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1.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509876

RESUMO

Primary thyroid squamous cell carcinoma (SCC) is a rare and highly aggressive cancer. Diagnostic work-up encompasses cervical ultrasonography, tissue biopsy and CT scan. Surgery, radiotherapy and chemotherapy are the available treatment modalities. With a mean survival rate of 7 months reported in the literature, our patient is alive 2 years after successful treatment of her advanced primary thyroid SCC with surgery and radiotherapy.


Assuntos
Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Neoplasias da Glândula Tireoide/radioterapia , Idoso , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Invasividade Neoplásica , Radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/complicações , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Tomografia Computadorizada por Raios X , Ultrassonografia
2.
Medicine (Baltimore) ; 99(45): e22977, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157940

RESUMO

Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.


Assuntos
Transtornos de Deglutição/fisiopatologia , Aspiração Respiratória/fisiopatologia , Idoso , Infecções Comunitárias Adquiridas/fisiopatologia , Feminino , Fluoroscopia , Humanos , Masculino , Limitação da Mobilidade , Pneumonia/fisiopatologia , Estudos Retrospectivos , Albumina Sérica/análise , Gravação em Vídeo
3.
Medicine (Baltimore) ; 99(35): e21793, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871899

RESUMO

The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (ß = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.


Assuntos
Transtornos de Deglutição/terapia , Dilatação/instrumentação , Endoscópios , Esfíncter Esofágico Superior/fisiopatologia , Estenose Esofágica/terapia , Transtornos de Deglutição/fisiopatologia , Estenose Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
PLoS One ; 15(9): e0237501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877418

RESUMO

PURPOSE: The concept of dysphagia/aspiration-related structures (DARS) was developed against the background of severe late side effects of radiotherapy (RT) for head and neck cancer (HNC). DARS can be delineated on CT scans, but with a better morphological discrimination on magnetic resonance imaging (MRI). Swallowing function was analyzed by use of patient charts and prospective investigations and questionnaires. METHOD: Seventeen HNC patients treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy between 5/2012 - 8/2015 were included. Planning CT (computed tomography) scans and MRIs (magnetic resonance imaging) prior, during 40 Gray (Gy) radiotherapy and posttreatment were available and co-registered to delineate DARS. The RT dose of each DARS was calculated. Five patients were investigated posttreatment for swallowing function and assessed by means of various questionnaires for quality of life (QoL), swallowing, and voice function. RESULTS: By retrospective comparison of DARS volume, a significant change in four of eight DARS was detected over time. Three increased and one diminished. The risk of posttreatment dysphagia rose by every 1Gy above the mean dose (D mean) of RT to DARS. 7.5 was the risk factor for dysphagia in the first 6 months, reducing to 4.7 for months 6-12 posttreatment. For all five patients of the prospective part of swallowing investigations, a function disturbance was detected. These results were in contrast to the self-assessment of patients by questionnaires. There was neither a dose dependency of D mean DARS volume changes over time nor of dysphonia and no correlation between volume changes, dysphagia or dysphonia. CONCLUSION: Delineation of DARS on MRI co-registered to planning CT gave the opportunity to differentiate morphology better than by CT alone. Due to the small number of patients with complete MRI scans over time, we failed to detect a dose dependency of DARS and swallowing and voice disorder posttreatment.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/radioterapia , Imagem por Ressonância Magnética , Sucção , Tomografia Computadorizada por Raios X , Adulto , Idoso , Deglutição , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Voz , Adulto Jovem
5.
Medicine (Baltimore) ; 99(38): e22136, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957335

RESUMO

The aim of this study was to investigate the effect of the jaw opening exercise (JOE) on the thickness of the suprahyoid muscle and hyoid bone movement compared with the head lift exercise (HLE) in patients with dysphagia after strokeThis study recruited 30 patients with dysphagia after stroke. The JOE group performed a JOE using a resistance bar. The HLE group performed the traditional HLE. The total intervention duration was 6 weeks. We measured the thickness of the digastric and mylohyoid muscles using ultrasound. Two-dimensional motion analysis of the hyoid bone was performed using Image J software. The Borg rating of the perceived exertion scale was used to assess the intensity level of physical activity during the 2 exercises.Both groups showed a significant increase in the thickness of the digastric and mylohyoid muscles (P < .05). Hyoid bone motion was significantly increased in the anterior and superior movement in both groups (P < .05). After the intervention, there was no significant difference between the 2 groups. The Borg rating of perceived exertion scale for the JOE group was significantly lower than that of the HLE group (P < .05).In conclusion, this study demonstrated that the JOE and the HLE had similar effects with respect to increasing suprahyoid muscle thickness and improving hyoid bone movement. However, the JOE required less perceived exertion than the HLE.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Terapia por Exercício/métodos , Acidente Vascular Cerebral/complicações , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Osso Hioide/fisiologia , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/fisiologia , Projetos Piloto , República da Coreia
6.
PLoS One ; 15(9): e0239440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946492

