study, developed in a tertiary hospital in September 2016. The sample defined by theoretical saturation consisted of seven mothers. Data collection was performed by unstructured interview, being audio-recorded and fully transcribed. Symbolic Interactionism was used as theoretical framework, and Thematic Content Analysis as methodological framework. Results: the following themes emerged: diagnosisimpact and coping; coping with overload and stress; interaction between caregivers as an acceptance and coping strategy; impact on family and social life of caregivers; and curiosity coping, and family and community prejudice. Final considerations: despite the physical and emotional overload, the mother figure plays the main and determining role in care, reflecting the complexity of care.

RESUMEN Objetivos: comprender las repercusiones psicosociales experimentadas por los padres cuidadores, como resultado del cuidado del niño con labio leporino y paladar hendido disfagico. Métodos: estudio cualitativo, desarrollado en un hospital terciario en septiembre de 2016. La muestra definida por saturación teórica consistió en siete madres. La recopilación de datos se realizó mediante entrevista no estructurada, grabada en audio y totalmente transcrita. Se utilizó como referencia teórica el interaccionismo simbólico y como referencia metodológica, el análisis de contenido temático. Resultados: se aclararon cinco categorías: impacto y afrontamiento del diagnóstico; hacer frente a la sobrecarga y el estrés; interacción entre cuidadores como una estrategia de aceptación y afrontamiento; impacto en la vida familiar y social de los cuidadores; y afrontamiento de curiosidad y prejuicio familiar y comunitario. Consideraciones finales: a pesar de la sobrecarga física y emocional, la figura materna desempeña el papel principal y determinante en la atención, lo que refleja la complejidad del proceso de lo cuidado.

RESUMO Objetivos: compreender as repercussões psicossociais vivenciadas por pais cuidadores, decorrentes do cuidado do filho com fissura labiopalatina, disfágico e em uso de sonda alimentadora. Métodos: estudo qualitativo, desenvolvido em um hospital terciário em setembro de 2016. A amostra definida por saturação teórica constou sete mães. A coleta de dados foi realizada por entrevista não estruturada, audiogravada e transcrita na íntegra. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico, a Análise de Conteúdo Temática. Resultados: foram elucidadas cinco categorias: impacto e enfrentamento do diagnóstico; enfrentamento da sobrecarga e o estresse; interação entre cuidadores como estratégia de aceitação e enfrentamento; impacto no convívio familiar e social dos cuidadores; e enfrentamento da curiosidade e o preconceito familiar e comunitário. Considerações finais: apesar da sobrecarga física e emocional, a figura materna exerce o papel principal e determinante no cuidado, refletindo a complexidade do processo de cuidar.

Orientações em alimentação e nutrição para adultos e idosos com COVID-19 em isolamento domiciliar e após alta hospitalar / Série Nutricionistas em Ação com a Ciência / Guidelines on food and nutrition for adults and the elderly with COVID-19 in home isolation and after hospital discharge / Nutritionists In Action Series with Science

Orientações em alimentação e nutrição para adultos e idosos com COVID-19 em isolamento domiciliar e após alta hospitalar, com suspeita ou diagnóstico do novo Coronavírus, também às pessoas que apresentam sintomas leves ou moderados e que não precisam ficar internadas em hospitais, direcionada também para os cuidadores e pessoas que convivem no mesmo ambiente e demais interessados no tema. Em uma linguagem acessível e usando ótimas ilustrações e tabelas, esclarece sobre os cuidados nutricionais e também sobre alguns alimentos e nutrientes importantes para a imunidade. Instrui como fazer em situações de falta de apetite, perda de paladar (Disgeusia), dificuldade para engolir (Disfagia), perda de olfato (Anosmia) e diarréia. Orienta sobre as compras dos alimentos, sobre os riscos de contaminação, tempo de validade e armazenagem na geladeira e freezer, bem como os cuidados no preparo dos mesmos. Apresenta instruções sobre a higienização das mãos com água e sabonete e como fazer a fricção anti-séptica das mãos com preparação alcoólicas, sobre o manuseio adequado na retirada do lixo e instruções para diluição da solução clorada para superfícies e para embalagens e alimentos. Por fim, apresenta sete passos para manter a alimentação saudável para adultos e idosos

