1
|
Chari A, Krishnan A, Rasche L, Ye JC, Garfall A, Popat R, Lipe B, Qin X, Campagna M, Masterson T, Tomlinson C, Hilder B, Tolbert J, Renaud T, Smit MD, Gray K, Kane C, Heuck C, van de Donk NWCJ. Clinical Management of Patients With Relapsed/Refractory Multiple Myeloma Treated With Talquetamab. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00174-5. [PMID: 38871558 DOI: 10.1016/j.clml.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Talquetamab is a bispecific antibody targeting the multiple myeloma-associated antigen G protein-coupled receptor family C group 5 member D (GPRC5D). In the phase 1/2 MonumenTAL-1 trial (NCT03399799/NCT04634552), overall responses rates were > 71% in patients with triple-class exposed relapsed/refractory multiple myeloma (RRMM). Due to the distribution of the target antigen, a unique pattern of GPRC5D-associated adverse events (AEs) was observed, together with T-cell redirection-associated AEs. Management strategies for talquetamab-associated AEs are described. DISCUSSION GPRC5D-associated AEs included dermatologic (rash, nonrash, and nail toxicities) and oral AEs (dysgeusia, dysphagia, and dry mouth). The incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were consistent with other T-cell redirection therapies. The incidence of high-grade infections was lower than observed with B-cell maturation antigen-targeting bispecific antibodies, with less frequent use of intravenous immunoglobulin required. GPRC5D-associated AEs were mostly low grade and led to few discontinuations. Skin toxicities were managed with emollients, topical corticosteroids, and oral corticosteroids (for high-grade, persistent, or AEs that progress). Nail toxicities were commonly managed with emollients. Based on investigator experience, dose modification may be effective for controlling oral events. Observation for potential weight changes is required. Infections were managed per standard of care. CRS and ICANS were effectively managed, consistent with other trials of T-cell redirection therapies. CONCLUSION Although talquetamab had a distinct safety profile, AEs were considered clinically manageable and mostly low grade. With appropriate education and support, health care practitioners can ensure patients with RRMM maintain quality of life and treatment adherence.
Collapse
Affiliation(s)
- Ajai Chari
- Department of Medicine, Hematology, and Medical Oncology and Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
| | - Amrita Krishnan
- Judy and Bernard Briskin Myeloma Center, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jing Christine Ye
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Alfred Garfall
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rakesh Popat
- Hematology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Brea Lipe
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Xiang Qin
- Janssen Research and Development, Spring House, PA
| | | | | | | | | | | | | | | | | | - Colleen Kane
- Janssen Research and Development, Spring House, PA
| | | | - Niels W C J van de Donk
- Department of Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Čulina D, Peček M, Gregurić T, Aras I, Košec A, Stevanović S. Hypercalcemia Associated With Severe Dysphagia in a Patient With Parathyroid Adenoma and Significant Cervical Spondylophytes. AACE Clin Case Rep 2024; 10:89-92. [PMID: 38799048 PMCID: PMC11127587 DOI: 10.1016/j.aace.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 05/29/2024] Open
Abstract
Background/Objective Severe dysphagia is a rare presenting symptom of primary hyperparathyroidism, whereas the most common hypercalcemia-related causes include gastrointestinal symptoms, such as anorexia, constipation, and pancreatitis. This case presentation aimed to describe swallowing difficulty as a leading symptom of hypercalcemia. Case Report A 62-year-old man experienced vomiting, dysphagia bordering with aphagia, and 20-kg weight loss in a 2-month period. The parathyroid hormone and serum calcium levels were 102 pmol/L (reference range, 1.8-7.9 pmol/L) and 4.12 mmol/L (reference range, 2.14-2.53 mmol/L), respectively. Ultrasound-guided exploration of the neck revealed a large, rounded hypoechoic mass inferior to the left thyroid lobe, which contained parathyroid tissue on fine-needle aspiration cytology examination. Contrast-enhanced neck computed tomography revealed a mass measuring 3.6 × 2.6 × 2.5 cm behind the left thyroid lobe, alongside massive ventral spondylophytes of the cervical spine at the level of the postcricoid segment of the hypopharynx. Magnetic resonance imaging confirmed ventral tissue displacement due to spondylophyte size and location. Surgical exploration of the left side of the neck was performed, and the left lower parathyroid gland weighing 9.07 g was excised. Pathohistologic findings verified a parathyroid gland adenoma. The postoperative values showed parathyroid hormone and serum calcium levels at 4.54 pmol/L and 2.25 mmol/L, respectively. Discussion The pathophysiology of dysphagia in hypercalcemia is not fully elucidated. In this case, the patient's improvement after surgery implies a plausible connection between hypercalcemia and dysphagia, suggesting a causal relationship. Conclusion Although aphagia is not a typical presenting symptom of parathyroid adenoma, it should be noted in the differential diagnosis.