RESUMO

Japan is the world's leading aging society, and increasing medical expenses for elderly people is an urgent issue. Since aspiration pneumonia in elderly people with impaired swallowing function is a huge problem in Japan, their expected long-term clinical course should be clarified. Accordingly, we collected data from 991 elderly (≥75 years old) patients whose swallowing function was evaluated by Kitasato Institute Hospital's speech therapists (January 1, 2010 to December 31, 2017). We analyzed the relationship between swallowing function and the subjects' long-term prognosis. To clarify the prognostic factors of patients with dysphagia, we obtained their clinical information (age, gender, activities of daily living, nutritional status, availability of alternative feeding pathways such as percutaneous endoscopic gastrostomy, and cognitive function). We confirmed 372 death cases and stratified the cases into three groups using Fujishima's swallowing ability grade, which is used to predict elderly people's real-world life expectancy. Results showed the median survival days were 331 and 952 days in Groups I (Grades 1-3, n = 308) and II (Grades 4-6, n = 153), respectively, whereas the median survival days for Group III (Grades 7-10, n = 530) could not be calculated. We conducted a multivariate analysis using the Cox proportional hazards model with Group I, which revealed that initial grade and percutaneous endoscopic gastrostomy were significant prognostic factors for the subjects' long-term survival. Nevertheless, further discussion is necessary, particularly to determine advanced care planning regarding indications for alternative feeding pathways in elderly patients with severe dysphagia, since percutaneous endoscopic gastrostomy could significantly prolong their survival.


Assuntos
Deglutição , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Japão , Masculino , Prognóstico
7.
J Stroke Cerebrovasc Dis ; 29(10): 105113, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912517

RESUMO

BACKGROUND: Swallowing disorders (dysphagia) is common in stroke patients. However, the epidemiology of post-stroke dysphagia (PSD) is poorly described. We herein synthesize the data of eligible studies on occurrence rate of dysphagia in Asian populations with stroke. METHODS: We searched the electronic databases (PubMed, Embase and Web of Science) to collect the studies on the prevalence of PSD. We used the Newcastle-Ottawa Scale (NOS) to estimate the quality of studies. The pooled dysphagia occurrence rate was obtained in Asian stroke patients. RESULTS: 40 studies (including 43 observations) from 2318 initial references were selected in the synthetic analysis. The pooled occurrence rate of dysphagia in post-stroke patients was 36.3% (95% CI, 33.3%-39.3%). Meta-regression analysis showed that the "country" and "developing level" may influence the pooled occurrence rate of PSD. CONCLUSION: Dysphagia is common in Asian post-stroke patients. Our meta-analysis may raise concern about evaluating and managing dysphagia in stroke patients.


Assuntos
Grupo com Ancestrais do Continente Asiático , Transtornos de Deglutição/etnologia , Deglutição , Acidente Vascular Cerebral/etnologia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
8.
Vasc Endovascular Surg ; 54(8): 747-751, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32748705

RESUMO

Dysphagia Lusoria is a condition when aberrant right subclavian artery (ARSA) causes esophageal compression. We report 2 cases of Dysphagia Lusoria treated by hybrid endovascular technique which included subclavian to carotid transposition and embolization of origin of ARSA. By using this technique, we avoided the need for thoracotomy. Both patients had complete symptom relief without any surgery related complication.


Assuntos
Anormalidades Cardiovasculares/cirurgia , Transtornos de Deglutição/etiologia , Embolização Terapêutica , Procedimentos Endovasculares , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Enxerto Vascular , Adulto , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico por imagem , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(34): e21795, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846813

RESUMO

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ±â€Š19.51 for the tube feeding group and 53.17 ±â€Š25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = -0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = -0.327, P = .013), mental health (r = -0.348, P = .008), and social functioning (r = -0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Qualidade de Vida , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Deglutição , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Inquéritos e Questionários
10.
Am J Gastroenterol ; 115(9): 1412-1428, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769426

RESUMO

Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a catheter-mounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG clinical guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.