Guidelines on food and nutrition for adults and the elderly with COVID-19 in home isolation and after hospital discharge, with suspicion or diagnosis of the new coronavirus, also those with mild or moderate symptoms and who do not need to be hospitalized, also directed to the caregivers and people who live in the same environment and others interested in the topic. In an accessible language and using great illustrations and tables, it clarifies about nutritional care and also about some foods and nutrients important for immunity. Instructs you how to do it in situations of poor appetite, loss of taste (dysgeusia), difficulty swallowing (dysphagia), loss of smell (anosmia) and diarrhea. It advises on food purchases, on the risks of contamination, expiration time and storage in the refrigerator and freezer, as well as care in preparing them. It presents instructions on hand hygiene with soap and water and how to rub hands with alcoholic preparations, on proper handling of waste removal and instructions for diluting the chlorinated solution to surfaces and to packaging and food. Finally, it presents seven steps to maintain healthy eating for adults and the elderly

The effect of "xanthan gum-based fluid thickener" on hydration, swallowing functions and nutritional status in total maxillectomy patients.

PURPOSE: Swallowing functions are affected after total maxillectomy operations and adjuvant chemoradiotherapy. The purpose of our study is to assess the role of xanthan gum based thickening agents on swallowing and hydration of maxillectomy patients on a randomized controlled fashion. METHODS: 12 of the 22 patients diagnosed with maxillary carcinoma and planned to undergo total maxillectomy was identified as study group and 10 of them were identified as control group. The study group used "xantham based liquid thickener" for liquid foods up to 3 months postoperatively and the control group did not use. Dysphagia-related quality of life, bioimpedance analysis, EAT-10 scores, swallowing functions were evaluated both preoperative and postoperative period. RESULTS: The mean age of the study group was 56 ± 9.87, and 41.6% were women. The mean age of control group was 60 ± 15.63, and 50% were women. Postoperative EAT-10 scores were statistically significant higher than preoperative scores in both groups (p < 0.05). In both of the study and control groups, a statistically significant reduction in dysphagia related quality of life was detected postoperatively (p < 0.05). Intracellular water, extracellular water and total body water detected statistically significant higher in study group at postoperative month three. CONCLUSION: Swallowing functions are affected due to total maxillectomy and radiotherapy. With this study, it has been shown that, total maxillectomy and radiotherapy reduce dysphagia-related quality of life. Swallowing dysfunction and dehydration has been shown to affect total maxillectomy patients. Using of 'xanthan gum-based fluid thickener' helps to maintain intracellular water, extracellular water, and total body water.

Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis.

BACKGROUND: Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis. AIMS: We conducted a retrospective cohort study to ascertain the efficacy and adherence to a combined and alternating treatment approach with topical corticosteroids and 2-food elimination diet for pediatric EoE. METHODS: Patients were prescribed a 2-food elimination diet (milk and soy) and topical corticosteroid (fluticasone or oral viscous budesonide) for 3 months, after which the steroid was discontinued and 2-food elimination diet continued for 3 months. An EGD was performed at baseline, 3 and 6 months. Clinical, endoscopic, and histologic data were extracted from electronic medical records. Nonparametric tests assessed adherence and outcomes. RESULTS: Twenty-nine eosinophilic esophagitis cases were included (mean age 11.5 years, 61% male). Complete adherence to combined therapy and 2-food elimination diet alone was 75 and 79%, respectively. Median eosinophil counts decreased from 51 to 2 eosinophils/hpf (p < 0.001) after combined treatment and rebounded to 31 (p = 0.07) after 2FED alone. Dysphagia improved after both the combined and 2-food elimination diet alone treatment approaches (52 vs. 11% and 10%; p = 0.001, 0.005). Nonsignificant improvements in endoscopic findings were documented across the length of follow-up. CONCLUSIONS: An initial combined treatment approach resulted in significant improvements in symptoms and histologic findings. While symptomatic improvements continued with 2-food elimination diet alone, the histologic improvement was not maintained. While loss to follow-up may obscure the efficacy of 2-food elimination diet alone, a combined/alternating treatment approach merits assessment in a larger prospective study.

