VIDEOFLUOROSCOPIC EVALUATION OF THE IMPACT OF CAPSULE SIZE AND SUBJECT'S AGE AND GENDER ON CAPSULE SWALLOWING.

BACKGROUND: People recurrently have difficulties swallowing solid medications, which can be associated with the size of the medication and the age and gender of individuals. OBJECTIVE: To evaluate the impact of capsule size and adults' age and gender on oral and pharyngeal capsule transit during capsule swallows. METHODS: Videofluoroscopy was used to measure capsule oral and pharyngeal transit during swallows in 49 healthy individuals (17 men and 32 women), with a mean age of 46 years (ranging from 23 to 88 years). Smaller capsules were filled with 0.50 mL of barium sulfate, and larger capsules were filled with 0.95 mL of barium sulfate; the volume of liquid ingested with the capsules was also quantified in each ingestion. The measurements included the oral preparation time, oral transit time, swallowing reaction time, time to laryngeal vestibule closure, laryngeal vestibule closure duration, pharyngeal transit time, and upper esophageal sphincter opening duration. RESULTS: The capsule size did not influence either the oral or pharyngeal transit time. Increased liquid volume was ingested with larger capsules and by people older than 40 years. The oral transit time was shorter in older adults (60-88 years), and the time to laryngeal vestibule closure was longer in women. CONCLUSION: The size of large capsules did not make a difference in oral or pharyngeal transit when compared with smaller capsules. The capsule size and the participant's age influenced the volume of liquid ingested - larger capsules and older individuals required a larger volume. The capsule oral transit was faster in individuals older than 60 years. BACKGROUND: •Swallowing is influenced by the characteristics of what is being swallowed. BACKGROUND: •There was no difference in swallowing capsules containing 0.50 mL or 0.95 mL. BACKGROUND: •Larger capsules need more liquid ingestion to make swallowing easier. BACKGROUND: •Individuals older than 40 years need a greater volume of liquid to swallow capsules than younger adults.

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.

RELATIONSHIP BETWEEN NUTRITIONAL STATUS, DYSPHAGIA, AND FUNCTIONAL EATING LEVEL IN ADULT PATIENTS WITH CEREBRAL PALSY IN LONG INSTITUTIONAL STAYS.

BACKGROUND: Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. OBJECTIVE: : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. METHODS: : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). RESULTS: : There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. CONCLUSION: : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

Eating Assessment Tool (EAT-10) Scores to Detect Self-Reported Dysphagia in Brazilians.

The Eating Assessment Tool (EAT-10) detects swallowing impairments (dysphagia) self-reported by patients according to their perception. This noninvasive, inexpensive, self-administered instrument is quickly and easily filled out. The objective of this investigation was to evaluate the scores, sensitivity, and specificity of the method to define self-reported dysphagia in Brazilians. EAT-10 scores were evaluated in 443 healthy individuals (273 women and 170 men), aged 20 to 84 years, with no swallowing difficulties or diseases, and 72 patients with diseases that cause dysphagia (35 women and 37 men), aged 29 to 88 years. Each of the 10 instrument items has a 0-4 rating scale, in which 0 indicates no problem and 4, a severe problem; total results range from 0 to 40. The median EAT-10 score of healthy subjects was 0 (range: 0-20), and that of patients was 14.5 (range: 1-40). Considering a ≥ 3 cutoff score to define dysphagia risk, it was self-reported by 97.2% of patients with dysphagia and 9.5% of no-disease individuals (97.2% sensitivity and 90.7% specificity). The positive predictive value of the test was 63% and the negative predictive value was 99.5%. Healthy women had higher scores (median 0, range: 0-20) than healthy men (median 0, range: 0-8, p < 0.01) and more results indicative of self-reported dysphagia (11.7%) than healthy men (5.9%). The EAT-10 cutoff score to detect self-reported dysphagia in Brazilians should be 3, as previously considered. Healthy women complain more of self-reported dysphagia than healthy men. The test has high sensitivity and specificity.

