1
|
Seeholzer LF, Julius D. Neuroendocrine cells initiate protective upper airway reflexes. Science 2024; 384:295-301. [PMID: 38669574 DOI: 10.1126/science.adh5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/21/2024] [Indexed: 04/28/2024]
Abstract
Airway neuroendocrine (NE) cells have been proposed to serve as specialized sensory epithelial cells that modulate respiratory behavior by communicating with nearby nerve endings. However, their functional properties and physiological roles in the healthy lung, trachea, and larynx remain largely unknown. In this work, we show that murine NE cells in these compartments have distinct biophysical properties but share sensitivity to two commonly aspirated noxious stimuli, water and acid. Moreover, we found that tracheal and laryngeal NE cells protect the airways by releasing adenosine 5'-triphosphate (ATP) to activate purinoreceptive sensory neurons that initiate swallowing and expiratory reflexes. Our work uncovers the broad molecular and biophysical diversity of NE cells across the airways and reveals mechanisms by which these specialized excitable cells serve as sentinels for activating protective responses.
Collapse
Affiliation(s)
- Laura F Seeholzer
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David Julius
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
2
|
Kaneko M, Sugiyama Y, Munekawa R, Kinoshita S, Mukudai S, Umezaki T, Dutschmann M, Hirano S. Sustained Effects of Capsaicin Infusion into the Oropharynx on Swallowing in Perfused Rats. Laryngoscope 2024; 134:305-314. [PMID: 37503765 DOI: 10.1002/lary.30918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To examine the sustained effects of oropharyngeal capsaicin stimulation on the regulation of swallowing, we recorded the swallowing-related nerve activities during continuous infusion of capsaicin solution into the oropharynx. METHODS In 33 in situ perfused brainstem preparation of rats, we recorded the activities of the vagus, hypoglossal, and phrenic nerves during fictive swallowing. The interburst intervals (IBIs) of the swallowing-related nerves during sequential pharyngeal swallowing (sPSW) elicited by electrical stimulation of the superior laryngeal nerve (SLN) during concurrent capsaicin stimulation of 10, 1, and 0.1 μM (n = 28) were compared with those during oropharyngeal infusion of saline (control) (n = 5). RESULTS The IBIs during SLN-induced sPSW were reduced at 5 min after initiation of continuous infusion of 10 and 1 μM capsaicin solution. The IBIs showed significant decreases to -25.8 ± 6.9%, -25.9 ± 5.3, -18.3 ± 3.7, and -12.0 ± 1.6 at 30 min following 1 μM capsaicin stimulation at SLN stimulus conditions at 5 Hz of 1.2 times threshold, 10 Hz of 40 μA, 5 Hz of 60 μA, and 10 Hz of 60 μA, respectively. Continuous capsaicin stimulation of 0.1 μM solution did not show significant sustained effects. CONCLUSION Pharmacological stimulation of capsaicin could provide time-dependent effects on the likelihood of swallowing, particularly subserving sustained facilitation of swallowing reflex with appropriate concentration of capsaicin. LEVEL OF EVIDENCE NA Laryngoscope, 134:305-314, 2024.
Collapse
Affiliation(s)
- Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryoto Munekawa
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Kinoshita
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiro Umezaki
- Department of Speech and Hearing Sciences, International University of Health and Welfare, and the Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Mathias Dutschmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
3
|
Clavé P, Ortega O, Rofes L, Alvarez-Berdugo D, Tomsen N. Brain and Pharyngeal Responses Associated with Pharmacological Treatments for Oropharyngeal Dysphagia in Older Patients. Dysphagia 2023; 38:1449-1466. [PMID: 37145201 DOI: 10.1007/s00455-023-10578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/07/2023] [Indexed: 05/06/2023]
Abstract
Impaired pharyngo-laryngeal sensory function is a critical mechanism for oropharyngeal dysphagia (OD). Discovery of the TRP family in sensory nerves opens a window for new active treatments for OD. To summarize our experience of the action mechanism and therapeutic effects of pharyngeal sensory stimulation by TRPV1, TRPA1 and TRPM8 agonists in older patients with OD. Summary of our studies on location and expression of TRP in the human oropharynx and larynx, and clinical trials with acute and after 2 weeks of treatment with TRP agonists in older patients with OD. (1) TRP receptors are widely expressed in the human oropharynx and larynx: TRPV1 was localized in epithelial cells and TRPV1, TRPA1 and TRPM8 in sensory fibers mainly below the basal lamina. (2) Older people present a decline in pharyngeal sensory function, more severe in patients with OD associated with delayed swallow response, impaired airway protection and reduced spontaneous swallowing frequency. (3) Acute stimulation with TRP agonists improved the biomechanics and neurophysiology of swallowing in older patients with OD TRPV1 = TRPA1 > TRPM8. (4) After 2 weeks of treatment, TRPV1 agonists induced cortical changes that correlated with improvements in swallowing biomechanics. TRP agonists are well tolerated and do not induce any major adverse events. TRP receptors are widely expressed in the human oropharynx and larynx with specific patterns. Acute oropharyngeal sensory stimulation with TRP agonists improved neurophysiology, biomechanics of swallow response, and safety of swallowing. Subacute stimulation promotes brain plasticity further improving swallow function in older people with OD.
Collapse
Affiliation(s)
- Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.
| |
Collapse
|
4
|
Hossain MZ, Kitagawa J. Transient receptor potential channels as an emerging therapeutic target for oropharyngeal dysphagia. Jpn Dent Sci Rev 2023; 59:421-430. [PMID: 38022386 PMCID: PMC10665593 DOI: 10.1016/j.jdsr.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Oropharyngeal dysphagia is a serious health concern in older adults and patients with neurological disorders. Current oropharyngeal dysphagia management largely relies on compensatory strategies with limited efficacy. A long-term goal in swallowing/dysphagia-related research is the identification of pharmacological treatment strategies for oropharyngeal dysphagia. In recent decades, several pre-clinical and clinical studies have investigated the use of transient receptor potential (TRP) channels as a therapeutic target to facilitate swallowing. Various TRP channels are present in regions involved in the swallowing process. Animal studies have shown that local activation of these channels by their pharmacological agonists initiates swallowing reflexes; the number of reflexes increases when the dose of the agonist reaches a particular level. Clinical studies, including randomized clinical trials involving patients with oropharyngeal dysphagia, have demonstrated improved swallowing efficacy, safety, and physiology when TRP agonists are mixed with the food bolus. Additionally, there is evidence of plasticity development in swallowing-related neuronal networks in the brain upon TRP channel activation in peripheral swallowing-related regions. Thus, TRP channels have emerged as a promising target for the development of pharmacological treatments for oropharyngeal dysphagia.
Collapse
Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| |
Collapse
|
5
|
Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
Collapse
Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Jiang W, Zou Y, Huang L, Zeng Y, Xiao LD, Chen Q, Zhang F. Gustatory stimulus interventions for older adults with dysphagia: a scoping review. Aging Clin Exp Res 2023:10.1007/s40520-023-02437-4. [PMID: 37209267 DOI: 10.1007/s40520-023-02437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.
Collapse
Affiliation(s)
- Wenyi Jiang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zou
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zeng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lily Dongxia Xiao
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Qian Chen
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengying Zhang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, China.
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China.
- West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
7
|
Cole CL, Yu VX, Perry S, Seenauth A, Lumpkin EA, Troche MS, Pitman MJ, Moayedi Y. Healthy Human Laryngopharyngeal Sensory Innervation Density Correlates with Age. Laryngoscope 2023; 133:773-784. [PMID: 35841384 DOI: 10.1002/lary.30287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Somatosensory feedback from upper airway structures is essential for swallowing and airway defense but little is known about the identities and distributions of human upper airway neurons. Furthermore, whether sensory innervation modifies with aging is unknown. In this study, we quantify neuronal and chemosensory cell density in upper airway structures and correlate with age. METHODS Participants underwent biopsies from base of tongue, lateral and midline pharyngeal wall, epiglottis, and arytenoids (N = 25 13 female/12 male; 20-80 years, mean 51.4 years without clinical diagnosis of dysphagia or clinical indication for biopsy). Tissue sections were labeled with antibodies for all neurons, myelinated neurons, and chemosensory cells. Densities of lamina propria innervation, epithelial innervation, solitary chemosensory cells, and taste buds were calculated and correlated with age. RESULTS Arytenoid had the highest density of innervation and chemosensory cells across all measures compared to other sites. Taste buds were frequently observed in arytenoid and epiglottis. Base of tongue, lateral pharynx, and midline posterior pharynx had minimal innervation and few chemosensory cells. Epithelial innervation was present primarily in close proximity to chemosensory cells and taste buds. Overall innervation and myelinated fibers in the arytenoid lamina propria decline with aging. CONCLUSION Findings establish the architecture of healthy adult sensory innervation and demonstrate the varied distribution of laryngopharyngeal innervation, necessary steps toward understanding the sensory basis for swallowing and airway defense. We also document age-related decline in arytenoid innervation density. These findings suggest that sensory afferent denervation of the upper airway may be a contributing factor to presbyphagia. LEVEL OF EVIDENCE NA Laryngoscope, 133:773-784, 2023.