Nutritional Therapy for Patients with Esophageal Cancer.

Malnutrition develops in 79% patients with esophageal cancer. Thus, these patients represent a group of cancer patients, which is the most nutritionally compromised. Dysphagia and more than 10% loss of body weight are already present at the time of diagnosis. Treatments for esophageal cancer contribute significantly to the development of malnutrition. This paper describes the nutritional treatment of patients and nutritional strategies in patients with dysphagia and other nutritional problems that accompany the treatment of patients with esophageal cancer. Here are shown the types and methods of nutritional support, which are suitable for this group of patients. Nutritional support of patients with esophageal cancer is performed as a parallel therapeutic route.

Nutritional management for Alzheimer ' s disease in all stages: mild, moderate, and severe

Alzheimer's disease corresponds to 50­70% of all dementia syndromes, classified as a progressive neurodegenerative disease showing diffuse cortical atrophy with three stages of evolution: mild, moderate, and severe. Behavioral symptoms and memory loss are major manifestations of the disease. Non-pharmacological interventions are essential to improve the quality of life of these patients. Interdisciplinary assistance is essential throughout the disease course. Regarding nutrition for patients with Alzheimer's disease, weight loss and behavioral changes related to food are major objects of scientific study, as they trigger deterioration of the quality of life of patients and caregivers. Knowing which nutritional guidelines should be used helps in clinical decisions. The study of nutrition in dementia is, therefore, critical for patient management.

Thickeners sold in Brazil: analysis of the composition and suitability for children under the age of 3 / Espessantes comercializados no Brasil: análise da composição e da adequação para crianças menores de 3 anos

Introduction: Thickeners are used in the treatment of swallowing disorders, named dysphagia. In Brazil there is no specific product for the pediatric population who under the age of 3 years. Objective: To analyze the different types of thickeners available in Brazil, considering their chemical composition and their use in pediatrics. Methods: Quantitative study, with descriptive approach based on the data collection. The brands of existing thickeners were analyzed in Brazil and their composition in relation to the Codex Alimentarius and nutritional recommendations for children from 0 to 3 years. Results: Eight brands were studied, three of which proved to be inappropriate for pediatric use because they have gum in their formulation. Other thickeners brands did not present inadequacies for use in the age group from 0 to 3 years old regarding to the type of carbohydrate, sodium content and total caloric value. Conclusion: In Brazil, 5 thickeners brands present in their composition levels of sodium and profile of carbohydrate adequate for children from 0 to 3 years, even when they are associated with infant formulas.(AU)

Introdução: Os espessantes são utilizados no tratamento dos distúrbios de deglutição, denominados disfagia, porém, no Brasil, não há produto específico para a população pediátrica menor de 3 anos. Objetivo: Analisar os diferentes tipos de espessantes disponíveis no Brasil, considerando sua composição química e sua utilização em pediatria. Método: Estudo quantitativo, do tipo descritivo com base no levantamento de dados. Foram analisadas as marcas de espessantes existentes no Brasil quanto a sua composição em relação ao Códex Alimentarius e recomendações nutricionais para crianças de 0 a 3 anos. Resultados: Foram estudadas oito marcas, das quais três mostraram-se inadequadas para utilização pediátrica, por possuírem goma em sua formulação. As demais marcas de espessantes não apresentaram inadequações para uso na faixa etária de 0 a 3 anos de idade no que se refere ao tipo de carboidrato, teor de sódio e valor calórico total. Conclusão: No Brasil, 5 marcas de espessantes apresentam em sua composição teores de sódio e perfil de carboidratos adequados para crianças de 0 a 3 anos, mesmo quando associadas a fórmulas infantis.(AU)

Rehabilitation Nutrition for Possible Sarcopenic Dysphagia After Lung Cancer Surgery: A Case Report.