Relação entre estado nutricional, disfagia, e nível funcional de alimentação em pacientes adultos com paralisia cerebral em instituição de longa permanência / Relationship between nutritional status, dysphagia, and functional eating level in adult patients with cerebral palsy in long institutional stays

ABSTRACT Background: Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. Objective : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. Methods : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). Results : There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. Conclusion : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

RESUMO Contexto: Dieta com consistência modificada para pacientes com disfagia internados em instituições por longa permanência pode causar desnutrição. Objetivo : Avaliar o estado nutricional de pacientes adultos com paralisia cerebral (PC) e disfagia internados em instituição de saúde por mais de dez anos. Métodos : É um estudo prospectivo realizado em 56 pacientes com PC com idades entre 25 e 71 anos, média: 44±12 anos. O estado nutricional, a disfagia e a capacidade de ingestão alimentar foram avaliados em dois momentos, separados por 12 meses, respectivamente pelo índice de massa corporal (IMC), protocolo de avaliação do risco de disfagia (PARD) e pela escala funcional de ingestão por via oral (FOIS), em 56 pacientes com PC internados em instituição hospitalar por mais de 10 anos, sem outro diagnóstico neurológico. Resultados : Não houve diferenças, entre dezembro de 2015 e dezembro de 2016, nas avaliações do peso, do estado nutricional, na classificação da consistência da dieta ingerida, na escala PARD para disfagia e na escala FOIS de avaliação de ingestão por via oral. Houve influência dos limites da consistência da dieta prescrita (IDDSI-FDS), da avaliação da disfagia e do nível funcional da alimentação no estado nutricional. Disfagia mais intensa e maior restrição alimentar foram associadas com pior estado nutricional. Conclusão : Em pacientes adultos com PC, avaliados com intervalo de 12 meses, não houve piora do estado nutricional. A intensidade da disfagia e as restrições alimentares são fatores que interferem no estado nutricional dos pacientes, disfagia e restrições alimentares mais intensas associadas com pior estado nutricional.

HIGLIGHTS •Diets with modified consistencies may cause malnutrition. •Patients with dysphagia in long term health institutions should ingest the prescribed amount of food to avoid malnutrition. •In patients with cerebral palsy with more intense dysphagia and greater eat restrictions are associated with the worse nutritional status. •The nutritional status of patients with cerebral palsy and dysphagia do not always worsen between assessments with 12-month interval.

Influência da obesidade, idade e sexo na dificuldade de ingestão de água espessada em indivíduos saudáveis / Influence of obesity, age and sex on difficulty swallowing thickened water in healthy subjects

Contexto e Objetivo: Ingestão de água com espessante diminui a aspiração para vias aéreas em pacientes com disfagia orofaríngea, entretanto pode causar dificuldade na ingestão. Nosso objetivo foi avaliar, em pessoas saudáveis, a influência da obesidade, idade e sexo na ingestão de água espessada. Desenho e local: Estudo transversal realizado em amostra de conveniência na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Método: Ingestão de água sem e com espessante foi avaliada em 75 indivíduos saudáveis (42 mulheres) com idades entre 18 e 62 anos, pelo teste de ingestão de água, com os voluntários ingerindo 100 ml de água na temperatura ambiente, sem e com 2,4 g de espessante alimentar. Foram medidos o tempo para ingerir todo o volume, o número de deglutições, e calculados o fluxo de ingestão e o volume em cada deglutição, com os voluntários indicando a sensação e a dificuldade na ingestão. Resultados: Com espessante, o fluxo de ingestão e o volume em cada deglutição foram menores, e houve maior dificuldade e pior sensação durante a ingestão. Obesidade e idade não influenciaram a ingestão. As mulheres tiveram menor fluxo de ingestão que os homens. Discussão: A utilização de água espessada em pacientes com disfagia pode ter dificuldades que comprometem a hidratação. Alteração do sabor e temperatura do líquido podem facilitar a ingestão. Conclusão: A ingestão de água em pessoas saudáveis tem influência da consistência e do sexo dos indivíduos, sem influência de idade ou obesidade.