Collapse
Affiliation(s)
- Caroline L Cole
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Victoria X Yu
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Sarah Perry
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Department of Medicine, University of Otago, Christchurch, New Zealand.,The University of Canterbury Rose Center for Stroke Recovery & Research at St. George's Medical Center, Christchurch, New Zealand
| | - Anisa Seenauth
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ellen A Lumpkin
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Yalda Moayedi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA.,Department of Neurology, Columbia University, New York, New York, USA.,Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
| |
Collapse
|
8
|
Hossain MZ, Ando H, Unno S, Roy RR, Kitagawa J. Pharmacological activation of transient receptor potential vanilloid 4 promotes triggering of the swallowing reflex in rats. Front Cell Neurosci 2023; 17:1149793. [PMID: 36909278 PMCID: PMC9992545 DOI: 10.3389/fncel.2023.1149793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
The swallowing reflex is an essential physiological reflex that allows food or liquid to pass into the esophagus from the oral cavity. Delayed triggering of this reflex is a significant health problem in patients with oropharyngeal dysphagia for which no pharmacological treatments exist. Transient receptor potential channels have recently been discovered as potential targets to facilitate triggering of the swallowing reflex. However, the ability of transient receptor potential vanilloid 4 (TRPV4) to trigger the swallowing reflex has not been studied. Here, we demonstrate the involvement of TRPV4 in triggering the swallowing reflex in rats. TRPV4 immunoreactive nerve fibers were observed in the superior laryngeal nerve (SLN)-innervated swallowing-related regions. Retrograde tracing with fluorogold revealed localization of TRPV4 on approximately 25% of SLN-afferent neurons in the nodose-petrosal-jugular ganglionic complex. Among them, approximately 49% were large, 35% medium, and 15% small-sized SLN-afferent neurons. Topical application of a TRPV4 agonist (GSK1016790A) to the SLN-innervated regions dose-dependently facilitated triggering of the swallowing reflex, with the highest number of reflexes triggered at a concentration of 250 μM. The number of agonist-induced swallowing reflexes was significantly reduced by prior topical application of a TRPV4 antagonist. These findings indicate that TRPV4 is expressed on sensory nerves innervating the swallowing-related regions, and that its activation by an agonist can facilitate swallowing. TRPV4 is a potential pharmacological target for the management of oropharyngeal dysphagia.
Collapse
Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Rita Rani Roy
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| |
Collapse
|
9
|
Min HS, Shin H, Yoon CH, Lee ES, Oh MK, Lee CH, Hwang S, Byun H. Effects of Carbonated Water Concentration on Swallowing Function in Healthy Adults. Dysphagia 2022; 37:1550-1559. [PMID: 35175420 DOI: 10.1007/s00455-022-10420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
In this study, we investigated the effects of carbonated water concentration on swallowing function using surface electromyography (sEMG). Healthy subjects (n = 52, 26.77 ± 3.21 years old) were asked to perform two swallows each of noncarbonated water, low-concentration carbonated water, medium-concentration carbonated water, and high-concentration carbonated water. Onset time, the mean sEMG activity amplitude, and duration of muscle activity in each swallow were measured and analyzed for orbicularis oris, masseter, submental muscle complex and infrahyoid muscles. Onset time significantly decreased and mean sEMG activity amplitude significantly increased with carbonation concentration. Therefore, stimulation with carbonation can be effective for modulating a faster and stronger swallow in the oral and pharyngeal phases of swallowing, and its effect on amplitude was greater in the oral phase than in the pharyngeal phase.Clinical Trials Registration This study is registered with Clinical Research Information Service (KCT0005925).
Collapse
Affiliation(s)
- Hoi Sik Min
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Heesuk Shin
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.,Institute of Health Science, Gyeongsang National University, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.,Institute of Health Science, Gyeongsang National University, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Eun Shin Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.,Institute of Health Science, Gyeongsang National University, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.,Institute of Health Science, Gyeongsang National University, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Sunwoo Hwang
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Hayoung Byun
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
| |
Collapse
|
10
|
Yang CW, Chen RD, Feng MT, Zhang MZ, Liu W, Liu XC, Wang DC. The therapeutic effect of capsaicin on oropharyngeal dysphagia: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:931016. [PMID: 36425319 PMCID: PMC9679510 DOI: 10.3389/fnagi.2022.931016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/17/2022] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Capsaicin is a specific agonist of TRPV1 (multimodal sensory receptor), which improves oropharyngeal dysphagia by increasing sensory input from the oropharynx and hypopharynx and by increasing repetitive stimulation of the cerebral cortex. The aim of this systematic review was to evaluate the therapeutic effect of capsaicin on swallowing disorders in stroke patients and the elderly. METHOD We searched Medline, Embase, PubMed, and Cochrane Library databases. We used the Mesh terms search database to screen all clinical trials that complied with the inclusion criteria. Studies were subjected to literature screening, quality assessment, and data extraction to remove studies that did not meet the inclusion criteria. After literature screening, quality assessment, and data extraction, a systematic review and meta-analysis of the included study were performed. RESULTS This systematic review and meta-analysis were prospectively registered on PROSPERO under registration number CRD42022313958. Five high-quality randomized controlled trials were ultimately included. The results of our meta-analysis showed a more significant reduction in swallowing function score change in the capsaicin group compared to the control group [SMD = -1.30, 95% CI: (-2.35, -0.25), P = 0.01] and on the Water swallowing test the improvement was significantly higher in the capsaicin group [RR = 2.46, 95% CI: (1.73, 3.50), P < 0.0001]. CONCLUSIONS Although the results of our meta-analysis showed that capsaicin improved swallowing function, most studies had an unclear bias and included few studies. More studies are needed to support this in the future. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero/display_record.php?RecordID=304061, identifier: 304061.
Collapse
Affiliation(s)
- Cong-wen Yang
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ru-dong Chen
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meng-ting Feng
- Department of Pediatrics, Jilin University, Changchun, China
| | | | - Wei Liu
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xu-chang Liu
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Da-chuan Wang
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| |
Collapse
|
11
|
Chen K, Xing L, Xu B, Li Y, Liu T, Zhang T, Shi H, Lu H, Zhou W, Hou J, Shi H, Qin D. Research progress in the risk factors and screening assessment of dysphagia in the elderly. Front Med (Lausanne) 2022; 9:1021763. [PMID: 36419790 PMCID: PMC9676222 DOI: 10.3389/fmed.2022.1021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 10/30/2023] Open
Abstract
With the aging of the population, the incidence of dysphagia has gradually increased and become a major clinical and public health issue. Early screening of dysphagia in high-risk populations is crucial to identify the risk factors of dysphagia and carry out effective interventions and health management in advance. In this study, the current epidemiology, hazards, risk factors, preventive, and therapeutic measures of dysphagia were comprehensively reviewed, and a literature review of screening instruments commonly used globally was conducted, focusing on their intended populations, main indicators, descriptions, and characteristics. According to analysis and research in the current study, previous studies of dysphagia were predominantly conducted in inpatients, and there are few investigations and screenings on the incidence and influencing factors of dysphagia in the community-dwelling elderly and of dysphagia developing in the natural aging process. Moreover, there are no unified, simple, economical, practical, safe, and easy-to-administer screening tools and evaluation standards for dysphagia in the elderly. It is imperative to focus on dysphagia in the community-dwelling elderly, develop unified screening and assessment tools, and establish an early warning model of risks and a dietary structure model for dysphagia in the community-dwelling elderly.