Sarcopenic dysphagia is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function. In this report, the authors describe a patient with possible sarcopenic dysphagia after lung cancer surgery and was treated subsequently by rehabilitation nutrition. A 71-year-old man with lung cancer experienced complications of an acute myocardial infarction and pneumonia after surgery. He was ventilated artificially, and a tracheotomy was performed. The patient received diagnoses of malnutrition, severe sarcopenia, and possible sarcopenic dysphagia. His dysphagia was improved by a combination of dysphagia rehabilitation including physical and speech therapy and an improvement in nutrition initiated by a nutrition support team. Finally, he no longer had dysphagia and malnutrition. Sarcopenic dysphagia should be considered in patients with sarcopenia and dysphagia. Rehabilitation nutrition using a combination of both rehabilitation and nutritional care management is presumptively useful for treating sarcopenic dysphagia.

Fonoaudiologia e nutrição em ambiente hospitalar: análise de terminologia de classificação das consistências alimentares / Speech-Language and Nutritional Sciences in hospital environment: analysis of terminology of food consistencies classification

RESUMO Objetivos: Verificar se há concordância entre fonoaudiólogos e nutricionistas na classificação de consistências alimentares utilizadas em hospitais e as opiniões sobre as possíveis consequências das divergências nessa classificação. Métodos: Estudo descritivo transversal com 30 fonoaudiólogos e 30 nutricionistas que trabalhavam em 14 hospitais da rede pública e/ou privada de Belo Horizonte. Os profissionais responderam um questionário elaborado pelas pesquisadoras e classificaram cinco alimentos, com e sem direcionamento teórico. Empregaram-se os testes estatísticos Exato de Fisher e Z para comparação de proporções, com nível de significância de 5%. Resultados: Tanto fonoaudiólogos (100%) quanto nutricionistas (90%) percebem divergência nas classificações, sendo que, respectivamente, 86,2% e 100% acreditam que essa divergência pode prejudicar a recuperação dos pacientes. O risco de aspiração de alimento foi o prejuízo mais citado. Para a classificação geral das consistências alimentares, a maior parte dos profissionais (88,5%) sugeriu de quatro a seis termos. Quanto à terminologia utilizada na classificação dos alimentos apresentados sem direcionamento teórico, os profissionais citaram 49 termos e concordaram apenas na classificação do sólido e do líquido. Com o direcionamento teórico, os profissionais concordaram também na classificação do pastoso grosso e do pastoso fino. Conclusão: Tanto fonoaudiólogos quanto nutricionistas reconhecem divergências na classificação das consistências alimentares e o consequente risco de prejuízos à recuperação do paciente. A utilização do direcionamento teórico aumentou a concordância entre os profissionais.

ABSTRACT Purpose To verify if there is an agreement between speech-language pathologists and nutritionists about the classification of food textures used in hospitals and their opinions about the possible consequences of differences in this classification. Methods This is a descriptive, cross-sectional study with 30 speech-language pathologists and 30 nutritionists who worked in 14 hospitals of public and/or private network in Belo Horizonte, Brazil. The professionals answered a questionnaire, prepared by the researchers, and classified five different foods, with and without theoretical direction. The data were analyzed using Fisher's exact and Z -tests to compare ratios with a 5% significance level. Results Both speech-language therapists (100%) and nutritionists (90%) perceive divergence in the classification and, 86.2% and 100% of them, respectively, believe that this difference may affect the patients' recovery. Aspiration risk was the most mentioned problem. For the general classification of food textures, most of the professionals (88.5%) suggested four to six terms. As to the terminology used in the classification of food presented without theoretical direction, the professionals cited 49 terms and agreed only in the solid and liquid classifications. With theoretical direction, the professionals also agreed in the classification of thick and thin paste. Conclusion Both the professionals recognized divergences in the classification of food textures and the consequent risk of damage to patient's recovery. The use of theoretical direction increased the agreement between these professionals.