Taste perception in complete denture wearers / Percepção do sabor em usuários de prótese dentária total

ABSTRACT Purpose: to assess the recognition of salty, sweet, and citrus tastes in complete denture wearers. Methods: the study included toothless individuals (experimental group) who had been using, for at least 3 months and at the most 5 years, acrylic resin removable bimaxillary complete dentures in good condition and with adequate maxillo-mandibular relationship. The same assessment was performed in the control group, which had 26 toothed individuals. Volunteers had no difficulties ingesting any type of food. Salty, sweet, and citrus tastes were assessed with filter paper strips soaked in such solutions and placed on the tongue dorsum. Assessments were performed in duplicate and in random order. Results: the percentage rate of errors was similar between the control (9.6±13.5%) and experimental groups (10.5±15.5%) (p=0.80). There was no difference in the frequency of correct perception of tastes between denture wearers and toothed individuals. Conclusion: individuals who wore acrylic resin removable bimaxillary complete dentures perceived salty, sweet, and citrus tastes like toothed individuals did.

RESUMO Objetivo: avaliar o reconhecimento dos sabores salgado, doce e cítrico em usuários de prótese dentária total. Métodos: foram incluídos indivíduos desdentados (grupo experimental) usuários de prótese total removível bimaxilar confeccionada em resina acrílica, com tempo mínimo de uso de três meses e máximo de cinco anos, em bom estado de conservação e com adequada relação maxilo-mandibular. Como grupo controle, a mesma avaliação foi realizada em 26 indivíduos dentados. Os voluntários não tinham dificuldade na ingestão de nenhum tipo de alimento. Os sabores salgado, doce e cítrico foram testados com fitas de papel filtro embebidas nas soluções e colocadas na parte dorsal da língua. As avaliações foram realizadas em duplicata e em ordem ao acaso. Resultados: a taxa percentual de erros foi igual entre os grupos controle (9,6±13,5%) e experimental (10,5±15,5%) (p=0,80). Não houve diferenças na frequência de percepção correta dos sabores entre indivíduos usuários de prótese e indivíduos dentados. Conclusão: usuários de prótese total removível bimaxilar confeccionada em resina acrílica têm a mesma percepção dos sabores salgado, doce e cítrico que indivíduos dentados.

Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux

Abstract Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. Objective The objective of the present review was to determine UES functional changes in GERD. Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.

Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux.

Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. Objective The objective of the present review was to determine UES functional changes in GERD. Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.

CORRELATION BETWEEN SYMPTOMS AND REFLUX IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE.

BACKGROUND: Esophageal symptoms of gastroesophageal reflux are the same in functional heartburn, non-erosive disease, and erosive disease. Their patient-perceived intensity may be related to gastroesophageal reflux intensity. OBJECTIVE: To evaluate whether the symptoms in GERD patients are related to the intensity of gastroesophageal acid reflux. METHODS: To test this hypothesis, 68 patients with heartburn (18 with functional heartburn, 28 with non-erosive reflux disease, and 22 with erosive reflux disease) had their symptoms evaluated by the Velanovich score (which mainly focuses on heartburn) and the Eating Assessment Tool (EAT-10) (which focuses on dysphagia). They were submitted to esophageal endoscopy and then, on another day, they answered the Velanovich and EAT-10 questionnaires and underwent manometry and 24-hour pHmetry (measured 5 cm proximal to the upper border of the lower esophageal sphincter). RESULTS: The Velanovich score was higher in patients with non-erosive and erosive diseases than in those with functional heartburn. The mean EAT-10 score did not differ between functional heartburn, erosive, and non-erosive gastroesophageal reflux disease. Considering the threshold of ≥5 to define dysphagia, 4 (22%) patients with functional heartburn, 12 (43%) with non-erosive disease, and 9 (41%) with erosive disease had dysphagia (P=0.18). There was: a) a moderate correlation between the Velanovich and DeMeester score and between Velanovich score and the percentage of acid exposure time (AET); b) a weak correlation between EAT-10 and DeMeester score and between EAT-10 and acid exposure time. CONCLUSION: There is a moderate positive correlation between heartburn and gastroesophageal reflux measurement. Dysphagia has a weak positive correlation with reflux measurement.