Collapse
Affiliation(s)
- Duje Čulina
- Department of Otorhinolaryngology and Head and Neck Surgery, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Mirta Peček
- Institute of Emergency Medicine of Virovitica County, Virovitica, Croatia
| | - Tomislav Gregurić
- Department of Radiology, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| | | | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| |
Collapse
|
3
|
Kestemont M, Gonze A, Ngueke Nguimgo Gaëlle G, Moorthamers S, Vermylen O. Contained Rupture of a Thoracic Aortic Aneurysm: A Rare and Life-Threatening Cause of Dysphagia. Cureus 2024; 16:e56517. [PMID: 38646362 PMCID: PMC11026946 DOI: 10.7759/cureus.56517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Dysphagia is commonly seen in the elderly and has both benign and malignant causes. A difficulty in swallowing due to the esophageal compression by the aorta, or dysphagia aortica, is a rare entity, little described in literature. However, diagnostic error or diagnostic and treatment delays of aortic dysphagia can be fatal. Herein, we report a case of dysphagia aortica caused by the contained rupture of a descending aneurysmatic thoracic aorta, presenting at the emergency department with acute dysphagia and diffuse chest pain, successfully treated by thoracic endovascular aneurysm repair.
Collapse
Affiliation(s)
| | | | | | | | - Olivier Vermylen
- Emergency Department, Brugmann University Hospital, Brussels, BEL
| |
Collapse
|
4
|
Polastri M, Di Marco L, Andreoli E. Odynophagia in individuals with neck pain: the importance of differential diagnosis in physiotherapy practice. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S129-S133. [PMID: 37960834 DOI: 10.12701/jyms.2023.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/19/2023] [Indexed: 11/15/2023]
Abstract
Odynophagia refers to painful swallowing caused by various underlying factors that must be excluded to determine the best treatment approach. Neck pain is a debilitating condition requiring treatment in rehabilitative settings. There are several circumstances in which odynophagia and neck pain coexist, such as tendinitis of the longus colli muscle and paravertebral calcification, prevertebral and retropharyngeal abscess, esophageal perforation, aortic dissection, thyroid cartilage fracture, thyrohyoid ligament syndrome, pneumomediastinum and subcutaneous emphysema, and after physical exercise. Physiotherapists are professionals most likely to encounter individuals with neck pain and provide interventions such as massage, manual therapy, exercise, and electrotherapy. Therefore, it is important to recognize that neck pain can stem from different clinical conditions that require interventions other than physiotherapy. A differential diagnosis is crucial to ensure appropriate referrals for therapeutic interventions.
Collapse
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Di Marco
- Department of Cardiac-Thoracic-Vascular Diseases, Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ernesto Andreoli
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
5
|
Spreafico G, Chiurazzi M, Bagnoli D, Emiliani S, de Bortoli N, Ciuti G. Endoluminal Procedures and Devices for Esophageal Tract Investigation: A Critical Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:8858. [PMID: 37960557 PMCID: PMC10650290 DOI: 10.3390/s23218858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
Diseases of the esophageal tract represent a heterogeneous class of pathological conditions for which diagnostic paradigms continue to emerge. In the last few decades, innovative diagnostic devices have been developed, and several attempts have been made to advance and standardize diagnostic algorithms to be compliant with medical procedures. To the best of our knowledge, a comprehensive review of the procedures and available technologies to investigate the esophageal tract was missing in the literature. Therefore, the proposed review aims to provide a comprehensive analysis of available endoluminal technologies and procedures to investigate esophagus health conditions. The proposed systematic review was performed using PubMed, Scopus, and Web of Science databases. Studies have been divided into categories based on the type of evaluation and measurement that the investigated technology provides. In detail, three main categories have been identified, i.e., endoluminal technologies for the (i) morphological, (ii) bio-mechanical, and (iii) electro-chemical evaluation of the esophagus.
Collapse
Affiliation(s)
- Giorgia Spreafico
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (G.C.)
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (G.C.)
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | | | | | - Nicola de Bortoli
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy;
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (G.C.)