Removal of oesophageal foreign bodies: comparison between oesophagoscopy and oesophagotomy in 39 dogs.

OBJECTIVES: To compare complication rates and outcomes after removal of oesophageal foreign bodies by endoscopy or by oesophagotomy. METHODS: Retrospective evaluation of medical records of dogs with oesophageal foreign bodies treated by endoscopy and/or oesophagotomy. Postoperative clinical signs, management, length of hospitalisation, type and rate of complications, and time interval to return to eating conventional diet were compared. RESULTS: Thirty-nine dogs diagnosed with oesophageal foreign bodies between 1999 and 2011 were included in the study. Most common breeds included West Highland white terrier, Jack Russell terrier and shih-tzu. Successful endoscopic removal was possible in 24 out of 32 cases (Group 1), while surgical removal was successful in 15 out of 15 cases (7 of which had unsuccessful attempts at endoscopic removal) (Group 2). Length of hospitalisation, time to removal of gastrostomy tube and time to eat conventional diet did not differ between the groups. After foreign body removal, the incidence of oesophagitis, oesophageal stricture and perforation observed during repeated endoscopy were similar between the groups. CLINICAL SIGNIFICANCE: In this retrospective study, removal of oesophageal foreign bodies either by oesophagoscopy or oesophagotomy had a similar outcome.

[Factors associated with mortality in patients with dysphagia help in making dietary and nutritional choices]. / Los factores relacionados con la mortalidad en pacientes con disfagia ayudan en la toma de decisiones dietéticas y nutricionales.

OBJECTIVE: To know what factors evaluated at the moment of admission are related with mortality among in-patients with dysphagia, during their stay in a longterm care hospital and may guide the dietary and nutritional intervention. MATERIAL AND METHODS: Retrospective, observational and descriptive cohort study over patients with dysphagia diagnosed by Volumen-Viscosity Clinical Exploration Method (VVCEM). Demographic and clinical variables were gathered, stay, mortality, when their dysphagia was re-evaluated and treatments. RESULTS: 182 patients were included, medium age of 78 years old, 50% of them died. Following factors were significantly associate with death by univariant analysis: aged 85 or older, previous diagnosis of dysphagia, oncological disease, high co-morbidity (Charlson between 2-5 and > 5 points), low functionality before hospitalization (Barthel Index < 40), MNA < 17 points, albumen < 3 g/ dl, high score in CONUT (5-12 points), to be on opioids, neuroleptics, antidepressants while performing VVCEM, and the assistance aim when admission. Following factors had signification for risk to die by multi-variant analysis: age, oncological disease, co-morbidity and albumen, but taking antidepressants turned out to be a protective factor. Analysis of contrast was applied by curve ROC. The area under the curve was 0.740 and the confidence interval (CI) 0.668-0.811. CONCLUSIONS: The above-mentioned information that may be evaluated in patients with dysphagia when admission, may help to define of more suitable and precocious form our welfare aims. In those cases with major risk of dying, it should prioritize comfort and safe swallowing. In those cases with low risk, in addition, should be effective improve to the maximum their nutritional condition.