Collapse
Affiliation(s)
- Kerong Chen
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Liwei Xing
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Bonan Xu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Li
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tianyun Liu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tingjuan Zhang
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongping Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wengang Zhou
- Department of Medical, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jianhong Hou
- Department of Orthopedics, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
12
|
Peña-Chávez RE, Schaen-Heacock NE, Hitchcock ME, Kurosu A, Suzuki R, Hartel RW, Ciucci MR, Rogus-Pulia NM. Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults. Dysphagia 2022. [PMID: 36266521 DOI: 10.1007/s00455-022-10525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
Collapse
|
13
|
Lin Y, Wan G, Wu H, Shi J, Zhang Y, Chen H, Wei X, Tang Z, Dai M, Dou Z, Wen H. The sensitivity and specificity of the modified volume-viscosity swallow test for dysphagia screening among neurological patients. Front Neurol 2022; 13:961893. [PMID: 36188363 PMCID: PMC9523084 DOI: 10.3389/fneur.2022.961893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a highly prevalent condition after stroke and other neurological diseases. The volume-viscosity swallow test (V-VST) is a screening tool for OD. Considering that the recommendations of volume and thickeners in the original V-VST limited the popularization and application of the test in the Chinese population, we provide the modified V-VST to detect OD among neurological patients. In addition, the accuracy of the modified V-VST to screen OD needs to be verified. We included 101 patients with neurological diseases. OD was evaluated by a modified V-VST and a videofluoroscopy swallowing study (VFSS) using 3 volumes (i.e., 3, 5, and 10 ml) and 4 viscosities (i.e., water, mildly thick, moderately thick, and extremely thick). In this study, to compare with the original V-VST results, a volume of 20 ml was also included. The discriminating ability of modified V-VST in detecting OD was assessed by the sensitivity and specificity values of clinical signs of impaired efficiency (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallowing (cough, voice changes, and oxygen desaturation ≥3%) in comparison to the results of VFSS. The modified V-VST showed 96.6% sensitivity and 83.3% specificity for OD, 85.2% sensitivity and 70% specificity for impaired safety, and 90.9% sensitivity and 76.9% specificity for impaired efficacy. Our study suggests that the modified V-VST offers a high discriminating ability in detecting OD among neurological patients.
Collapse
|
14
|
Tomsen N, Ortega O, Alvarez-Berdugo D, Rofes L, Clavé P. A Comparative Study on the Effect of Acute Pharyngeal Stimulation with TRP Agonists on the Biomechanics and Neurophysiology of Swallow Response in Patients with Oropharyngeal Dysphagia. Int J Mol Sci 2022; 23:ijms231810773. [PMID: 36142680 PMCID: PMC9506471 DOI: 10.3390/ijms231810773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Fluid thickening is the main compensatory strategy for patients with oropharyngeal dysphagia (OD) associated with aging or neurological diseases, and there is still no pharmacological treatment. We aimed to compare the effects of increasing bolus viscosity with that of acute stimulation with TRPV1, TRPA1 or TRPM8 agonists on the biomechanics and neurophysiology of swallow response in patients with OD. We retrospectively analyzed seven studies from our laboratory on 329 patients with OD. The effect of increasing shear viscosity up to 3682 mPa·s was compared by videofluoroscopy and pharyngeal sensory evoked potentials (pSEP) with that of adding to the bolus: capsaicin (TRPV1, 150 μM/10 μM), piperine (TRPA1/V1, 1 mM/150 μM), menthol (TRPM8, 1 mM/10 mM), cinnamaldehyde-zinc (TRPA1, 100 ppm−70 mM), citral (TRPA1, 250 ppm) or citral-isopulegol (TRPA1-TRPM8, 250 ppm−200 ppm). Fluid thickening improved the safety of swallow by 80% (p < 0.0001) by delaying bolus velocity by 20.7 ± 7.0% and time to laryngeal vestibule closure (LVC) by 23.1 ± 3.7%. Capsaicin 150μM or piperine 1 mM significantly improved safety of swallow by 50% (p < 0.01) and 57.1% (p < 0.01) by speeding time to LVC by 27.6% (p < 0.001) and 19.5% (p < 0.01) and bolus velocity by 24.8% (p < 0.01) and 16.9% (p < 0.05), respectively. Cinnamaldehyde-zinc shortened the P2 latency of pSEPs by 11.0% (p < 0.01) and reduced N2-P2 amplitude by 35% (p < 0.01). In conclusion, TRPV1 and TRPV1/A1 agonists are optimal candidates to develop new pharmacological strategies to promote the recovery of brain and swallow function in patients with chronic OD.
Collapse
Affiliation(s)
- Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Correspondence: ; Tel.: +34-937417700 (ext. 2284)
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Barcelona, Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Barcelona, Spain
| |
Collapse
|
15
|
Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
Collapse
Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| |
Collapse
|
16
|
Edmonds CE, German RZ, Bond LE, Mayerl CJ. Oropharyngeal Capsaicin Exposure Improves Infant Feeding Performance in an Animal Model of Superior Laryngeal Nerve Damage. J Neurophysiol 2022; 128:339-349. [PMID: 35822726 PMCID: PMC9359634 DOI: 10.1152/jn.00063.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sensorimotor feedback is critical to safe and effective swallowing. Because of this, sensory interventions have the potential to treat dysphagia. One such treatment may be found in capsaicin, which activates the internal branch of the superior laryngeal nerve (iSLN). The iSLN initiates the pharyngeal swallow, and a more sensitive iSLN should more readily elicit swallowing and improve swallow safety. We explored the neurophysiological mechanism by which capsaicin improves swallow performance using an infant pig model with a unilateral iSLN lesion. Using high-speed videofluoroscopy, we collected oropharyngeal kinematic data while pigs suckled on bottles, before and after applying capsaicin to the posterior tongue and valleculae. We found that capsaicin application decreased maximal bolus sizes, which improved swallow safety. Furthermore, capsaicin improved performance when infant pigs swallowed more moderately sized boluses. However, capsaicin did not change swallow frequency, the number of sucks prior to each swallow, nor total pharyngeal transit time (TPT). Similarly, excursions of the hyoid, thyroid, and posterior tongue were unchanged. TPT and hyoid and thyroid excursions maintained relationships with bolus size post-capsaicin, suggesting that these variables are less sensitive to sensory intervention. The timing and extent of posterior tongue movement were only correlated with bolus size pre-capsaicin, which could imply that capsaicin fundamentally changes in relationships between tongue movements and bolus size. Our results provide insight into the neural control of swallowing and capsaicin's mechanism of action, and suggest that capsaicin may be beneficial in treating acute infant dysphagia.
Collapse
Affiliation(s)
- Chloe E Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States
| | - Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States
| |
Collapse
|
17
|
Hossain MZ, Ando H, Unno S, Kitagawa J. TRPA1s act as chemosensors but not as cold sensors or mechanosensors to trigger the swallowing reflex in rats. Sci Rep 2022; 12:3431. [PMID: 35236901 DOI: 10.1038/s41598-022-07400-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/17/2022] [Indexed: 12/19/2022] Open
Abstract
We examined the role of TRPA1s in triggering the swallowing reflex. TRPA1s predominantly localized on thin nerve fibers and fibroblast-like cells in swallowing-related regions and on small to medium-sized superior laryngeal nerve-afferents in the nodose–petrosal–jugular ganglionic complex. Topical application of a TRPA1 agonist, allyl isothiocyanate (AITC), dose-dependently triggered swallowing reflexes. Prior topical application of a TRPA1 antagonist significantly attenuated the AITC-induced reflexes. Application of cold AITC (4 °C) very briefly reduced the on-site temperature to < 17 °C (temperature at which TRPA1s can be activated), but had no effect on triggering of the reflex. By contrast, reducing the on-site temperature to < 17 °C for a longer time by continuous flow of cold AITC or by application of iced AITC paradoxically delayed/prevented the triggering of AITC-induced reflexes. Prior application of the TRPA1 antagonist had no effect on the threshold for the punctate mechanical stimuli-induced reflex or the number of low-force or high-force continuous mechanical pressure stimuli-induced reflexes. TRPA1s are functional and act as chemosensors, but not as cold sensors or mechanosensors, for triggering of the swallowing reflex. A brief cold stimulus has no effect on triggering of the reflex. However, a longer cold stimulus delays/prevents triggering of the reflex because of cold anesthesia.
Collapse
|
18
|
Pekacka-Egli AM, Herrmann J, Spielmanns M, Goerg A, Schulz K, Zenker E, Windisch W, Kulnik ST. Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report. Geriatrics (Basel) 2022; 7:geriatrics7020027. [PMID: 35314599 PMCID: PMC8938770 DOI: 10.3390/geriatrics7020027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.