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| |
Collapse
|
6
|
Ferreira RP, Alves LM, Mangilli LD. Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly. Codas 2023; 36:e20220232. [PMID: 37820239 DOI: 10.1590/2317-1782/20232022232pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/13/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. METHODS This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. RESULTS Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p<0.001) and oral hygiene frequency (p=0.03). CONCLUSION In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.
Collapse
Affiliation(s)
- Ronivaldo Pinto Ferreira
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
| | - Luana Marsicano Alves
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
| | - Laura Davison Mangilli
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
| |
Collapse
|
7
|
Hurtte E, Young J, Gyawali CP. Dysphagia. Prim Care 2023; 50:325-338. [PMID: 37516505 DOI: 10.1016/j.pop.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can be differentiated with a careful history. Neuromuscular processes are more prevalent than structural causes in oropharyngeal dysphagia, therefore, investigation should start with a modified barium swallow. In contrast, structural processes dominate in esophageal dysphagia, and endoscopy can offer biopsy and therapy by way of dilation. Manometry is performed for esophageal dysphagia when no structural etiology is found. Specific management of dysphagia is dependent on the etiology and mechanism of dysphagia.
Collapse
Affiliation(s)
- Edward Hurtte
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Jocelyn Young
- United Health Services Hospitals, Johnson City, NY, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| |
Collapse
|
8
|
Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, Ramos-Díaz M, Santana-López BN, Alcaraz-Jiménez JA, Rico-Rodríguez J, Santana-Cabrera L. Dysphagia in intensive care, a real problem: analysis of risk factors. ENFERMERIA INTENSIVA 2023; 34:115-125. [PMID: 36935305 DOI: 10.1016/j.enfie.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/08/2022] [Indexed: 03/19/2023]
Abstract
AIMS To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.
Collapse
Affiliation(s)
- L P Armas-Navarro
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - Y G Santana-Padilla
- Area Quirúrgica del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Mendoza-Segura
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - M Ramos-Díaz
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - B N Santana-López
- Unidad de Medicina Intensiva del Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - J A Alcaraz-Jiménez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - J Rico-Rodríguez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Santana-Cabrera
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain.
| |
Collapse
|
9
|
Kazemian E, Solinski M, Wozniak A, Charous S. Dysphagia After Prolonged Intubation in SARS-CoV-19 Patients: A Single Institution Retrospective Review. Cureus 2023; 15:e41544. [PMID: 37554611 PMCID: PMC10404913 DOI: 10.7759/cureus.41544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
To determine the impact of various factors on swallowing in SARS-CoV-19 patients after prolonged intubation. Methods: A retrospective chart review of SARS-CoV-19 patients intubated between February 2020 and March 2021 was performed. Independent variables, including duration and factors of intubation, and patient demographic characteristics were analyzed. Formal swallow studies were performed for patients who failed a screening swallow evaluation. Results: Seventy-three individuals of 308 patients reviewed had a dysphagia score of ≤5. A total of 49% of patients' dysphagia resolved prior to discharge, with a median of eight days between extubation and the last evaluation. The median duration of intubation was 11 days. Increasing age, congestive heart failure, cerebrovascular disease, and hypertension were associated with dysphagia at the first and/or last evaluation. Hispanic ethnicity was associated with a decreased risk of dysphagia (all p<0.05). Conclusions: Although various patient factors including age and congestive heart failure were associated with the development of dysphagia after prolonged intubation, the length of intubation was not.