Correlação entre sintomas e refluxo em pacientes com doença do refluxo gastroesofágico / Correlation between symptoms and reflux in patients with gastroesophageal reflux disease

ABSTRACT Background: Esophageal symptoms of gastroesophageal reflux are the same in functional heartburn, non-erosive disease, and erosive disease. Their patient-perceived intensity may be related to gastroesophageal reflux intensity. Objective To evaluate whether the symptoms in GERD patients are related to the intensity of gastroesophageal acid reflux. Methods To test this hypothesis, 68 patients with heartburn (18 with functional heartburn, 28 with non-erosive reflux disease, and 22 with erosive reflux disease) had their symptoms evaluated by the Velanovich score (which mainly focuses on heartburn) and the Eating Assessment Tool (EAT-10) (which focuses on dysphagia). They were submitted to esophageal endoscopy and then, on another day, they answered the Velanovich and EAT-10 questionnaires and underwent manometry and 24-hour pHmetry (measured 5 cm proximal to the upper border of the lower esophageal sphincter). Results The Velanovich score was higher in patients with non-erosive and erosive diseases than in those with functional heartburn. The mean EAT-10 score did not differ between functional heartburn, erosive, and non-erosive gastroesophageal reflux disease. Considering the threshold of ≥5 to define dysphagia, 4 (22%) patients with functional heartburn, 12 (43%) with non-erosive disease, and 9 (41%) with erosive disease had dysphagia (P=0.18). There was: a) a moderate correlation between the Velanovich and DeMeester score and between Velanovich score and the percentage of acid exposure time (AET); b) a weak correlation between EAT-10 and DeMeester score and between EAT-10 and acid exposure time. Conclusion: There is a moderate positive correlation between heartburn and gastroesophageal reflux measurement. Dysphagia has a weak positive correlation with reflux measurement.

RESUMO Contexto Os sintomas esofágicos do refluxo gastroesofágico são os mesmos na pirose funcional, doença do refluxo não erosiva e doença erosiva. A intensidade percebida pelo paciente pode estar relacionada à intensidade do refluxo gastroesofágico. Objetivo Avaliar se os sintomas em pacientes com doença do refluxo gastroesofágico estão relacionados à intensidade do refluxo. Métodos: Sessenta e oito pacientes com pirose (18 com pirose funcional, 28 com doença do refluxo não erosiva e 22 com doença erosiva) tiveram seus sintomas avaliados pelo escore de Velanovich (que avalia principalmente pirose) e o Instrumento de Autoavaliação da Alimentação (EAT-10) (que avalia disfagia). Os pacientes foram submetidos à endoscopia esofágica e, em outro dia, responderam aos questionários Velanovich e EAT-10 e realizaram manometria e pHmetria de 24 horas (medida 5 cm proximal à borda superior do esfíncter esofágico inferior). Resultados O escore de Velanovich foi maior em pacientes com doença não erosiva e doença erosiva do que naqueles com pirose funcional. A pontuação média da EAT-10 não diferiu entre pirose funcional, doença do refluxo gastroesofágico erosiva e não erosiva. Considerando o limiar ≥5 para definir disfagia, 4 (22%) pacientes com pirose funcional, 12 (43%) com doença não erosiva e 9 (41%) com doença erosiva apresentavam disfagia (P=0,18). Houve: a) correlação moderada entre os escores de Velanovich e DeMeester e entre os escores de Velanovich e o percentual de tempo de exposição ao ácido (AET); b) uma correlação fraca entre o EAT-10 e o escore DeMeester e entre o EAT-10 e o tempo de exposição ao ácido. Conclusão Existe uma correlação positiva moderada entre a pirose e a medida do refluxo gastroesofágico. Disfagia tem correlação fraca com a medição do refluxo.