Objetivo: Conocer en los pacientes con disfagia ingresados en un Hospital de Media y Larga Estancia, qué factores, valorados al ingreso, están relacionados con fallecer durante su hospitalización y pueden orientar la intervención dietética y nutricional. Material y método: Estudio de cohorte retrospectivo, observacional y descriptivo de pacientes diagnosticados de disfagia por el Método de Exploración Clínica Volumen- Viscosidad (MECVV). Se recogieron variables demográficas y clínicas, estancia, éxitus, revaloraciones de disfagia y tratamientos. Resultados: Se incluyeron 182 pacientes, con edad media de 78 años, fallecieron el 50%. En el análisis univariante se asociaron significativamente con el éxitus: edad >= 85 años, diagnóstico previo de disfagia, padecer enfermedad oncológica, elevada comorbilidad (Charlson entre 2-5 y > 5 puntos), baja funcionalidad previa a hospitalización (Índice de Barthel < 40 puntos), MNA < 17 puntos, albúmina < 3 g/dl, alta puntuación del CONUT (de 5-12 puntos), tratamiento con: opioide, neuroléptico o antidepresivo al realizar el MECVV, y objetivo asistencial al ingreso. En análisis multivariante obtuvieron significación: edad, enfermedad oncológica, comorbilidad, y albúmina como factores de riesgo para fallecer, y llevar antidepresivo como factor protector. Se aplicó análisis de contraste con Curva ROC. El área bajo la curva fue 0,740 y el intervalo de confianza (IC) 0,668-0,811. Conclusiones: En pacientes con disfagia, los datos referidos valorados al ingreso, pueden ayudar a definir más adecuada y precozmente objetivos asistenciales. En los casos con mayor riesgo de fallecer se priorizará una ingesta segura y de confort, y en aquellos con bajo riesgo, además deberá ser eficaz para intentar mejorar al máximo su estado nutricional.

Dysphagia following posterior fossa surgery in adults.

OBJECTIVE: Our study seeks to assess the incidence of aspiration and prolonged dysphagia needing enteral feeding at discharge (EFD) in adults after posterior fossa (p-fossa) surgery. METHODS: A retrospective review was done on 56 patients with p-fossa surgery who needed a swallowing evaluation postoperatively. Questionnaires were sent to patients with EFD. Using univariate and multiple logistic regression analysis, risk factors for aspiration, EFD, and continued enteral feeds were identified. RESULTS: Most patients were male and had p-fossa tumors. Multiple swallowing evaluations were needed in 25 (45%) patients. Aspiration was seen in 23 (41%) and 16 (27%) had EFD. Older age and number of evaluations were significantly associated with both aspiration and EFD (P < 0.05). Lateral approach was significantly associated with EFD (P = 0.047). In addition, multiple logistic regression identified aspiration as an independent significant predictor for EFD (P < 0.01). Mean operative time and tumor location did not have a significant correlation with EFD. At mean follow-up (15 months), only 5/16 needed continued enteral feeds. CONCLUSION: Although 27% patients had EFD after p-fossa surgery, only 5/56 (9%) required continued enteral feeding. Aspiration, age, and lateral surgical approach is associated with EFD. In patients who demonstrate aspiration, we recommend placement of enteral feeding tube. Although most will not require continued enteral feeding at follow-up, longer follow-ups are needed.

Fiber-optic endoscopic evaluation of swallowing (FEES): predictor of swallowing-related complications in the head and neck cancer population.

BACKGROUND: The treatment of head and neck cancer is associated with significant dysphagia and morbidity. Prescribing a safe oral diet in this population is challenging. METHODS: Data from 116 consecutive patients having 189 fiber-optic endoscopic evaluation of swallowing (FEES) examinations over a 3-year period were analyzed. All patients had been treated for head and neck cancer and subsequently were assessed by FEES. The primary outcome was the incidence of swallowing-related adverse events resulting from the FEES-based dietary recommendations. RESULTS: There were 10 episodes of aspiration pneumonia, 4 episodes of airway obstruction, 3 unanticipated insertions of gastrostomy tubes, and 2 unexplained deaths within the study period. The overall rate of adverse events was 10.1%. The only statistically significant predictor of adverse events was the Rosenbek score (p = .03). CONCLUSIONS: Our experience is that FEES guides appropriate and safe diet recommendations in this population.

Dietetic management in gastrointestinal complications from antimalignant chemotherapy.

Antineoplastic chemotherapy (CT) represents the systemic treatment of malignant tumors. It can be used alone or combined with surgery and / or radiotherapy. The cytotoxic agents used in chemotherapy work on both cancerous cells and noncancerous cells of the body, generally resulting in high toxicity. The biological aggressiveness of chemotherapy particularly affects rapidly replicating cells, such as those of the digestive tract, resulting in adverse effects that impair food intake, leading to compromised nutritional status and which may lead to cachexia. The main toxic effects of chemotherapy in the gastrointestinal tract include nausea, vomiting -these are the most frequent- constipation, diarrhea, xerostomia, mucositis, dysphagia and anorexia. Given the high frequency of such effects, nutritional intervention should be an integral part of cancer treatment, to maintain and/or improve the patient's nutritional status and reduce or minimize the side effects caused by treatment. Accordingly, the goal of this study is to review dietetic conduct in the process of caring for patients undergoing cancer chemotherapy.