Collapse
Affiliation(s)
- Elycia Kazemian
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mark Solinski
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Amy Wozniak
- Statistics, Loyola University Chicago Health Sciences Division Center for Translational Research and Education, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| |
Collapse
|
10
|
Achalu S, Berry R, Zhuo J, Bredenoord AJ, Clarke JO, Fass R, Gyawali CP, Kahrilas PJ, Katzka DA, Massey BT, Penagini R, Roman S, Savarino E, Vela MF, Kamal AN. Development and modification of a dysphagia question prompt list to improve patient-physician communication: Incorporating both esophageal expert and patient perspectives. Neurogastroenterol Motil 2023:e14600. [PMID: 37122123 DOI: 10.1111/nmo.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Question prompt lists (QPLs) are structured sets of disease-specific questions, intended to encourage question-asking by patients and enhance patient-physician communication. To date, a dysphagia-specific QPL has not been developed for patients with esophageal dysphagia symptoms. We aim to develop a dysphagia-specific QPL incorporating both esophageal expert and patient perspectives, applying rigorous methodology. METHODS The QPL content was generated applying a two-round modified Delphi (RAND/UCLA) method among 11 experts. In round one, experts provided five answers to the prompts: "What general questions should patients ask when being seen for dysphagia?" and "What questions do I not hear patients asking but, given my experience, I believe they should be asking?" In round two, experts rated proposed questions on a 5-point Likert scale. Responses rated as "essential" or "important", determined by an a priori median threshold of ≥4.0, were accepted for inclusion. Subsequently, 20 patients from Stanford Health Care were enrolled to modify the preliminary QPL, to incorporate their perspectives and opinions. Patients independently rated questions applying the same 5-point Likert scale. At the end, patients were encouraged to propose additional questions to incorporate into the QPL by open-endedly asking "Are there questions we didn't ask, that you think we should?" KEY RESULTS Eleven experts participated in both voting rounds. Of 85 questions generated from round one, 60 (70.6%) were accepted for inclusion, meeting a median value of ≥4.0. Questions were combined to reduce redundancy, narrowing down to 44 questions. Questions were categorized into the following six themes: 1. "What is causing my dysphagia?"; 2. "Associated symptoms"; 3. "Testing for dysphagia"; 4. "Lifestyle modifications"; 5. "Treatment for dysphagia"; and 6. "Prognosis". The largest number of questions covered "What is causing my dysphagia" (27.3%). Twenty patients participated and modified the QPL. Of the 44 questions experts agreed were important, only 30 questions (68.2%) were accepted for inclusion. Six patients proposed 10 additional questions and after incorporating the suggested questions, the final dysphagia-specific QPL created by esophageal experts and modified by patients consisted of 40 questions. CONCLUSIONS & INFERENCES Incorporating expert and patient perspectives, we developed a dysphagia-specific QPL to enhance patient-physician communication. Our study highlights importance of incorporating patient perspective when developing such a communication tool. Further studies will measure the impact of this communication tool on patient engagement.
Collapse
Affiliation(s)
- Sudharshan Achalu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Rani Berry
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Justin Zhuo
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Albert J Bredenoord
- Division of Neurogastroenterology and Motility, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - John O Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth, Cleveland, Ohio, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peter J Kahrilas
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - David A Katzka
- Division of Gastroenterology, Columbia University, New York, New York, USA
| | - Benson T Massey
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Roberto Penagini
- Division of Gastroenterology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Sabine Roman
- Division of Digestive Physiology, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | | | - Marcelo F Vela
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Afrin N Kamal
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| |
Collapse
|
11
|
Implementation of a free water protocol at a long term acute care hospital. Sci Rep 2023; 13:2626. [PMID: 36823156 PMCID: PMC9950376 DOI: 10.1038/s41598-023-29448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
This feasibility study aimed to trial a Free Water Protocol (FWP) for patients with thin liquid dysphagia in the Long-Term Acute Care Hospital (LTACH) setting. Patients with dysphagia are often prescribed thickened liquids to avoid or mitigate aspiration. While this clinical intervention can minimize the risk of aspiration pneumonia (PNA), it is generally not well received by patients. As such, the goal of this study was to determine if patients who knowingly aspirate thin liquids can safely tolerate thin liquid water, and if so, to what degree of benefit. The study assessed for adverse events, fluid intake, hydration status, quality of life, and overall swallow function outcomes. These measurements were taken over a 7 day trial period using inventories, lab work, clinical judgment, and observation. Ten participants were enrolled in this study with 9 having sufficient data for analysis (n = 9). No adverse events related to the FWP were observed, and patients saw improved total fluid intake (P = 0.0074), swallow-related quality of life (P = 0.0273), and overall swallow function (P = 0.0002). The results in this feasibility study allowed for the hospital wide implementation of the FWP and laid out the groundwork for future studies looking at longitudinal effects of a FWP.
Collapse
|
12
|
Kater KA, Seedat J. Weighing up the pros and cons of dysphagia triage in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e10. [PMID: 36861903 PMCID: PMC9982486 DOI: 10.4102/sajcd.v70i1.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap. OBJECTIVES To establish the reliability and validity of a researcher-developed dysphagia triage checklist. METHOD A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist. RESULTS Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes. CONCLUSION The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia.Contribution: The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.