Collapse
Affiliation(s)
- Anna Maria Pekacka-Egli
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Correspondence: ; Tel.: +41-55-256-69-70
| | - Jana Herrmann
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Marc Spielmanns
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
| | - Arthur Goerg
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Katharina Schulz
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Eveline Zenker
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Wolfram Windisch
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St. George’s University of London, London SW17 0RE, UK;
| |
Collapse
|
19
|
Amaya PA, Maria L, Anna S, Rosa P, Helena B, Lluis V. Differences in the use of food textures in oropharyngeal dysphagia according to the place of living. Clin Nutr ESPEN 2022; 48:196-201. [DOI: 10.1016/j.clnesp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
|
20
|
Inamoto Y, Kaneoka A. Swallowing Disorders in the Elderly. Curr Phys Med Rehabil Rep 2022. [DOI: 10.1007/s40141-021-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
| |
Collapse
|
22
|
Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
Collapse
Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
| |
Collapse
|
23
|
Shapira-Galitz Y, Levy A, Madgar O, Shpunt D, Zhang Y, Wang B, Wolf M, Drendel M. Effects of carbonation of liquids on penetration-aspiration and residue management. Eur Arch Otorhinolaryngol 2021; 278:4871-4881. [PMID: 34292401 PMCID: PMC8297430 DOI: 10.1007/s00405-021-06987-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/23/2022]
Abstract
Objective Carbonation as a sensory enhancement strategy for prevention of aspiration of thin liquids has not been thoroughly studied. The aim of our study was to examine the effect of carbonation on penetration–aspiration and pharyngeal residue in dysphagia patients using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) and to identify parameters associated with a response to carbonation. Methods A cross-sectional study of patients undergoing FEES in a dysphagia clinic. Patients were offered 100 cc of dyed water. Penetration–aspiration was scored using the penetration–aspiration scale (PAS). Residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Patients with a PAS ≥ 2 for water were subsequently offered 100 cc of carbonated water. PAS, YPR-SRS and residue clearance were compared between thin and carbonated liquids. Multivariate logistic regression analysis was used to identify predictors for good response to carbonation. Results 84 patients were enrolled, 77.4% males, with diverse dysphagia etiologies (58.3% neurogenic, 11.9% radiation-induced, 23.8% deconditioning-induced, and 6% neck surgery induced). Median PAS was 7 (IQR 4–8) for thin liquids and 4.5 (IQR 2–8) for carbonated liquids (P = 0.0001). YPR-SRS was reduced for carbonated compared to thin liquids in the vallecula (1.58 ± 0.83 vs 1.76 ± 0.93, P = 0.001) and piriform sinuses (1.5 ± 0.87 vs 1.67 ± 0.9, P = 0.002). 31 patients had improvement in PAS with carbonation. Deconditioning as a dysphagia etiology was found to predict good response to carbonation on multivariate logistic regression analysis. Conclusion Carbonation may prevent aspiration and improve residue management for some patients with dysphagia for liquids. Level of evidence IV.
Collapse
Affiliation(s)
- Yael Shapira-Galitz
- Otolaryngology-Head and Neck Surgery Department, Kaplan Medical Center, #1 Pasternak St., Rehovot, Israel. .,Hadassah School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Audrey Levy
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ory Madgar
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dina Shpunt
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yan Zhang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Binhuan Wang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael Wolf
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Drendel
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
Collapse
Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
25
|
Suntrup-Krueger S, Muhle P, Kampe I, Egidi P, Ruck T, Lenze F, Jungheim M, Gminski R, Labeit B, Claus I, Warnecke T, Gross J, Dziewas R. Effect of Capsaicinoids on Neurophysiological, Biochemical, and Mechanical Parameters of Swallowing Function. Neurotherapeutics 2021; 18:1360-1370. [PMID: 33449304 PMCID: PMC8423940 DOI: 10.1007/s13311-020-00996-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/25/2023] Open
Abstract
Oropharyngeal dysphagia is prevalent in age-related neurological disorders presenting with impaired efficacy and safety of swallowing due to a loss of muscle force and sensory deficits. Stimulating the oropharynx with capsaicin that mediates Substance P release is an emerging pharmacological treatment option which needs further scientific evidence. Our aim was to comprehensively evaluate the effect of capsaicin on biochemical, neurophysiological, and biomechanical parameters of swallowing function. In a randomized study on healthy individuals, the impact of orally administered capsaicinoids at different dosages and application durations in comparison to non-carbonated water was evaluated. Time course and magnitude of salivary Substance P increase were monitored. Magnetoencephalography was used to detect cortical swallowing network alterations. Modifications in swallowing biomechanics were measured applying high-resolution pharyngeal manometry. Capsaicinoids at 10 μmol/L improved swallowing efficacy as seen by a significant increase of pharyngeal contractile integral and upper esophageal sphincter activation and relaxation times in manometry. Significant improvement of precision in a challenging swallow task accompanied by a reduction in swallowing-related submental electromyographic power was observed with capsaicinoids preconditioning at 10 μmol/L over 5 min, but not with continuous stimulation. The cortical activation pattern remained unchanged after any intervention. A significant increase of salivary Substance P was not detected with 10 μmol/L but with 50 μmol/L and lasted for 15 min after application. Capsaicinoids mediate dose-dependent Substance P release and positively alter swallowing biomechanics in healthy subjects. The results provide supportive evidence for the value of natural capsaicinoids to improve swallowing function.
Collapse
Affiliation(s)
- Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Isabella Kampe
- Pediatrics Department, St. Franziskus-Hospital Ahlen, Robert-Koch-Straße 55, 59227, Ahlen, Germany
| | - Paula Egidi
- Department of Anesthesiology and Intensive Care Medicine, Clemenshospital Münster, Duesbergweg 124, 48153, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Frank Lenze
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Richard Gminski
- Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Bendix Labeit
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| |
Collapse
|
26
|
Zhang Q, Wu S. Effects of Synchronized Neuromuscular Electrical Stimulation (NMES) on the Submental Muscles During Ingestion of a Specified Volume of Soft Food in Patients with Mild-to-Moderate Dysphagia Following Stroke. Med Sci Monit 2021; 27:e928988. [PMID: 33780432 PMCID: PMC8018178 DOI: 10.12659/msm.928988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is a method for producing regular contractions of muscles that have been paralyzed. This study aimed to evaluate the effects of synchronized NMES on the submental muscles during ingestion of a specified volume of soft food in patients with mild-to-moderate dysphagia following stroke. Material/Methods Eighty-three patients with mild-to-moderate dysphagia following stroke were enrolled and randomly divided into 3 groups: conventional training (CT) (n=28), eating training (ET) (n=28), and intensive swallowing training (IST) (n=27). The CT group received conventional swallow training, the ET group was given additional individual feedings with a specified volume of soft food, and the IST group received intensive swallowing training with synchronized NEMS. All of the patients were evaluated before and after the treatment with a modified barium swallow, and the Dysphagia Outcome and Severity Scale (DOSS); the numbers of patients with Stroke-Associated Pneumonia (SAP) and wet voice also were assessed. Results After 6 weeks, DOSS scores improved in patients in all 3 groups, and there were significant differences among the groups in their scores (P<0.001 for both measures). In the CT and ET groups, there was a statistically significant difference in the number of patients with SAP before and after treatment (P=0.010 and P<0.001, respectively). There also were fewer cases in the IST group than in the CT (P=0.042) and ET groups (P=0.011). After completion of treatment, compared with the first treatment, there were significantly fewer patients with wet voices in the CT (P<0.001) and IST groups (P<0.001). Conclusions Feeding a specified volume of soft food plus synchronized NMES of the submental muscles can improve the swallowing function of patients with mild-to-moderate dysphagia following stroke and it reduces their risk of food aspiration.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
| | - Shuang Wu
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
| |
Collapse
|
27
|
Tomsen N, Ortega O, Nascimento W, Carrión S, Clavé P. Oropharyngeal Dysphagia in Older People is Associated with Reduced Pharyngeal Sensitivity and Low Substance P and CGRP Concentration in Saliva. Dysphagia 2021; 37:48-57. [PMID: 33710390 DOI: 10.1007/s00455-021-10248-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
Substance P (SP) and Calcitonine gene-related peptide (CGRP) are released by sensory nerve fibers in the oropharynx. Patients with oropharyngeal dysphagia (OD) present reduced oropharyngeal sensitivity and low SP concentration in saliva. We aimed to assess the concentration of salivary SP and CGRP in healthy volunteers, and older people without and with OD, and the relationship with pharyngeal sensory threshold. We included 15 healthy volunteers, 14 healthy elderly and 14 elderly with OD. Swallow function was assessed by videofluoroscopy (VFS). Pharyngeal sensory threshold was assessed by intrapharyngeal electrical stimulation. Hydration and phase angle were assessed by bioimpedance. Saliva samples were collected with a Salivette® to determine SP and CGRP concentration by ELISA. Elderly patients with OD presented impaired safety of swallow (PAS 4.38 ± 0.77 p < 0.0001 vs. healthy volunteers = 1 and healthy elderly = 1.43 ± 0.51). Healthy elderly and elderly with OD presented a reduction in intracellular water and saliva volume (healthy elderly, 592.86 ± 327.79 μl, p = 0.0004; elderly with OD, 422.00 ± 343.01 μl, p = 0.0001 vs healthy volunteers, 1333.33 ± 615.91 μl, r = 0.6621, p < 0.0001). Elderly patients with OD presented an impairment in pharyngeal sensory threshold (10.80 ± 3.92 mA vs. healthy volunteers, 5.74 ± 2.57 mA; p = 0.007) and a reduction in salivary SP (129.34 pg/ml vs. healthy volunteers: 173.89 pg/ml; p = 0.2346) and CGRP levels (24.17 pg/ml vs. healthy volunteers: 508.18 pg/ml; p = 0.0058). There was a negative correlation between both SP and CGRP concentrations and pharyngeal sensory threshold (r = - 0.450, p = 0.024; r = - 0.4597, p = 0.036, respectively), but only SP identified elderly patients with OD with higher pharyngeal sensory threshold. Elderly patients with OD presented hydropenia and sarcopenia, reduced salivary SP and CGRP and impaired pharyngeal sensitivity. Our study suggests SP levels in saliva as a potential biomarker to monitor pharyngeal sensitivity in elderly patients with OD.