Dysphagia is a strong predictor of death and functional dependence at three months post-stroke / Disfagia é um forte preditor de morte e dependência funcional três meses após acidente vascular cerebral

ABSTRACT Background: Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. Objective: To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. Methods: Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure. Results: A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13.3 years, mean time from stroke to swallowing assessment was 4.2±4.1 days, and 45.2% of the patients had dysphagia. Age (OR=1.02; 95%CI 1.00-1.04; p=0.017), known medical history of obstructive sleep apnea (OR=5.13; 95%CI 1.74-15.15; p=0.003), and stroke severity at hospital admission (OR=1.10; 95%CI 1.06-1.15; p<0.001) were independently associated with dysphagia. Dysphagia (OR=3.78; 95%CI 2.16-6.61; p<0.001) and stroke severity (OR=1.05; 95%CI 1.00-1.09; p=0.024) were independently associated with death or functional dependence at three months. Conclusions: Dysphagia was present in almost half of stroke patients. Age, obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months.

RESUMO Antecedentes: Poucos estudos brasileiros investigaram fatores de risco para disfagia e suas complicações associadas em uma grande coorte. Objetivo: Investigar frequência, preditores e desfechos associados da disfagia em pacientes até três meses após acidente vascular cerebral (AVC). Métodos: Selecionamos pacientes admitidos consecutivamente em um centro especializado em AVC agudo. Excluímos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, AVC hemorrágico de causa secundária, AVC não agudo ou aqueles que não consentiram em participar. A deglutição foi avaliada por fonoaudiólogos, por meio do teste de deglutição de volume-viscosidade. A função geral foi avaliada usando-se escala de Rankin modificada, índice de Barthel e medida de independência funcional. Resultados: Foram admitidos 831 pacientes e incluídos 305. A idade média foi 63,6±13,3 anos, o tempo médio da avaliação foi 4,2±4,1 dias e 45,2% apresentavam disfagia. Idade (razão de chances [OR] 1,02; intervalo de confiança [IC95%] 1,00-1,04; p=0,017), história médica conhecida de apneia obstrutiva do sono (OR=5,13; IC95% 1,74-15,15; p=0,003) e gravidade do AVC na admissão hospitalar (OR=1,10; IC95% 1,06-1,15; p<0,001) foram independentemente associados à disfagia. Disfagia (OR=3,78; IC95% 2,16-6,61; p<0,001) e gravidade do AVC (OR=1,05; IC95% 1,00-1,09; p=0,024) foram independentemente associadas com morte ou dependência funcional em três meses. Conclusões: A disfagia esteve presente em quase metade dos pacientes com AVC. Idade, apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, que esteve independentemente associada com morte ou dependência funcional em três meses.

Oral motor function in obesity.

BACKGROUND: Obese individuals may have impaired oral sensory functioning and abnormal oral motor function, a consequence of fat deposition in muscles. OBJECTIVE: To evaluate the oral motor function in obese individuals. MATERIAL AND METHODS: Three observational cross-sectional studies were performed. In total, 140 participants were evaluated: (1) orofacial myofunctional evaluation (OMES) was performed in 26 obese and 26 control subjects; (2) time taken for suction of 50 ml of water through straws of 3 mm and 6 mm of diameter was measured in 30 obese and 30 control subjects; (3) the oral phase of swallowing of 5 ml moderately thick and 5 ml extremely thick boluses was analysed by videofluoroscopy in 14 obese and 14 control subjects. Obese and non-obese control subjects had body mass index ≥40 kg/m2 and <30 kg/m2 , respectively. RESULTS: Obese subjects had worse oral myofunctional evaluation scores in posture/appearance (lips, jaw, cheeks, tongue and hard palate), in mobility (lips, tongue, jaw and cheeks) and in breathing, deglutition and mastication functions (p ≤ .020). The OMES total score was 73.5 ± 5.5 in obese and 92.8 ± 3.7 in controls subjects (p < .001). There was no difference between the groups in the time taken for 50 ml of water suction through the 3-mm- or 6-mm-diameter straw. Videofluoroscopic evaluation of the bolus swallowed demonstrated a longer oral preparation time in obese individuals for both boluses (p ≤ .040) and no difference in oral transit time (p ≥ .140). CONCLUSION: A moderate change in oral motor function was observed in obese individuals with BMI ≥40 kg/m2 .