Collapse
Affiliation(s)
- Kelly-Ann Kater
- Department of Speech Pathology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
| | - Jaishika Seedat
- Department of Speech Pathology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
Zhang PP, Yuan Y, Lu DZ, Li TT, Zhang H, Wang HY, Wang XW. Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia 2023; 38:145-158. [PMID: 35849209 PMCID: PMC9873714 DOI: 10.1007/s00455-022-10486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Abstract
The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.
Collapse
Affiliation(s)
- Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - De-Zhi Lu
- School of Medical, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Ting-Ting Li
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China.
- Rehabilitation Department, Affiliated Hospital of Weifang Medical College, 518 Fuyuan Street, Weifang, Shandong, China.
| |
Collapse
|
14
|
Sun W, Kang X, Zhao N, Dong X, Li S, Zhang G, Liu G, Yang Y, Zheng C, Yu G, Shuai L, Feng Z. Study on dysphagia from 2012 to 2021: A bibliometric analysis via CiteSpace. Front Neurol 2022; 13:1015546. [PMID: 36588913 PMCID: PMC9797971 DOI: 10.3389/fneur.2022.1015546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aims to review the documents on dysphagia, summarize the research direction, analyze the research hot spots and frontiers, report the research trends, and provide new ideas for future development in the field via CiteSpace. Methods We retrieved articles on dysphagia published between 2012 and 2021 from the Web of Science Core Collection database. We downloaded the entire data and utilized CiteSpace version 5.8.R3 (64-bit) to analyze the number of publications annually, cited journals, countries, institutions, authors, cited authors, cited references, and keywords. We visualized the data with a knowledge map, collaborative network analysis, cluster analysis, and strongest citation burst analysis. Results We obtained 14,007 papers with a continually increasing trend over time. The most productive country and institute in this field were the United States (4,308) and Northwestern University (236), respectively. Dysphagia (5,062) and Laryngoscope (2,812) were the most productive journals, Elizabeth Ward had the highest number of publications (84), and Logeman et al.'s article (centrality: 0.02) was the most referenced. The most common keywords were dysphagia, management, quality of life, deglutition disorder, diagnosis, aspiration, prevalence, children, outcome, and oropharyngeal dysphagia. Conclusion This study analyzed the current literature on dysphagia via CiteSpace and identified its research hot spots and frontiers. The prevalent global trends in dysphagia research and the growing public awareness about healthcare and quality of life suggest that research on dysphagia will gain popularity with further breakthroughs.
Collapse
Affiliation(s)
- Weiming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China,*Correspondence: Weiming Sun
| | - Xizhen Kang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Na Zhao
- Department of Rehabilitation Medicine, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Xiangli Dong
- Jiangxi Medical College, Nanchang University, Nanchang, China,Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shilin Li
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Gaoning Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Guanxiu Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yang Yang
- School of Life Science, Nanchang University, Nanchang, China
| | - Chafeng Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guohua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China,Lang Shuai
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Medical College, Nanchang University, Nanchang, China,Zhen Feng
| |
Collapse
|
15
|
Shen Z, Hou Y, Huerman A, Ma A. Patients with dysphagia: How to supply nutrition through non-tube feeding. Front Nutr 2022; 9:1060630. [PMID: 36532550 PMCID: PMC9757495 DOI: 10.3389/fnut.2022.1060630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear. SETTING AND PARTICIPANTS All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia. METHODS We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English. RESULTS We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics. CONCLUSION AND IMPLICATIONS It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.
Collapse
Affiliation(s)
- Zhean Shen
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yingze Hou
- Sanquan College, Xinxiang Medical University, Xinxiang, China
| | - Ayideng Huerman
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
| | - Aiqin Ma
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| |
Collapse
|
16
|
Armas-Navarro L, Santana-Padilla Y, Mendoza-Segura L, Ramos-Díaz M, Santana-López B, Alcaraz-Jiménez J, Rico-Rodríguez J, Santana-Cabrera L. La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo. ENFERMERIA INTENSIVA 2022. [DOI: 10.1016/j.enfi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
17
|
Zahra T, Ravikumar Y, Voloshyna D, Shams Y, Shaik TA, Sandhu QI, Sahtiya S, Saleem F, Ghaffari MAZ. An Unusual Presentation of Esophageal Tuberculosis: A Case Report. Cureus 2022; 14:e29642. [PMID: 36320941 PMCID: PMC9608034 DOI: 10.7759/cureus.29642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
The lungs, kidneys, liver, and pancreas are just some of the organs that can be affected by tuberculosis. Tuberculosis is a disease that can affect many organs of the human body. Rarely can tuberculosis (TB) manifest itself in the digestive tract; in fact, the gastrointestinal tract ranks as the sixth most common site of extrapulmonary TB. However, involvement of the esophagus by tuberculosis is extremely uncommon. We present a case of esophageal tuberculosis in a 27-year-old man with epigastric pain and weight loss as his only symptoms. There were no complaints of odynophagia or dysphagia, nor was there any evidence of immunodeficiency. Upper gastrointestinal endoscopy found an ulcer 26 centimeters from the incisor. Histopathology and a biopsy confirmed the diagnosis of primary esophageal tuberculosis. Six months after beginning anti-TB therapy, he was confirmed to be free of tuberculosis.