Consumo alimentar de crianças e adolescentes com disfagia decorrente de estenose de esôfago: avaliação com base na pirâmide alimentar brasileira / Food consumption by children and adolescent with dysphagia due to esophageal stricture: assessment based on the Brazilian food guide pyramid

OBJETIVO: Avaliar o consumo alimentar de pacientes com disfagia decorrente de estenose de esôfago, comparando a dieta de consistência líquida com a dieta de consistência pastosa e sólida, com base na Pirâmide Alimentar Brasileira. MÉTODOS: Estudo de corte transversal, no qual foram incluídos consecutivamente 31 pacientes com estenose esofágica, sendo 18 (58,0 por cento) cáustica, 7 (22,6 por cento) pós-cirúrgica, 3 (9,7 por cento) péptica e 3 (9,7 por cento) sem causa definida. Empregou-se o recordatório de 24 horas; os alimentos foram transformados em porções em função dos oito grupos de alimentos, conforme recomendado por Philippi. Utilizou-se o teste Kruskal-Wallis e Exato de Fisher, fixando em 5 por cento o nível de rejeição da hipótese de nulidade. RESULTADOS: A idade variou entre 15 e 176 meses (mediana, 56 meses), sendo 28 crianças e três adolescentes, e 18 do sexo masculino. Vinte e nove pacientes (93,5 por cento) apresentavam disfagia, sendo grave em 34,4 por cento (10/29), moderada em 41,3 por cento (12/29), e leve em 24,1 por cento (7/29). O consumo mediano de porções de cereais, leguminosas, e óleos e gorduras foi menor no grupo com dieta líquida (p<0,005), o qual também apresentou maior proporção de pacientes cujo consumo foi abaixo do proposto pela pirâmide alimentar quando comparado ao grupo com dieta pastosa e sólida, com diferença estatisticamente significante (p<0,05). CONCLUSÃO: O suporte nutricional é de extrema importância no tratamento de pacientes com estenose esofágica, principalmente na disfagia grave, cuja dieta deve ser adaptada à consistência líquida, devido ao risco nutricional que se atribui à limitada ingestão alimentar, e para que o tratamento dietético seja precocemente instituído.

OBJECTIVE: This study assessed food intake by patients with dysphagia due to esophageal stricture and compared liquid, soft and solid diets based on the Brazilian Food guide pyramid. METHODS: This cross-sectional study consecutively included 31 patients with esophageal stricture, of which 18 (58.0 percent) were caustic, 7 (22.6 percent) were postoperative, 3 (9.7 percent) were peptic and 3 (9.7 percent) were of unknown etiology. The 24-hour dietary recall was used and the foods were converted into servings according to the eight food groups, as recommended by Philippi. The Kruskal-Wallis and Fisher's Exact Test were used and the significance level was set at 5 percent. RESULTS: The ages of the patients varied from 15 to 176 months (median: 56 months). There were 28 children and 3 adolescents, of which 28 were males. Twenty-nine patients (93.5 percent) presented dysphagia, of which 34.4 percent (10/29) were severe, 41.3 percent (12/29) were moderate and 24.1 percent (7/29) were mild. The median intake of grain, legume and fat servings was smaller in the liquid diet group (p<0.005). This group also had a significantly greater proportion of patients whose intakes were below those recommended by the food pyramid (p<0.05). CONCLUSION: Nutritional support is extremely important in the treatment of patients with esophageal stricture, especially those with severe dysphagia. These patients need a liquid diet because of the nutritional risk associated with inadequate food intake, which also allows early introduction of the dietary treatment.