Collapse
Affiliation(s)
- Noemí Tomsen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain
- Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, Carretera de Cirera s/n 08304, Mataró, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Omar Ortega
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain
- Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, Carretera de Cirera s/n 08304, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, Carretera de Cirera s/n 08304, Mataró, Spain
| | - Silvia Carrión
- Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, Carretera de Cirera s/n 08304, Mataró, Spain
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.
- Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, Carretera de Cirera s/n 08304, Mataró, Spain.
| |
Collapse
|
28
|
Nascimento W, Tomsen N, Acedo S, Campos-Alcantara C, Cabib C, Alvarez-Larruy M, Clavé P. Effect of Aging, Gender and Sensory Stimulation of TRPV1 Receptors with Capsaicin on Spontaneous Swallowing Frequency in Patients with Oropharyngeal Dysphagia: A Proof-of-Concept Study. Diagnostics (Basel) 2021; 11:461. [PMID: 33799960 DOI: 10.3390/diagnostics11030461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) divided into three groups: GI-18-39 yr, GII-40-59 yr, and GIII->60 yr. OD was assessed by the Volume-Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10-5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min; p = 0.0385) and GIII (0.50 ± 0.31 swallows/min; p < 0.0001) compared to GI (1.03 ± 0.62 swallows/min), and there was a moderate significant correlation between age and SFF (r = -0.3810; p < 0.0001). No effect of gender on SSF was observed. Capsaicin caused a strong and significant increase in SSF after the TRPV1 stimulation when comparing to basal condition (pre-capsaicin: 0.41 ± 0.32 swallows/min vs post-capsaicin: 0.81 ± 0.51 swallow/min; p = 0.0003). OD in patients with post-stroke OD and acute stimulation with TRPV1 agonists caused a significant increase in SSF, further suggesting the potential role of pharmacological stimulation of sensory pathways as a therapeutic strategy for CPG activation in patients with OD.
Collapse
|
29
|
Abstract
Recent events bring the importance of respiratory health to the forefront of our collective attention. In this issue of Cell, a new study by Prescott and Umans et al. reveals how a dedicated laryngeal sensory motor reflex circuit protects our airways from aspirated foods or liquids.
Collapse
Affiliation(s)
- Yalda Moayedi
- Department of Physiology and Cellular Biophysics, Columbia University Medical Center, 1150 Saint Nicholas Ave, New York, NY 10032; Thompson Family Foundation Initiative at CUMC, New York, NY, USA
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 180 Fort Washington Ave, New York, NY 10032
| | - Joriene C de Nooij
- Department of Neurology, Columbia University Medical Center, 630 West 168(th) Street, New York, NY 10032; Columbia University Motor Neuron Center, Columbia University Medical Center, 650 West 168(th) Street, New York, NY 10032; Thompson Family Foundation Initiative at CUMC, New York, NY, USA.
| |
Collapse
|
30
|
Tsuji K, Tsujimura T, Sakai S, Suzuki T, Yoshihara M, Nagoya K, Magara J, Satoh Y, Inoue M. Involvement of capsaicin-sensitive nerves in the initiation of swallowing evoked by carbonated water in anesthetized rats. Am J Physiol Gastrointest Liver Physiol 2020; 319:G564-G572. [PMID: 32878469 DOI: 10.1152/ajpgi.00233.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Capsaicin powerfully evokes the swallowing reflex and is a known therapeutic agent for improving dysphagia and preventing aspiration pneumonia. However, the role of capsaicin-sensitive nerves in the initiation of swallowing evoked by various natural stimuli remains unclear. To explore this question, we blocked laryngeal capsaicin-sensitive nerves following the coapplication of QX-314 and capsaicin (QX/Cap), and investigated the effects on swallowing evoked by mechanical and chemical stimulation in anesthetized rats. Swallows were evoked by capsaicin, carbonated water (CW), distilled water (DW), and punctate mechanical stimulation using von Frey filaments applied topically to the larynx. Swallows were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles. The initiation of swallowing by capsaicin was strongly suppressed at 5 min following QX/Cap treatment and returned in a time-dependent manner. CW-evoked swallows at 5 min following QX/Cap treatment were significantly diminished compared with before and 30 min after treatment. In contrast, DW-evoked and mechanically evoked swallows were unchanged by QX/Cap treatment. Furthermore, CW-evoked swallows were virtually abolished by transection of the superior laryngeal nerves and significantly decreased by the topical application of acid-sensing ion channel-3 (ASIC3) inhibitor APETx2, but they were not affected by the nonselective transient receptor potential channel inhibitor ruthenium red or the ASIC1 inhibitor mambalgin-1. Taken together, we speculate that capsaicin-sensitive nerves play an important role in the initiation of CW-evoked swallows.NEW & NOTEWORTHY The initiation of swallowing evoked by laryngeal capsaicin and carbonated water application was diminished by the coapplication of QX-314 and capsaicin. Carbonated water-evoked swallows were also abolished by transection of the superior laryngeal nerves and were inhibited by the acid-sensing ion channel-3 inhibitor. Capsaicin-sensitive nerves are involved in the initiation of carbonated water-evoked swallows.
Collapse
Affiliation(s)
- Kojun Tsuji
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan.,Department of Physiology, The Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Shogo Sakai
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Kouta Nagoya
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Yoshihide Satoh
- Department of Physiology, The Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| |
Collapse
|
31
|
Nakato R, Manabe N, Hanayama K, Kusunoki H, Hata J, Haruma K. Diagnosis and treatments for oropharyngeal dysphagia: effects of capsaicin evaluated by newly developed ultrasonographic method. J Smooth Muscle Res 2020; 56:46-57. [PMID: 32581185 PMCID: PMC7324726 DOI: 10.1540/jsmr.56.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Rui Nakato
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroaki Kusunoki
- Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
32
|
Cabib C, Nascimento W, Rofes L, Arreola V, Tomsen N, Mundet L, Palomeras E, Michou E, Clavé P, Ortega O. Short-term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2020; 32:e13887. [PMID: 32449296 DOI: 10.1111/nmo.13887] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurorehabilitation strategies for chronic poststroke (PS) oropharyngeal dysphagia (OD) have been mainly focused on the neurostimulation of the pharyngeal motor cortex with only marginal effects. In contrast, treatments targeting the PS oropharyngeal sensory pathway dysfunction offer very promising results, but there is little knowledge on the underlying mechanisms. We aimed to explore the neurophysiological mechanisms behind the effect of three sensory neurostimulation strategies. METHODS We carried out a randomized two-blinded parallel group's crossover sham-controlled clinical trial in 36 patients with unilateral stroke and chronic unsafe swallow to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) of the primary sensory cortex (A), oral capsaicin (B) and intra-pharyngeal electrical stimulation (IPES; C). The effect was evaluated immediately after the interventions with videofluoroscopy (VFS) and motor/sensory evoked potentials (MEP/SEP). KEY RESULTS Interventions induced no changes in the biomechanics of the swallow response during VFS. However, an enhancement of motor cortex excitability (latency shortening and increased size of thenar MEP) was found with active interventions (A + B + C, and B/C alone; P < .05 for all) but not with sham. Active but not sham interventions shortened pharyngeal SEP latency in the ipsilesional hemisphere (A + B + C: P2-peak, P = .039; A: N2-peak, P = .034) and antagonized the physiological habituation in pharyngeal MEP (A + B + C and A alone, P < .05 for both). CONCLUSIONS AND INFERENCES Sensory pathway neurostimulation strategies caused immediate enhancement of motor cortex excitability with peripheral strategies (capsaicin and IPES) and of pharyngeal sensory conduction with rTMS. These changes support the use of sensory neurorehabilitation strategies in promoting swallow recovery in chronic PS-OD.