Assuntos
Transtornos de Deglutição/diagnóstico , Esôfago/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Transtornos de Deglutição/fisiopatologia , Monitoramento do pH Esofágico/métodos , Esofagoscopia/métodos , Refluxo Gastroesofágico/fisiopatologia , Humanos , Manometria/métodos
11.
J Nutr Health Aging ; 24(6): 576-581, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32510109

RESUMO

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.


Assuntos
Transtornos de Deglutição/dietoterapia , Casas de Saúde/normas , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Masculino , Prevalência
12.
J Zoo Wildl Med ; 51(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549579

RESUMO

A 32-yr-old male black-handed spider monkey (Ateles geoffroyi) with marked kyphosis and reduced spinal range of motion developed intermittent regurgitation, which was managed with an acid reducer. Diffuse idiopathic skeletal hyperostosis (DISH) was suspected in this animal due to radiographically evident ossification of the anterior longitudinal ligament. At repeat radiographic evaluation 1.5 yr later, due to weight loss and increased frequency of regurgitation, the cervical spine was deviated ventrally and appeared to be impinging on the thoracic inlet. The spider monkey was humanely euthanized due to poor prognosis, and the presumptive diagnosis of DISH was confirmed via postmortem computed tomography and necropsy. DISH has not been reported in black-handed spider monkeys, and secondary dysphagia, an uncommon but recognized consequence in humans, has not been reported in a nonhuman primate. Earlier recognition of this possibly underreported disease process may increase treatment options and effectiveness of intervention.


Assuntos
Ateles geoffroyi , Transtornos de Deglutição/diagnóstico , Hiperostose Esquelética Difusa Idiopática/diagnóstico , Doenças dos Macacos/diagnóstico , Animais , Animais de Zoológico , Transtornos de Deglutição/fisiopatologia , Evolução Fatal , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/patologia , Masculino , Doenças dos Macacos/patologia , Doenças dos Macacos/fisiopatologia , Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X/veterinária
13.
NeuroRehabilitation ; 46(4): 501-509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538883

RESUMO

BACKGROUND: Stroke is one of the most important causes of swallowing difficulty. It is seen in one of every two patients with stroke. Although the swallowing function is controlled by both hemispheres, it is unknown which hemisphere is more dominant than another for controlling the swallowing function. However, the aspiration and pharyngeal phase dysfunction can be seen in right hemisphere involvement while oral phase dysfunction can be seen in left hemisphere involvement. OBJECTIVE: The aim of this study was to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with hemiplegia. STUDY DESIGN: The study was designed as a cross-sectional study. METHODS: Patients with unilateral strokes that damaged the right (Group I: n = 37) and left (Group II: n = 20) hemispheres were included. Swallowing difficulties were evaluated with the Turkish version of the Eating Assessment Tool. The water swallowing performance was measured with the 100 ml water swallow test. The muscle endurance (ME) of deep neck flexors was measured in the chin-tuck position. The laryngeal function was measured indirectly with maximum phonation time (MPT). RESULTS: The mean age of patients was 73.54±7.28 years in Group I and the mean age of patients was 73.15±6.94 years in Group II. There were no differences in maximum phonation time, water swallowing performance (swallow volume, capacity, and speed), and swallowing difficulty (p > 0.05). The neck flexor muscular endurance of patients with unilateral strokes that damaged the left hemisphere was better than the patients with unilateral strokes that damaged the right hemisphere (p < 0.05). There was a relationship between MPT and ME, MPT and swallowing difficulty, ME and swallowing difficulty (r:0.637, p:0.000; r:-0.465, p:0.004; r:-0.473, p:0.003 respectively) in the right hemisphere involvement patients. There was a relationship between swallowing difficulty to swallowing volume and swallowing capacity (respectively, r:-0.402 and p:0.014; r:-0.473 and p:0.003) in the patients with unilateral strokes that damaged the right hemisphere. There was no relationship between other parameters in Group I (p > 0.05). There was no relationship between all parameters in Group II (p > 0.05). CONCLUSIONS: This study is the first study to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with unilateral strokes that damaged the right or left hemispheres. In light of the findings of the study, it was thought that swallowing should be evaluated in detail especially in hemiplegic patients with right hemisphere involvement. There is a need for studies examining the results of swallowing rehabilitation on right or left hemisphere in hemiplegic individuals.