Collapse
|
18
|
Lim W, Jeong Y, Yoo B. Rheological Information of Pudding-Thick Liquids Prepared Using Commercial Food Thickeners Marketed in Korea for Dysphagic Patients According to the Manufacturers’ Guidelines. Clin Nutr Res 2022; 11:1-8. [PMID: 35223676 PMCID: PMC8844529 DOI: 10.7762/cnr.2022.11.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 12/04/2022] Open
Abstract
Food thickeners are commonly used to prepare thickened liquids for the management of dysphagia. The National Dysphagia Diet (NDD) thickness levels of thickened liquids prepared with commercial food thickeners are known to vary depending on the thickener type, recommended amount of thickener, thickener brand, and preparation instructions. Particularly, detailed preparation instructions must be provided by the manufacturers to achieve the correct thickness levels. However, the rheological information on product labels provided by manufacturers is typically not accurate. Here, various pudding-thick liquids were prepared by mixing commercial xanthan gum (XG)-based thickeners based on the manufacturers’ guidelines, and their rheological properties were characterized. Several thickened liquids prepared with four different XG-based thickeners (A-D) marketed in Korea did not meet the pudding-like criterion (> 1,750 mPa·s) based on the NDD guidelines. Significant differences in rheological parameter values (ηa,50, n, and G′) were also identified among the various thickened liquids. Only one thickener (thickener A) manufactured in Korea showed optimal results, which satisfied the pudding-thick viscosity range for various food liquids and also showed lower stickiness and enhanced bolus formation ability for easy and safe swallowing when compared to other thickeners (B, C, and D).
Collapse
Affiliation(s)
- Woobin Lim
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
| | - Yulim Jeong
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
| |
Collapse
|
19
|
Lanzoni G, Sembenini C, Gastaldo S, Leonardi L, Bentivoglio VP, Faggian G, Bosa L, Gaio P, Cananzi M. Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach. Front Pediatr 2022; 10:885308. [PMID: 35813384 PMCID: PMC9263077 DOI: 10.3389/fped.2022.885308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Pediatric esophageal dysphagia (PED) is an infrequent condition that can be determined by a large number of disorders. The etiologic diagnosis is challenging due to overlapping clinical phenotypes and to the absence of pediatric diagnostic guidelines. This review aims to summarize the most relevant causes of ED during childhood, highlight the clinical scenarios of PED presentation and discuss the indications of available diagnostic tools. Available information supports that PED should always be investigated as it can underlie life-threatening conditions (e.g., foreign body ingestion, mediastinal tumors), represent the complication of benign disorders (e.g., peptic stenosis) or constitute the manifestation of organic diseases (e.g., eosinophilic esophagitis, achalasia). Therefore, the diagnosis of functional PED should be made only after excluding mucosal, structural, or motility esophageal abnormalities. Several clinical features may contribute to the diagnosis of PED. Among the latter, we identified several clinical key elements, relevant complementary-symptoms and predisposing factors, and organized them in a multi-level, hierarchical, circle diagram able to guide the clinician through the diagnostic work-up of PED. The most appropriate investigational method(s) should be chosen based on the diagnostic hypothesis: esophagogastroduodenoscopy has highest diagnostic yield for mucosal disorders, barium swallow has greater sensitivity in detecting achalasia and structural abnormalities, chest CT/MR inform on the mediastinum, manometry is most sensitive in detecting motility disorders, while pH-MII measures gastroesophageal reflux. Further studies are needed to define the epidemiology of PED, determine the prevalence of individual underlying etiologies, and assess the diagnostic value of investigational methods as to develop a reliable diagnostic algorithm.