Collapse
Affiliation(s)
- Christopher Cabib
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ernest Palomeras
- Neurology Department, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Emilia Michou
- Technological Educational Institute Western Greece, Patras, Greece
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
33
|
Kittipanya-Ngam P, Benjapornlert P, Rattanakanokchai S, Wattanapan P. Effect of TRP-Stimulating Compounds to Reduce Swallowing Response Time in the Elderly: A Systematic Review. Dysphagia 2020; 36:614-622. [PMID: 32869155 DOI: 10.1007/s00455-020-10175-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
There is still controversy on evidence supporting compounds that stimulate the transient receptor potential cation channel (TRP) receptor, which can reduce the latency of swallowing reflex. This systematic review aims to evaluate the effectiveness of TRP-stimulating compounds to reduce swallowing reflex time in the elderly. We searched the following databases: PubMed, EMBASE, OVID, Central, Scopus, ISI, CINALH, LILACS, CRD database, and Open grey until June 1st, 2019. We included randomized controlled trials (RCTs) which compared swallowing time between TRP-stimulating compounds and placebo or no treatment in population aged more than 60 years old. We assessed bias using the Cochrane risk of bias tool. Three authors independently screened and selected studies. Quality assessment and data extraction were performed by two authors independently. Of 363 reviews, we included four RCTs. Two RCTs used black pepper, one RCT used capsaicinoids, and the other one used capsaicin ointment to stimulate the TRPV1 receptor. All of the studies were assessed at unclear bias except the study, which used capsaicin ointment with assessed as low risk of bias. Meta-analysis could not be done in this study due to the different baseline characteristics and definition of swallowing reflex time. This review demonstrates the potential effect of TRPV1-stimulating compounds to reduce swallowing response time in the elderly were remains unclear. Most studies had an unclear bias. Further larger and well-designed RCTs are needed to draw robust conclusions.
Collapse
Affiliation(s)
- Pajeemas Kittipanya-Ngam
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd., Nai Mueang, Mueang Khon Kaen District, Khon Kaen, 40000, Thailand
| | - Paitoon Benjapornlert
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
| | - Siwanon Rattanakanokchai
- Faculty of Public Health, Khon Kaen University, 123 Mittraphap Rd., Nai Mueang, Mueang Khon Kaen District, Khon Kaen, 40000, Thailand
| | - Pattra Wattanapan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd., Nai Mueang, Mueang Khon Kaen District, Khon Kaen, 40000, Thailand
| |
Collapse
|
34
|
Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
Collapse
Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| |
Collapse
|
35
|
Wierenga MR, Crawford CR, Running CA. Older US adults like sweetened colas, but not other chemesthetic beverages. J Texture Stud 2020; 51:722-732. [PMID: 32594514 DOI: 10.1111/jtxs.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
Many older adults suffer from difficulty swallowing thin beverages like water or coffee. To improve swallowing safety, beverages are typically thickened. This creates a new problem: the thickened beverages can be disgusting. New research suggests chemesthesis, particularly spiciness, carbonation, or intense sourness, could improve swallowing without the need for thickeners. Yet, whether such beverages would be liked by older adults is unknown. We thus conducted this experiment to establish older adults' sensory perception and liking/disliking of commercially available chemesthetic beverages. We recruited participants to rate sweetness, sourness, fizziness, stinging, and liking/disliking of unsweetened carbonated waters (1 plain, 5 flavored), sour orange juice, spicy ginger beer, and colas (sugar or aspartame-sweetened). Initial tests (N = 30 older adults) indicated sour orange juice, spicy ginger beer, and two of the flavored waters were not well-liked, so other beverages were selected for a second test (N = 94, 30 younger adults, 64 older adults). Sweetened, carbonated colas were the best-liked of the beverages. The unsweetened, flavored carbonated waters were in general not liked. Regarding comparisons of sensory ratings between older and younger adults, only sweetness differed between age groups. In particular, intensity ratings for the chemesthetic aspects of the beverages (stinging/burning/spiciness, fizziness) and the sour taste did not differ by age. As the chemesthetic properties are the most likely reason the beverages could aid in swallowing safety, observing no suppression of these sensations in older adults is encouraging for the potential of these products as a treatment option.
Collapse
Affiliation(s)
- Madison R Wierenga
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Ciera R Crawford
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Cordelia A Running
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
36
|
Tomsen N, Alvarez-Berdugo D, Rofes L, Ortega O, Arreola V, Nascimento W, Martin A, Cabib C, Bolivar-Prados M, Mundet L, Legrand C, Clavé P, Michlig S. A randomized clinical trial on the acute therapeutic effect of TRPA1 and TRPM8 agonists in patients with oropharyngeal dysphagia. Neurogastroenterol Motil 2020; 32:e13821. [PMID: 32064725 DOI: 10.1111/nmo.13821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) treatment is moving away from compensatory strategies toward active treatments that improve swallowing function. The aim of this study was to assess the acute therapeutic effect of TRPA1/M8 agonists in improving swallowing function in OD patients. METHODS Fifty-eight patients with OD caused by aging, stroke, or neurodegenerative disease were included in a three-arm, quadruple-blind, randomized clinical trial (NCT02193438). Swallowing safety and efficacy and the kinematics of the swallow response were assessed by videofluoroscopy (VFS) during the swallow of 182 ± 2 mPa·s viscosity (nectar) boluses of a xanthan gum thickener supplemented with (a) 756.6 μmol/L cinnamaldehyde and 70 μmol/L zinc (CIN-Zn) (TRPA1 agonists), (b) 1.6 mmol/L citral (CIT) (TRPA1 agonist), or (c) 1.6 mmol/L citral and 1.3 mmol/L isopulegol (CIT-ISO) (TRPA1 and TRPM8 agonists). The effects on pharyngeal event-related potentials (ERP) were assessed by electroencephalography. KEY RESULTS TRPA1 stimulation with either CIN-Zn or CIT reduced time to laryngeal vestibule closure (CIN-Zn P = .002, CIT P = .023) and upper esophageal sphincter opening (CIN-Zn P = .007, CIT P = .035). In addition, CIN-Zn reduced the penetration-aspiration scale score (P = .009), increased the prevalence of safe swallows (P = .041), and reduced the latency of the P2 peak of the ERP. CIT-ISO had no positive effect on biomechanics or neurophysiology. No significant adverse events were observed. CONCLUSIONS AND INFERENCES TRPA1 stimulation with CIN-Zn or CIT improves the swallow response which, in the case of CIN-Zn, is associated with a significant improvement in cortical activation and safety of swallow. These results provide the basis for the development of new active treatments for OD using TRPA1 agonists.
Collapse
Affiliation(s)
- Noemí Tomsen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.,Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Alvarez-Berdugo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Omar Ortega
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Viridiana Arreola
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Alberto Martin
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Christopher Cabib
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Mireia Bolivar-Prados
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Lluís Mundet
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | | | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | | |
Collapse
|
37
|
|
38
|
Hossain MZ, Ando H, Unno S, Nakamoto T, Kitagawa J. Functional involvement of acid-sensing ion channel 3 in the swallowing reflex in rats. Neurogastroenterol Motil 2020; 32:e13728. [PMID: 31565832 DOI: 10.1111/nmo.13728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Difficulty swallowing represents a major health problem. Swallowing function is improved by incorporating weak acids in suspensions/food boluses, implicating acid-sensing ion channels (ASICs) in the swallowing reflex. However, the functional involvement of ASICs in the swallowing reflex has not been fully elucidated. METHODS We localized ASIC3s in swallowing-related regions innervated by the superior laryngeal nerves (SLNs) and those in the nodose-petrosal-jugular ganglionic complex (NPJc) and examined their functional involvement in evoking the swallowing reflex in rats. KEY RESULTS We localized ASIC3s on epithelial cells and nerve fibers in swallowing-related regions innervated by the SLNs. In the NPJc, around half of the SLN-afferent neurons expressed ASIC3. Two-thirds of ASIC3s were localized on unmyelinated neurons in the nodose and petrosal ganglia. In the jugular ganglia, they were equally distributed on unmyelinated and myelinated neurons. Topical application of a synthetic non-proton ASIC3 activator, 2-guanidine-4-methylquinazoline (GMQ), and its natural endogenous ligand agmatine (a metabolite of the amino acid arginine) in swallowing-related regions evoked a considerable number of swallowing reflexes. Increasing the concentration of GMQ and agmatine up to a certain concentration increased the number of evoked reflexes and shortened the interval between the evoked reflexes. Agmatine was less potent than GMQ in its ability to evoke swallowing reflexes. Prior topical application of an ASIC3 antagonist significantly attenuated the number of GMQ- and agmatine-evoked swallowing reflexes. CONCLUSIONS & INFERENCES Acid-sensing ion channel 3s localized on nerves and epithelial cells in swallowing-related regions are functional in evoking the swallowing reflex and activation of these channels via a pharmacological agonist appears to improve swallowing behavior.