Assuntos
Encéfalo/patologia , Transtornos de Deglutição/etiologia , Deglutição , Hemiplegia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Feminino , Hemiplegia/complicações , Humanos , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade
14.
J Smooth Muscle Res ; 56(0): 46-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32581185

RESUMO

Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may cause fatal complications such as aspiration pneumonia. However, there is no established treatment for OD. The relationship between the transient receptor potential vanilloid 1 (TRPV1) and substance P released by activated TRPV1 was recently demonstrated. Further, there are several reports showing that capsaicin, a specific agonist of TRPV1, can improve OD. Currently, the evaluation of swallowing is mainly performed by videofluoroscopic examination. However, there are no reports on the clinical application of ultrasonography using tissue Doppler imaging. In this review, we describe the pathophysiology and treatments for OD, introduce our novel US method to evaluate cervical esophageal motility, and then outline our clinical study examining the effects of capsaicin, a specific TRPV1 agonist, in older patients with OD.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/terapia , Ultrassonografia Doppler/métodos , Capsaicina/farmacologia , Capsaicina/uso terapêutico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Motilidade Gastrointestinal , Humanos , Substância P , Canais de Cátion TRPV/agonistas , Canais de Cátion TRPV/metabolismo
15.
Am J Gastroenterol ; 115(10): 1669-1680, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32558689

RESUMO

INTRODUCTION: Esophageal dysmotility including features of achalasia may develop because of bariatric surgery. However, the prevalence of these complications is unknown. We sought to define the prevalence of dysphagia and major esophageal motility disorders including achalasia after bariatric surgery through a large retrospective database review. METHODS: Patients with a history of laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass who underwent a diagnostic high-resolution impedance manometry (HRIM) either before or after bariatric surgery across 3 large tertiary referral sites from June 2012 through February 2019 were identified from a procedural database. HRIM studies were interpreted per the Chicago classification v3.0 by a blinded investigator (K.R.). Demographic/clinical features were collected. In addition, patients who underwent bariatric surgery from January 2014 to April 2015 were contacted and administered a validated symptom assessment survey to gauge the overall prevalence of dysphagia in a postbariatric population. RESULTS: A total of 137 patients were identified, including 97 who underwent HRIM after bariatric surgery (laparoscopic sleeve gastrectomy [n = 39, 40.1%]; Roux-en-Y gastric bypass [n = 58, 59.8%]) at a median of 5.84 years (interquartile range 2.1-12.5) postoperatively and 40 preoperative bariatric surgery candidates with medically complicated obesity. A manometric pattern consistent with achalasia was identified in 7 (7.2%) postsurgical patients compared with none in the preoperative group (P = 0.08). We further identified a separate achalasia-like pattern defined by aperistalsis and increased intragastric pressure (postobesity surgery esophageal dysfunction [POSED]) in 5 (5.2%) postsurgical patients vs none found preoperatively (P = 0.14). Achalasia or POSED was associated with postbariatric surgery (12.4% vs 0%, P = 0.02). Increasing time since surgery was independently associated with the development of achalasia (median 12.5 vs 5.8 years, P = 0.02), POSED (median 15.0 vs 5.8 years, P = 0.02) and major motility disorders (6.6 vs 4.9 years, P = 0.01). Furthermore, among 271 postbariatric surgery patients contacted for symptom assessment via survey, the prevalence of dysphagia was 13.7% at a mean 3.9 years after surgery. DISCUSSION: Postoperative dysphagia is a common long-term complication of bariatric surgery. This is potentially the consequence of a time-dependent association with the development of postoperative esophageal dysmotility, particularly achalasia and POSED. Consequently, esophageal dysmotility may be an important under-recognized complication of bariatric surgery.


Assuntos
Acalasia Esofágica/epidemiologia , Transtornos da Motilidade Esofágica/epidemiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Cirurgia Bariátrica , Estudos Transversais , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Acalasia Esofágica/fisiopatologia , Transtornos da Motilidade Esofágica/fisiopatologia , Feminino , Gastrectomia , Derivação Gástrica , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Período Pré-Operatório , Pressão , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
17.
Ann Otol Rhinol Laryngol ; 129(11): 1101-1109, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32500729

RESUMO

OBJECTIVES: To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS). METHODS: 129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status. RESULTS: The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls (P > .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness (P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 (P < .0125). CONCLUSION: Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors.Level of Evidence: 3b.