Collapse
Affiliation(s)
- Gloria Lanzoni
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Camilla Sembenini
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Stefano Gastaldo
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Letizia Leonardi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | | | - Giovanna Faggian
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Luca Bosa
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Mara Cananzi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| |
Collapse
|
20
|
Abstract
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
Collapse
Affiliation(s)
- E Berryhill McCarty
- Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street #500, Pittsburgh, PA 15213, USA
| | - Tiffany N Chao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| |
Collapse
|
21
|
Paudel MS, Parajuli SR, Baral B, Poudel P, Dhungana I. Primary Esophageal Tuberculosis With Dysphagia. Cureus 2021; 13:e16236. [PMID: 34367833 PMCID: PMC8344969 DOI: 10.7759/cureus.16236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis is a common infection caused by Mycobacterium tuberculosis. Tuberculosis can affect many organ systems of the human body including the gastrointestinal tract. Esophageal involvement of tuberculosis is however rare. A 60 years old male from Nepal with an occupational history suggestive of exposure to tuberculosis presented with dysphagia. He did not have any other complaints and his physical examination was unremarkable. An upper gastrointestinal endoscopic examination revealed an esophageal ulcer at 25 cm from incisors. Biopsy from the edge of the ulcer revealed granulomas with central caseous necrosis. A computed tomography scan of the chest and abdomen did not reveal additional lesions. Considering the higher prevalence of tuberculosis in the geographical area, he was started on an empirical antitubercular regimen. His dysphagia subsided within two weeks of starting therapy. A repeat upper gastrointestinal examination at six months of therapy revealed complete healing of the esophageal lesion. In this case report, we review the symptomatology, diagnosis, and treatment of esophageal tuberculosis.
Collapse
Affiliation(s)
- Mukesh S Paudel
- Gastroenterology, National Academy of Medical Sciences, Kathmandu, NPL
| | | | - Bidisha Baral
- Medicine, National Tuberculosis Control Centre, Kathmandu, NPL
| | - Puskar Poudel
- Internal Medicine, Kathmandu University, Kathmandu, NPL
| | - Ishan Dhungana
- Pathology, B.P. Koirala Memorial Cancer Hospital, Bharatpur, NPL
| |
Collapse
|
22
|
Chang MC, Lee C, Park D. Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies. J Clin Med 2021; 10:jcm10132990. [PMID: 34279475 PMCID: PMC8267875 DOI: 10.3390/jcm10132990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND the Videofluoroscopic Dysphagia Scale (VDS) is used to interpret and predict the long-term prognosis of patients with dysphagia. However, the inter-rater agreement of the VDS was shown to be lower in a previous study. To overcome the mentioned limitation of the VDS, a modified version (mVDS) was created and applied clinically. We aimed to validate its usefulness in determining the appropriate feeding method and predicting the prognosis of dysphagia. METHODS the videofluroscopic swallowing study (VFSS) data of 50 patients with dysphagia were collected retrospectively. The VFSS data were evaluated using the mVDS, and the inter-rater reliability was calculated. We also evaluated the association between the mVDS and type of feeding method selected, and between the mVDS and presence of aspiration pneumonia in patients with dysphagia. RESULTS among the different parameters of mVDS, "aspiration" showed the highest reliability (k = 0.767), followed by "mastication" and "lip closure" (k = 0.648 and k = 0.634, respectively). Conversely, "triggering pharyngeal swallow" and "pyriformis residue" demonstrated the lowest reliabilities (k = 0.312 and k = 0.324, respectively). The intraclass correlation coefficient (ICC), which is used as a measure of the reliability of the total mVDS score, was 0.876. In all patients with dysphagia, the mVDS score correlated significantly with the type of feeding method selected (p < 0.05), and the presence of aspiration pneumonia (p < 0.05). CONCLUSION the ICC of the total mVDS score was 0.876. Therefore, the mVDS could be a useful tool for quantifying the severity of dysphagia. It could be helpful in the analysis of the VFSS findings among patients with dysphagia in clinical settings and research.