Dysphagia is a strong predictor of death and functional dependence at three months post-stroke.

BACKGROUND: Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. OBJECTIVE: To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. METHODS: Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure. RESULTS: A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13.3 years, mean time from stroke to swallowing assessment was 4.2±4.1 days, and 45.2% of the patients had dysphagia. Age (OR=1.02; 95%CI 1.00-1.04; p=0.017), known medical history of obstructive sleep apnea (OR=5.13; 95%CI 1.74-15.15; p=0.003), and stroke severity at hospital admission (OR=1.10; 95%CI 1.06-1.15; p<0.001) were independently associated with dysphagia. Dysphagia (OR=3.78; 95%CI 2.16-6.61; p<0.001) and stroke severity (OR=1.05; 95%CI 1.00-1.09; p=0.024) were independently associated with death or functional dependence at three months. CONCLUSIONS: Dysphagia was present in almost half of stroke patients. Age, obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months.

Citations of Brazilian manuscripts published in the journal Dysphagia from 2001 to 2020 / Citações dos trabalhos brasileiros publicados na revista Dysphagia de 2001 a 2020

ABSTRACT Purpose: to compare the number of citations in papers conducted in Brazil and published in the journal Dysphagia between 2001 and 2020 with that of papers conducted in other countries and published in the same number, volume, and year. Methods: in September 2021, the study assessed the number of citations received by Brazilian papers (n = 34) and reference group papers - which counted two for every Brazilian one (n = 68), published in the same number, volume, and year, between 2001 and 2020. Results: Brazilian papers published in the period had a lower mean number of citations (14.6) than those in the reference group (23.1, p = 0.01). From 2001 to 2010, the mean number of citations in the reference group (31.1) was greater than that of the Brazilian papers (16.7, p = 0.03), though not between 2011 and 2020 (Brazilians: 13.1, reference group: 17.5, p = 0.23). Two Brazilian papers (5.9%) and 18 from other countries (26.5%) received more than 30 citations between 2001 and 2020. Conclusion: the results suggest that the number of citations received by Brazilian papers is not influenced by the time since they have been published, unlike the papers in the reference group.

RESUMO Objetivo: comparar o número de citações de trabalhos realizados no Brasil e publicados na revista Dysphagia entre os anos de 2001 e 2020, com o de trabalhos realizados em outros países e publicados no mesmo número, volume e ano. Métodos: foi avaliado, em setembro de 2021, o número de citações dos trabalhos brasileiros (n=34) e de um grupo de referência com dois trabalhos para cada trabalho brasileiro (n=68), publicados no mesmo número, volume e ano, entre 2001 e 2020. Resultados: os trabalhos brasileiros publicados no período tiveram menor média de citações (14,6) quando comparados com os trabalhos do grupo de referência (23,1, p=0,01). A média de citações do grupo de referência (31,1) foi maior do que a dos brasileiros (16,7) no período 2001 a 2010 (p=0,03), mas não no período 2011 a 2020 (brasileiros: 13,1, grupo de referência: 17,5, p=0,23). Dois trabalhos brasileiros (5,9%) e 18 trabalhos de outros países (26,5%) tiveram mais de 30 citações no período 2001 a 2020. Conclusão: os resultados sugerem que no número de citações dos trabalhos realizados no Brasil não há influência do tempo em que os trabalhos estão publicados, o que foi observado nos trabalhos do grupo de referência.

SYMPTOMS ASSOCIATED WITH DIFFERENT DEGREES OF MEGAESOPHAGUS IN CHAGAS DISEASE.