Assuntos
Transtornos de Deglutição/diagnóstico , Deglutição/fisiologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Fluoroscopia/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doenças da Coluna Vertebral/cirurgia , Estudos de Casos e Controles , Vértebras Cervicais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Inferior/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
18.
Neurology ; 95(2): e194-e205, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32527970

RESUMO

OBJECTIVE: To determine whether objective and quantitative assessment of dysarthria and dysphagia in spinocerebellar ataxia type 2 (SCA2), specifically at pre-ataxic and early disease phases, can act as sensitive disease markers. METHODS: Forty-six individuals (16 with pre-ataxic SCA2, 14 with early-stage ataxic SCA2, and 16 healthy controls) were recruited in Holguin, Cuba. All participants underwent a comprehensive battery of assessments including objective acoustic analysis, clinician-derived ratings of speech function and swallowing, and quality of life assessments of swallowing. RESULTS: Reduced speech agility manifest at the pre-ataxic stage was observed during diadochokinetic tasks, with the magnitude of speech deficit augmented in the early ataxic stage. Speech rate was slower in early-stage ataxic SCA2 compared with pre-ataxic SCA2 and healthy controls. Reduced speech agility and speech rate correlated with disease severity and time to ataxia onset, verifying that speech deficits occur prior to ataxia onset and increase in severity as the disease progresses. Whereas dysphagia was observed in both pre-ataxic and ataxic SCA2, it was not associated with swallowing-related quality of life, disease severity, or time to ataxia onset. CONCLUSIONS: Speech and swallowing deficits appear sensitive to disease progression in early-stage SCA2, with syllabic rate a viable marker. Findings provide insight into mechanisms of disease progression in early-stage SCA2, signaling an opportunity for stratifying early-stage SCA2 and identifying salient markers of disease onset as well as outcome measures in future early-stage therapeutic studies.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Ataxias Espinocerebelares/complicações , Ataxias Espinocerebelares/fisiopatologia , Adolescente , Adulto , Biomarcadores , Transtornos de Deglutição/psicologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Articulação da Fala , Distúrbios da Fala/psicologia , Ataxias Espinocerebelares/psicologia , Adulto Jovem
19.
Am J Otolaryngol ; 41(4): 102501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32409161

RESUMO

PURPOSE: To evaluate the prevalence of oropharyngeal dysphagia in elderly patients suffering from minimal or mild cognitive decline. PATIENTS AND METHODS: We retrospectively collected the data of patients suffering from mild cognitive impairment or mild dementia and were undergoing management for suspected oropharyngeal dysphagia, in our department. All our patients were subjected to Mini Mental State Examination test, MD Anderson dysphagia inventory and caregiver mealtime and dysphagia questionnaire. We performed a mealtime observation study and endoscopic evaluation of swallowing in all our patients. Following evaluation, we then analysed the data statistically. RESULTS: Out of 708 patients who visited us for cognitive decline and suspected oropharyngeal dysphagia in the last two years, 52 patients were confirming to the inclusion criteria of this study. Classification of oropharyngeal dysphagia patients according to ASHA-NOMS scale showed that 32.7% of patients presented with grade 4 of dysphagia followed by another 32.7% with grade 5 and 30.8% presented with grade 6. Only 3.8% of our patients were considered normal (grade 7 of ASHA-NOMS scale). MD Anderson dysphagia inventory could collected swallowing alterations in only 23.1% of the cases. The caregiver mealtime and dysphagia questionnaire showed acceptable caregivers patient management in 53.8% of patients. CONCLUSION: Our study underscores the fact that oropharyngeal dysphagia is present in many cases of mild cognitive decline. While patients understate their swallowing problems, the caregivers are not competent enough to manage this situation in a great percentage of cases. Only a mealtime observation by a speech-language pathologist along with FEES is able to identify the true prevalence of the condition.


Assuntos
Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/epidemiologia , Transtornos de Deglutição/epidemiologia , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Comorbidade , Deglutição , Transtornos de Deglutição/fisiopatologia , Demência/fisiopatologia , Humanos , Estudos Retrospectivos
20.
Sci Rep ; 10(1): 7268, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32350338

RESUMO

Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5-78%) to high or excellent (89-100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = -0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach's alpha) was either "good" or "excellent". Intra and inter-rater reliability were largely "excellent" (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery.


Assuntos
Transtornos de Deglutição , Acidente Vascular Cerebral , Idoso , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/patologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Reino Unido
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