Collapse
Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation medicine, Yeungnam University Hospital, Daegu 41061, Korea;
| | - Changbae Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
- Correspondence: ; Tel.: +82-52-250-7222; Fax: +82-52-250-7228
| |
Collapse
|
23
|
Araujo IK, Roman S, Napoléon M, Mion F. Diagnostic yield of adding solid food swallows during high-resolution manometry in esophageal motility disorders. Neurogastroenterol Motil 2021; 33:e14060. [PMID: 33314459 DOI: 10.1111/nmo.14060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-resolution manometry (HRM) is a key method to evaluate esophageal motility disorders. Current evaluation is usually performed with single water swallows (SWS) that may not challenge esophageal function or reproduce symptoms. Solid food swallows (SFS) could increase the diagnostic yield for clinically relevant disorders. METHODS Patients with dysphagia referred for esophageal HRM during a 2-year period in a single center were reviewed retrospectively and included if SFS was performed during HRM. Chicago classification v3.0 was used to define esophageal motility disorders. KEY RESULTS One hundred and four patients with dysphagia were included (59% women, mean age 57 years). Ineffective esophageal motility was the most frequent motility disorder. Compared to SWS, the diagnosis changed after SFS in 33 patients (31.7%) including a change from normal or minor diagnosis toward major motility disorders in 14 (13.4%). Fifteen subjects (14.4%) shifted from a minor disorder on SWS to normal after SFS. SFS changed the diagnosis in 53.8% of patients with previous surgery versus 29.5% of those without (p = 0.023). Pressurization during rapid drink challenge was more frequent when SFS changed the diagnosis to major motility disorders (69.2% vs. 37.3%, p = 0.033). Twenty-nine percent of patients reported symptoms during SFS, mostly those with diagnostic change to major disorders after SFS (71.4% of patients with changes to major disorders vs. 22.2% of patients without, p < 0.0001). CONCLUSION & INFERENCES Solid food swallows is a simple way to improve the diagnostic yield of HRM in patients with dysphagia and should be added to manometry protocol in daily clinical practice.
Collapse
Affiliation(s)
- Isis K Araujo
- Endoscopy and Motility Unit, Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Sabine Roman
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,Digestive Physiology, Lyon I University, Université de Lyon, Lyon, France.,LabTAU, Inserm U1032, Université de Lyon, Lyon, France
| | - Marie Napoléon
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - François Mion
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,Digestive Physiology, Lyon I University, Université de Lyon, Lyon, France.,LabTAU, Inserm U1032, Université de Lyon, Lyon, France
| |
Collapse
|
24
|
Kim TY, Park D, Lee SE, Kim BH, Son SI, Choi SH. Clinical Usefulness of the Korean Version of the Dysphagia Handicap Index: Reliability, Validity, and Role as a Screening Test. Dysphagia 2021; 37:183-191. [PMID: 33586044 DOI: 10.1007/s00455-021-10262-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
This study aimed to measure the validity and reliability of the Korean version of the Dysphagia Handicap Index (K-DHI) and evaluate its diagnostic efficacy for predicting aspiration. We enrolled 104 patients with dysphagia symptoms (D group) and 88 controls (ND group). Among controls, there were 43 patients without dysphagia symptoms (ND patient group). All subjects completed the K-DHI survey. The D and ND group patients underwent the Gugging Swallowing Screen (GUSS) and videofluoroscopic swallowing study (VFSS). Two weeks later, the D group completed the second session of the K-DHI survey. The internal consistency of the K-DHI was good to excellent (Cronbach's α: 0.79-0.95). The test-retest reliability of the K-DHI survey was also high (interclass correlation coefficient = 0.88). There were moderate correlations between the K-DHI and GUSS (r = - 0.65, p < 0.001) as well as findings of VFSS-videofluoroscopic dysphagia scale (r = 0.55, p < 0.001) and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (r = - 0.55, p < 0.001). For predicting aspiration, the K-DHI cutoff value was 11 (sensitivity, 0.82; specificity, 0.72; positive predictive value, 0.34; and negative predictive value, 0.96). K-DHI ≥ 11 [odds ratio (OR), 6.43; 95% Confidence Interval (CI) (1.87-22.16); p = 0.003] and GUSS ≤ 15 [OR 4.73; 95% CI (1.59-14.07); p = 0.005] were independent risk factors for aspiration on VFSS. The K-DHI is a reliable and valid self-reporting instrument for evaluating patient's quality of life associated with dysphagia among the Korean language population. It is also useful for the screening of aspiration.
Collapse
Affiliation(s)
- Tae Yeon Kim
- Speech-Language Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 352, Huimang-daero, Pohang, 37659, Republic of Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 352, Huimang-daero, Pohang, 37659, Republic of Korea.
| | - Byung Hee Kim
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 352, Huimang-daero, Pohang, 37659, Republic of Korea
| | - Seok Il Son
- Occupational Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Seong Hee Choi
- Department of Audiology and Speech-Language Pathology, Catholic University of Daegu, 13-13, Hayang-ro, Hayang-eup, Gyeongsan, 38430, Republic of Korea.
| |
Collapse
|