Collapse
Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Hiroshi Ando
- Department of Biology, Institute for Oral Science, Matsumoto Dental University, Shiojiri, Japan
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Tetsuji Nakamoto
- Division of Oral Pathogenesis and Disease Control, Department of Oral Implantology, Asahi University School of Dentistry, Mizuho, Japan
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| |
Collapse
|
39
|
Wang Z, Wu L, Fang Q, Shen M, Zhang L, Liu X. Effects of capsaicin on swallowing function in stroke patients with dysphagia: A randomized controlled trial. J Stroke Cerebrovasc Dis 2019; 28:1744-1751. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/05/2019] [Accepted: 02/11/2019] [Indexed: 12/19/2022] Open
|
40
|
Turkington L, Ward EC, Farrell A, Porter L, Wall LR. Impact of carbonation on neurogenic dysphagia and an exploration of the clinical predictors of a response to carbonation. Int J Lang Commun Disord 2019; 54:499-513. [PMID: 30729616 DOI: 10.1111/1460-6984.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The need for effective compensatory strategies in neurogenic dysphagia management has led to the exploration of sensory enhancement strategies (SES), such as carbonated liquids. Despite some positive findings, evidence related to the efficacy of carbonation as an SES is limited. AIMS To determine if carbonated thin liquids reduced dysphagia symptoms and to explore clinical factors associated with response to carbonation. METHODS & PROCEDURES Participants (n = 29) with neurogenic dysphagia demonstrating deep penetration or aspiration on thin liquids during videofluoroscopic swallow studies (VFSS) completed a set protocol: discrete sips of non-carbonated thin fluids (DS-NC) followed by discrete sips of carbonated thin fluids (DS-C) and then consecutive sips of carbonated fluids (CS-C). The impact of carbonation was identified through changes to swallow physiology (videofluoroscopy dysphagia scale-VDS) and depth of airway compromise (penetration-aspiration scale-PAS). Demographic variables including genetic taste type, cranial nerve function and key results from the VDS were examined for association with carbonation response using both individual parameter analysis and exploratory cluster analysis. OUTCOMES & RESULTS Significant (p < 0.05) improvements in PAS scores were noted in DS-C and CS-C conditions compared with DS-NC. Total VDS score was also significantly (p < 0.05) reduced (i.e., improved function) in the DS-NC condition. Individual variability in response to carbonation was noted and no clear clinical factors associated with carbonation response in the current set of parameters were identified. CONCLUSION & IMPLICATIONS Findings support that carbonated thin fluids sometimes result in neurogenic dysphagia symptom reduction. However, identifying the clinical characteristics of patients who may benefit from trials of carbonation needs further investigation.
Collapse
Affiliation(s)
- Leisa Turkington
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, Brisbane, QLD, Australia
| | - Anna Farrell
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
| | - Linda Porter
- Medical Imaging Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
| | - Laurelie R Wall
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, Brisbane, QLD, Australia
| |
Collapse
|
41
|
Tomsen N, Ortega O, Rofes L, Arreola V, Martin A, Mundet L, Clavé P. Acute and subacute effects of oropharyngeal sensory stimulation with TRPV1 agonists in older patients with oropharyngeal dysphagia: a biomechanical and neurophysiological randomized pilot study. Therap Adv Gastroenterol 2019; 12:1756284819842043. [PMID: 31068978 PMCID: PMC6492367 DOI: 10.1177/1756284819842043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/12/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Older people with oropharyngeal dysphagia (OD) present a decline in pharyngeal sensory function. The aim of this proof-of-concept study was to assess the biomechanical and neurophysiological effects of acute and subacute oropharyngeal sensory stimulation with transient receptor potential vanilloid 1 (TRPV1) agonists (capsaicinoids) in older patients with OD. METHODS We studied the effect of a single dose versus multiple doses (2 weeks) of oral capsaicin treatment (10-5 M) or placebo in 28 older patients with OD (81.2 ± 4.6 years) using videofluoroscopy (penetration-aspiration scale [PAS], timing of swallow response) and electroencephalography (EEG) (latency and amplitude of pharyngeal event-related potential [ERP]). RESULTS Acute stimulation by capsaicinoids 10-5 M did not improve swallow function and did not produce significant changes in pharyngeal ERP. In contrast, after 10 days of treatment, patients presented a clinically relevant and statistically significant reduction in the laryngeal vestibule closure (LVC) time (22.5%, p = 0.042), and in the PAS (24.2%, p = 0.038), compared with the placebo group. EEG results showed a reduction in the latency of the N1 peak (28.6%, p = 0.007) and an increase of the amplitude of the P1-N2 (59.4%, p = 0.038) and the N2-P2 (43.6%, p = 0.050) peaks. We observed a strong and significant correlation between the reduction in the latency of the N1 peak and change in LVC time after subacute treatment (r = 0.750, p = 0.003). CONCLUSIONS After 2 weeks of treatment, oropharyngeal sensory stimulation with capsaicinoids induced cortical changes that were correlated with improvements in swallowing biomechanics in older patients with OD. These results further show that sensory stimulation by TRPV1 agonists can become a useful pharmacological treatment for older patients with OD.
Collapse
Affiliation(s)
- Noemí Tomsen
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Omar Ortega
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Viridiana Arreola
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
| | - Alberto Martin
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
| | - Lluís Mundet
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
| | | |
Collapse
|
42
|
Furkim AM, da Silva RG, Vanin G, Martino R. The association between temporal measures of swallowing with penetration and aspiration in patients with dysphagia: A meta-analysis. NeuroRehabilitation 2019; 44:111-129. [PMID: 30776021 DOI: 10.3233/nre-182553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Temporal features of swallowing physiology vary with age in healthy normals and have the potential to impact swallow safety and efficiency in patients with dysphagia. We conducted a meta-analysis to assess the relation between temporal features of swallowing with penetration, aspiration and residue in adult patients with dysphagia regardless of etiology. METHODS Operational definitions of relevant terms were defined a priori. A search of 5 databases was conducted to November 2016 without restriction to language. Two independent raters reviewed abstracts and full articles, with discrepancies resolved by consensus. All accepted articles advanced to data extraction and critical appraisal according to Cochrane standards. Analysis of pooled data compared measures between groups. RESULTS Of the 11 articles accepted, the temporal measures used in three or more studies were grouped into morphofunctional categories: bolus transit time; pharyngeal response time; laryngeal closure time; and upper esophageal opening time. Across all selected articles, definitions varied for abnormal swallow and only 4 articles reported rater blinding and reliability for measures related to timing. Pooled data identified two main findings: a. longer pharyngeal response time was associated with penetration and/or aspiration (MD = 0.40 95% CI 0.59 - 0.22), and longer upper esophageal opening duration was associated with only aspiration (PAS ≥ 6) (MD = 0.09 95% CI 0.16 - 0,02). No studies were found that related temporal measures and residue. CONCLUSION Our pooled findings identified an association of two temporal measures with penetration and/or aspiration but none with residue. The current evidence remains limited due to the heterogeneity across studies in how swallow measures were operationalized. Future work with a standardized and reproducible approach is direly needed.
Collapse
Affiliation(s)
- Ana Maria Furkim
- Department of Speech-Language Pathology, University of Toronto, Canada.,Department of Speech-Language Pathology and Hearing Sciences, Federal University of Santa Catarina, Brazil
| | - Roberta Gonçalves da Silva
- Department of Speech-Language Pathology and Hearing Sciences, São Paulo State University-UNESP at Marília, Brazil
| | - Gabriela Vanin
- Swallowing Lab, University of Toronto, University Health Network, Canada
| | - Rosemary Martino
- Swallowing Lab, University of Toronto, University Health Network, Canada.,Department of Speech-Language Pathology, Rehabilitation Sciences Institute, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Affiliate Scientist, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
43
|
Santoso LF, Kim DY, Paydarfar D. Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder. Head Neck 2019; 41:E71-E78. [PMID: 30620442 DOI: 10.1002/hed.25588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/14/2018] [Accepted: 12/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed "sensory dysphagia" and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. METHODS AND RESULTS Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune-mediated neuronopathy, and nerve damage from prior traumatic intubation. CONCLUSIONS Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.
Collapse
Affiliation(s)
- Laura F Santoso
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Daniel Y Kim
- Department of Otolaryngology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David Paydarfar
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Neurology, Dell Medical School at University of Texas at Austin, Austin, Texas
| |
Collapse
|
44
|
Hossain MZ, Ando H, Unno S, Masuda Y, Kitagawa J. Activation of TRPV1 and TRPM8 Channels in the Larynx and Associated Laryngopharyngeal Regions Facilitates the Swallowing Reflex. Int J Mol Sci 2018; 19:E4113. [PMID: 30567389 DOI: 10.3390/ijms19124113] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/06/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022] Open
Abstract
The larynx and associated laryngopharyngeal regions are innervated by the superior laryngeal nerve (SLN) and are highly reflexogenic. Transient receptor potential (TRP) channels have recently been detected in SLN innervated regions; however, their involvement in the swallowing reflex has not been fully elucidated. Here, we explore the contribution of two TRP channels, TRPV1 and TRPM8, located in SLN-innervated regions to the swallowing reflex. Immunohistochemistry identified TRPV1 and TRPM8 on cell bodies of SLN afferents located in the nodose-petrosal-jugular ganglionic complex. The majority of TRPV1 and TRPM8 immunoreactivity was located on unmyelinated neurons. Topical application of different concentrations of TRPV1 and TRPM8 agonists modulated SLN activity. Application of the agonists evoked a significantly greater number of swallowing reflexes compared with the number evoked by distilled water. The interval between the reflexes evoked by the agonists was shorter than that produced by distilled water. Prior topical application of respective TRPV1 or TRPM8 antagonists significantly reduced the number of agonist-evoked reflexes. The findings suggest that the activation of TRPV1 and TRPM8 channels present in the swallowing-related regions can facilitate the evoking of swallowing reflex. Targeting the TRP channels could be a potential therapeutic strategy for the management of dysphagia.