BACKGROUND: Dysphagia is the most frequent digestive symptom in Chagas disease, although other symptoms are reported. These symptoms can be associated with the degree of radiological impairment of the esophagus and the duration of dysphagia. OBJECTIVE: This investigation aimed to assess the symptoms and the time of dysphagia related to the different degrees of megaesophagus in patients with Chagas disease. METHODS: A total of 29 patients aged 48 to 73 years participated in this investigation. All of them had dysphagia and a positive serum result for Chagas disease. They were submitted to the assessment of symptoms and radiological examination of the esophagus to assess the degree of megaesophagus, which ranged from I (mild change) to IV (intense change). Dysphagia was quantified with the Eating Assessment Tool (EAT-10). RESULTS: Twelve (41%) patients had megaesophagus degree I, 9 (31%) had degree II, and 8 (28%) had degrees III (6) and IV (2). The intensity of dysphagia was not related to the result of the radiological examination, with EAT-10 median of 5.5 for the degree I, 9.0 for degree II, and 5.5 for degrees III and IV (P>0.25). Choking (14%), regurgitation (21%), voice complaint (21%), weight loss (17%), and odynophagia (17%) were not related to the degree of megaesophagus. Voice changes and odynophagia were related to the patients' time of dysphagia. Likewise, the frequency of symptoms and EAT-10 values were related to the duration of dysphagia. CONCLUSION: The longer the patient had dysphagia, the more frequent were the symptoms reported by the patients. There was no relationship between the degrees of megaesophagus and the symptoms and intensity of dysphagia.

Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease.

BACKGROUND: Chagas disease, caused by the flagellate protozoan Trypanosoma cruzi, is an infectious cause of secondary achalasia and megaesophagus. Moreover, the oral and pharyngeal phases of swallowing may also be affected, which may contribute to dysphagia and increase the possibility of airway aspiration during and/or after swallowing. This cross-sectional study evaluated, with videofluoroscopy, the oral, pharyngeal, and esophageal phases of swallowing in patients with megaesophagus caused by Chagas disease. The hypothesis is that there is impairment of the pharyngeal phase of swallowing that may increase the risk of airway aspiration. METHODS: A total of 29 patients, aged 48 - 73 years (mean: 63.8 ± 5.1 years), with dysphagia, radiological changes in the esophagus, and positive serologic test for Chagas disease, participated in the study. They were submitted to the videofluoroscopic evaluation of oral, pharyngeal, and esophageal phases, swallowing twice 10 mL of liquid and 10 mL of thickened barium boluses. RESULTS: The most frequent findings were: oral residues and ineffective ejection in the oral phase; residues in vallecula, pharynx, and pyriform sinuses in the pharyngeal phase; abnormal esophageal motility, longer clearance, and longer transit in the esophageal phase. Laryngeal penetration was seen in 28% of the patients. Patients with increased esophageal diameter had more pharyngeal residues than patients without increased esophageal diameter. None of the patients had airway aspiration. CONCLUSION: Megaesophagus caused by Chagas disease may affect all phases of swallowing, with an increase in oral and pharyngeal residues which suggest the impairment of oral and pharyngeal efficiency. None of the patients had airway aspiration.

Sintomas associados aos diferentes graus de megaesôfago na doença de Chagas / Symptoms associated with different degrees of megaesophagus in chagas disease

ABSTRACT BACKGROUND: Dysphagia is the most frequent digestive symptom in Chagas disease, although other symptoms are reported. These symptoms can be associated with the degree of radiological impairment of the esophagus and the duration of dysphagia. OBJECTIVE: This investigation aimed to assess the symptoms and the time of dysphagia related to the different degrees of megaesophagus in patients with Chagas disease. METHODS: A total of 29 patients aged 48 to 73 years participated in this investigation. All of them had dysphagia and a positive serum result for Chagas disease. They were submitted to the assessment of symptoms and radiological examination of the esophagus to assess the degree of megaesophagus, which ranged from I (mild change) to IV (intense change). Dysphagia was quantified with the Eating Assessment Tool (EAT-10). RESULTS: Twelve (41%) patients had megaesophagus degree I, 9 (31%) had degree II, and 8 (28%) had degrees III (6) and IV (2). The intensity of dysphagia was not related to the result of the radiological examination, with EAT-10 median of 5.5 for the degree I, 9.0 for degree II, and 5.5 for degrees III and IV (P>0.25). Choking (14%), regurgitation (21%), voice complaint (21%), weight loss (17%), and odynophagia (17%) were not related to the degree of megaesophagus. Voice changes and odynophagia were related to the patients' time of dysphagia. Likewise, the frequency of symptoms and EAT-10 values were related to the duration of dysphagia. CONCLUSION: The longer the patient had dysphagia, the more frequent were the symptoms reported by the patients. There was no relationship between the degrees of megaesophagus and the symptoms and intensity of dysphagia.