Collapse
|
45
|
Schröder JB, Marian T, Muhle P, Claus I, Thomas C, Ruck T, Wiendl H, Warnecke T, Suntrup-Krueger S, Meuth S, Dziewas R. Intubation, tracheostomy, and decannulation in patients with Guillain-Barré-syndrome-does dysphagia matter? Muscle Nerve 2018; 59:194-200. [PMID: 30390307 DOI: 10.1002/mus.26377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/18/2018] [Accepted: 10/28/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Although patients with Guillain-Barré syndrome frequently require orotracheal intubation and tracheostomy, the incidence and relevance of neurogenic dysphagia prior to intubation and risk factors for prolonged requirement for a tracheal cannula have not yet been identified. METHODS Retrospective analysis of the medical records of 88 patients was performed. Clinical characteristics were compared between intubated and nonintubated patients and between immediately decannulated and not immediately decannulated patients. RESULTS Thirty-five (39.7%) patients required tracheostomy. Neuromuscular weakness and related respiratory insufficiency were the main reasons for intubation. In the subgroup of tracheotomized patients, immediate decannulation after completed respiratory weaning was possible in 14 (40%) patients. The severity of dysphagia, in particular pharyngolaryngeal hypesthesia, was related to the length of cannulation. DISCUSSION Respiratory muscle weakness is the main reason for intubation, whereas neurogenic dysphagia is the main risk factor for persisting cannulation. Dysphagia after weaning is most frequently characterized by severe laryngeal sensory deficit. Muscle Nerve 59:194-200, 2019.
Collapse
Affiliation(s)
- Jens Burchard Schröder
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Thomas Marian
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Christian Thomas
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Sven Meuth
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| |
Collapse
|
46
|
Alvarez-Berdugo D, Rofes L, Casamitjana JF, Enrique A, Chamizo J, Viña C, Pollán CM, Clavé P. TRPM8, ASIC1, and ASIC3 localization and expression in the human oropharynx. Neurogastroenterol Motil 2018; 30:e13398. [PMID: 29971861 DOI: 10.1111/nmo.13398] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/24/2018] [Indexed: 12/06/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is a prevalent disease with poor prognosis among older people and has no pharmacological treatment. Polymodal sensory receptors like the TRP or ASIC family receptors are potential targets to treat OD. TRPM8 agonists and acidic solutions can improve the swallow response in patients with OD, but little is known about the expression of TRPM8, ASIC1, and ASIC3 in the human oropharynx. The aim of this study was to assess the expression and localization of TRPM8, ASIC1, and ASIC3 in human samples of the oropharynx to lay the basis for new pharmacological treatments for OD. METHODS Pathology-free samples from oropharyngeal regions innervated by cranial nerves V, IX, and X were obtained during major ENT surgery and processed to obtain mRNA (20 patients) or to be used in immunohistochemical assays (12 patients). TRPM8, ASIC1, and ASIC3 expression and localization were studied with RT-qPCR and fluorescent immunohistochemistry. KEY RESULTS ASIC3 was expressed in the 3 regions studied with similar levels and was localized on sensory fibers innervating the mucosa below the basal lamina of all studied regions. TRPM8 was also co-localized on the sensory fibers innervating the mucosa below the basal lamina of all studied regions. In contrast, ASIC1 was only found in the nerves innervating the tongue muscular fibers. CONCLUSIONS & INFERENCES TRPM8 and ASIC3 are found on submucosal sensory nerves in the human oropharynx. Our study lays the basis to use oropharyngeal TRPM8 and ASIC3 receptors as therapeutic targets to develop new active pharmacological treatments for OD patients.
Collapse
Affiliation(s)
- D Alvarez-Berdugo
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain
| | - L Rofes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain
| | - J F Casamitjana
- ENT Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - A Enrique
- ENT Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - J Chamizo
- ENT Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - C Viña
- ENT Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - C M Pollán
- ENT Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - P Clavé
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain.,Fundació Institut de Investigació Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
47
|
Miarons M, Tomsen N, Nascimento W, Espín À, López-Faixó D, Clavé P, Rofes L. Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia. Neurogastroenterol Motil 2018; 30:e13397. [PMID: 30043538 DOI: 10.1111/nmo.13397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/23/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND We have recently found a potential protective effect of beta-blockers on oropharyngeal dysphagia (OD). The action mechanism by which beta-blockers could wield this protective effect is unknown, but the neurotransmitter substance P (SP) could play a key role. The aim of this study was to analyze serum and saliva SP levels in patients taking beta-blockers (TBB), and to explore its relationship with OD. METHODS Adult (>50 year) patients TBB were randomly recruited from the primary care setting and 1:1 matched by age, sex, and Barthel Index (BI) with patients not taking beta-blockers (NTBB). Serum and saliva samples were taken and analyzed for their SP levels using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic and clinical variables were collected. Dysphagia was evaluated in all patients using the clinical volume-viscosity swallow test (V-VST). KEY RESULTS We studied 28 patients TBB (64.96 ± 7.31 years, 57.1% women, BI 99.6 ± 1.31, carvedilol-equivalent dose 24.11 ± 18.12 mg) and 28 patients NTBB (65.61 ± 6.43 years, 57.1% women, BI 99.6 ± 1.31). SP serum levels were significantly higher in patients TBB (260.68 ± 144.27 vs 175.46 ± 108.36 pg/mL, P = .009) as were SP saliva levels (170.34 ± 146.48 vs 102.73 ± 52.28 pg/mL, P < .001) compared with patients NTBB. The prevalence of OD was 32.1% in patients TBB and 67.9% in patients NTBB (P = .015). Moreover, patients with OD had significantly lower SP saliva levels in comparison with patients without clinical signs of OD (98.39 ± 43.25 vs 174.69 ± 147.21 pg/mL) P < .001. CONCLUSIONS & INFERENCES We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD.
Collapse
Affiliation(s)
- M Miarons
- Department of Pharmacy, Hospital de Mataró, Mataró, Spain
| | - N Tomsen
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - W Nascimento
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - À Espín
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - D López-Faixó
- Department of Pharmacy, Hospital de Mataró, Mataró, Spain
| | - P Clavé
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - L Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
48
|
Brates D, Molfenter SM, Thibeault SL. Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy. Dysphagia 2018; 34:298-307. [PMID: 30043080 DOI: 10.1007/s00455-018-9927-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions. METHODS Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE ('reduced' or 'normal') were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2-C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted. RESULTS Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2-C4) and normal (mean = 110.6% C2-C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings. CONCLUSIONS Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decision-making, clinicians should remain cautious when making judgments about HE using these methods.
Collapse
Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA.,Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA.
| |
Collapse
|
49
|
Nakato R, Manabe N, Shimizu S, Hanayama K, Shiotani A, Hata J, Haruma K. Effects of Capsaicin on Older Patients with Oropharyngeal Dysphagia: A Double-Blind, Placebo-Controlled, Crossover Study. Digestion 2018; 95:210-220. [PMID: 28319947 DOI: 10.1159/000463382] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The standard of care for older patients with oropharyngeal dysphagia (OD) is poor. Stimulation of transient receptor potential vanilloid 1 might become a pharmacological strategy for these patients. This study aimed to compare the therapeutic effect of film food containing 0.75 µg of capsaicin in these patients. METHODS In a crossover, randomized trial, 49 patients with OD were provided capsaicin or identical placebo at least 7 days apart. Patients' reported symptoms during repeated swallowing, the volume, pH and substance P (SP) concentrations in saliva, and cervical esophageal wall motion evaluated by ultrasonographic tissue Doppler imaging were obtained before and after capsaicin or placebo administration. RESULTS Significantly more patients with OD who took capsaicin experienced improvement in symptoms than those who took placebo. Salivary SP levels were significantly increased after capsaicin administration compared with placebo in the effective group. The duration of cervical esophageal wall opening was significantly shorter in capsaicin administration in the effective group. Furthermore, a significant negative correlation was found between the duration of cervical esophageal wall opening and salivary SP levels. CONCLUSION Elevated salivary SP concentrations stimulated by capsaicin greatly improve the safety and efficacy of swallowing, and shorten the swallow response in older patients with OD.
Collapse
Affiliation(s)
- Rui Nakato
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | | | | | | | | | | |
Collapse
|
50
|
Burgos R, Bretón I, Cereda E, Desport JC, Dziewas R, Genton L, Gomes F, Jésus P, Leischker A, Muscaritoli M, Poulia K, Preiser JC, Van der Marck M, Wirth R, Singer P, Bischoff SC. ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-96. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
|