RESUMO CONTEXTO: Disfagia é o mais frequente sintoma digestivo da doença de Chagas; entretanto, outros sintomas podem ser referidos. Esses sintomas podem ser associados ao grau de comprometimento radiológico do esôfago e à duração da disfagia. OBJETIVO: Avaliar os sintomas e o tempo de disfagia relacionados com os diferentes graus de megaesôfago em pacientes com doença de Chagas. MÉTODOS: Participaram da investigação 29 pacientes com idades entre 48 e 73 anos, todos com disfagia e teste sorológico positivo para doença de Chagas. Eles foram submetidos à avaliação de sintomas e exame radiológico do esôfago para avaliar o grau de megaesôfago, que variou de I (alteração discreta) a IV (alteração intensa). Disfagia foi quantificada pelo método Eating Assessment Tool (EAT-10). RESULTADOS: Doze (41%) pacientes apresentaram grau I de megaesôfago, 9 (31%) grau II, e 8 (28%) graus III/IV. A intensidade da disfagia não foi relacionada com o resultado do exame radiológico, com a mediana do EAT-10 de 5,5 para o grau I, 9,0 para o grau II, e 5,5 para os graus III/IV (P>0,25). Engasgo (14%), regurgitação (21%), queixa vocal (21%), perda de peso (17%), e odinofagia (17%) não foram relacionados ao grau de megaesôfago. Houve relação entre alteração vocal e odinofagia com o tempo que os pacientes tinham disfagia. Houve relação entre frequência de sintomas e valores do EAT-10 com a duração da disfagia. CONCLUSÃO: Quanto mais longo o tempo que o paciente tem disfagia maior a frequência de sintomas referidos pelos pacientes. Não há relação entre graus de megaesôfago com os sintomas e a intensidade da disfagia.

Management of Esophageal Dysphagia in Chagas Disease.

Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.

Translation and Validation of the TOR-BSST© into Brazilian Portuguese for Adults with Stroke.

Brazil has a higher rate of dysphagia in stroke patients compared to developed countries, but does not have a fully validated method for early identification of dysphagia in this population. The aim of this study is to translate the TOR-BSST© into Brazilian Portuguese and assess the newly translated version for reliability and validity with Brazilian adult patients with stroke. The translation of the TOR-BSST© followed a multi-step process, according to the International Quality of Life Assessment project. For validation, we included patients with age ≥ 18 years and stroke diagnosis confirmed by neuroimaging and tolerance for videofluoroscopic swallowing assessment. The BR-PTfinal TOR-BSST© was administered by two trained screeners within two hours of videofluoroscopy. All assessors were independent and blinded. Estimates for reliability used the intraclass correlation coefficient (ICC) and for accuracy both sensitivity (SN) and negative predictive (NP) values were used, along with 95% confidence intervals (CI). Sixty patients were enrolled and tested for a mean (SD) of 14.4 (6.9) days from last seen normal. Of all the patients, 41 (68.3%) failed the BR-PTfinal TOR-BSST© and 21 (35%) were scored to have dysphagia on videofluoroscopy, of which 11 (52.4%) had mild dysphagia. The overall reliability between screeners was satisfactory (ICC = 0.59; 95% CI 0.32 to 0.76). The SN and NP values for the BR-PTfinal TOR-BSST© were 85.7% (95% CI 0.62-0.96) and 84.2% (95% CI 0.72-0.95), respectively. The TOR-BSST© was successfully translated to Brazilian Portuguese with the BR-PTfinal TOR-BSST© proven to have high sensitivity and negative predictive values when compared to gold standard videofluoroscopy.