Chronic Dysphagia Research Articles

Daily Challenges and Resources of Adults with Chronic Dysphagia: A Qualitative Investigation.

Identifying and addressing daily challenges and resources associated with chronic oropharyngeal dysphagia (OD) is a pivotal, though still neglected component of person-centred care, yet overlooked in research studies. To investigate these dimensions, 25 Italian adults with chronic OD due to cancer or neurodegenerative diseases participated in semi-structured interviews, designed following a modified framework analysis approach. Two researchers independently transcribed and coded interviews, elaborated a working analytical framework, indexed and charted the data, solving discrepancies through negotiated agreement and discussion with a third researcher. Proportion agreement on extracted quotations was calculated. Overall, 457 quotations were extracted from the interviews (88% agreement). Daily challenges pertained to physical, practical, and social domains; most participants reported OD-related problems; almost half mentioned care needs and obstacles in using healthcare services. Concerning resources in OD management, most participants referred to problem-focused and meaning-focused coping strategies, personal capabilities, and support from family and healthcare services. Finally, almost half of the participants reported OD-related changes in life view and meaning. Findings suggest that adjusting to OD implies challenges and resource mobilization in different life domains. Future studies should longitudinally elucidate the dynamics of positive adjustment, to promote patient-centred OD care based on individually perceived needs and challenges, and to inform healthcare policies.

68-year-old patient with chronic dysphagia, dilated and lumen-filled esophagus

68-year-old patient with chronic dysphagia, dilated and lumen-filled esophagus

A 77-Year-Old Male with a Rapid Change in Mental Status.

A 77-year-old male who presented to the emergency department with generalized weakness and worsening chronic dysphagia was diagnosed with pneumonia. Shortly after receiving vascular access for his treatment, he had a rapid change in his mental status and neurological examination.

Cellular landscape of the esophageal epithelium in systemic sclerosis

Abstract Systemic sclerosis (SSc) is a rare autoimmune disease characterized by vasculopathy and progressive fibrosis of the skin and internal organs. Individuals with SSc often suffer from chronic acid reflux and dysphagia due to loss of esophageal motility, but this pathogenesis is poorly understood. Recently, studies have suggested that esophageal epithelial cells (EECs) may play a central role in the pathogenesis of SSc esophageal dysmotility. In this study, we performed a thorough transcriptomic investigation of the SSc esophageal epithelium in humans to determine whether distinct changes in EECs contribute to esophageal impairment in SSc. We performed single-cell RNA sequencing of paired proximal and distal esophageal mucosa biopsies from 10 individuals with SSc, 4 comparator individuals with gastroesophageal reflux disease (GERD), and 6 healthy controls (HCs), yielding 230,720 EECs across 40 samples. SSc and GERD samples had significantly fewer terminally differentiated, superficial cells than HCs, and differential gene expression between conditions was primarily limited to superficial EECs. Gene dysregulation in SSc was highly correlated with GERD, but was relatively greater in the proximal region, including unique dysregulation of immune mediators that correlated with esophageal dysmotility. This work sheds light on the cellular roots of esophageal dysfunction in SSc and serves as an atlas to guide future efforts to identify actionable targets in the esophagus in SSc.

The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy.

The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy. Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method. A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2-3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64). Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.

Dysphagia is associated with increased mortality risk after hip fracture surgery.

This study aims to explore the prevalence of dysphagia, as well as mortality associated with dysphagia in the elderly population receiving surgical treatment for a hip fracture. A retrospective cohort study was completed at an academic level 1 tertiary care center. Patients older than or equal to 65 admitted with a hip fracture diagnosis from January 2015 to December 2020 (n = 617) were included. The main outcome was the prevalence of dysphagia and association with mortality. Secondary analysis included timing of dysphagia and contributions to mortality. Fifty-six percent of patients had dysphagia, and the mortality rates were higher in patients with dysphagia (8.9%) versus those without dysphagia (2.6%), chi-square p = 0.001, and odds ratio 3.69 (CI 1.6-8.5). Mortality rates in patients with acute dysphagia were also higher (12.4%) than those with chronic dysphagia (5%) and chi-squared p = 0.02. Mortality rates in patients with a perioperative dysphagic event (13.9%) were higher than those with non-perioperative dysphagia (4%) and chi-squared p = 0.001. Mortality rates in patients who had acute perioperative dysphagia (21.2%) were higher than those with chronic dysphagia that presented perioperatively (6.8%) and chi-squared p = 0.006. This study demonstrates high rates of dysphagia in the elderly hip fracture population and a significant association between dysphagia and mortality. Timing and chronicity of dysphagia were relevant, as patients with acute perioperative dysphagia had the highest mortality rate. Unlike other identified risk factors, dysphagia may be at least partially modifiable. More research is needed to determine whether formal evaluation and treatment of dysphagia lowers mortality risk.

Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study.

Chronic oropharyngeal dysphagia (COD) and aspiration after esophageal cancer surgery may have clinical significance; however, it is a rarely studied topic. In a prospective cross-sectional observational study we comprehensively evaluated the nature, severity, and impact of COD, its predictors, and the impact of the surgical approach and site of anastomosis. Forty participants were recruited via purposive sampling from the (Irish) National Center between November 2021 and August 2022. Swallow evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2 (DIGESTv2), MBS Impairment Profile, Penetration-Aspiration Scale)]. Functional Oral Intake Scale (FOIS) identified oral intake status. The patient reported outcome measures of swallowing, and Quality of Life (QL) included EAT-10 and MD Anderson Dysphagia Inventory (MDADI). Fourteen (35%) participants presented with COD on DIGESTv2 and 10% had uncleared penetration/aspiration. Avoidance or modification of diet on FOIS was observed in 17 (42.5%). FOIS was associated with pharyngeal dysphagia (OR = 4.05, P = 0.046). Median (range) EAT-10 and MDADI Composite results were 3(0-30) and 77.9(60-92.6), respectively. Aspiration rates significantly differed across surgical groups (P = 0.029); only patients undergoing transhiatal surgery aspirated. Survivors of esophageal cancer surgery may have COD that is undiagnosed, potentially impacting swallow-related QL. Given the small number of aspirators, further research is required to determine whether aspiration risk is associated with surgical approach. A FOIS score below 7 may be a clinically useful prompt for the MDT to refer for evaluation of COD following curative intent surgery. These data present findings that may guide preventive and rehabilitative strategies toward optimizing survivorship.

Cuidados Paliativos: Disfagia, perspectivas clínicas y psicosociales

Comprehensive nursing care in situations of health vulnerability implies a complete analysis from clinical and psychosocial references. Dysphagia, difficulty in swallowing, is an important risk, caused by organic lesions or neuromuscular dysfunctions. Normal swallowing is divided into four phases, any of which can be affected and lead to dysphagia. Dysphagia is associated with diseases such as Parkinson's disease, esophageal cancer, and pulmonary disorders. Its prevalence is high in older patients, with 30% in those over 65 years of age and up to 86% in older adults hospitalized with pneumonia. Its early detection is crucial, as it can lead to comorbidities such as dehydration, malnutrition and aspiration pneumonia. Tolerance tests with foods of different textures and liquids of various viscosities are used to assess dysphagia. Results may indicate impaired chewing, oral storage of food, reduced laryngeal elevation, and more. In addition, instrumental tests such as videofluoroscopy and endoscopic examination are used to detect aspiration and other abnormalities. The goal of comprehensive diagnosis is to find solutions and early oral rehabilitation, adopt appropriate therapeutic measures, improve posture and ergonomics, strengthen the oropharyngeal musculature and prevent associated risks. Quality of life in people with chronic dysphagia is addressed in the context of advanced chronic diseases or palliative care.

Dysphagia Revealing an Aberrant Subclavian Artery or Arteria Lusoria: A Case Report

Aberrant right subclavian arteries (ARSA), also known as arteria lusoria, are among the commonest aortic arch anomalies, by passing behind the esophagus, it can cause a condition known as lusoric dysphagia, responsible for symptoms of discomfort. This artery is often associated with other anomalies, such as the non-recurrent laryngeal nerve, the bicarotid trunk, and with diseases such as aneurysms, congenital heart defects and even genetic syndromes. Here we report a case of an 82-year-old women patient has been referred to our department for an angio scanner of the supra-aortic trunk for etiological assessment of chronic dysphagia. Which has revealed an aberrant right subclavian artery (Arteria lusoria) associated with a bicarotid trunk.

Use of a prosthetic conduit for stent delivery in transcarotid artery revascularization for patients with unfavorable anatomy.

Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cmminimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement. Patients undergoing elective TCAR with a conduit from 2021 to 2022 were retrospectively identified. After carotid artery exposure, a 6-mm prosthetic graft was anastomosed to the common carotid artery in an end-to-side fashion. After stent delivery, the conduit was ligated and oversewn. The patient demographics, procedural details, and outcomes were recorded and compared with our nonconduit TCAR experience. A total of 11 patients (64% male; age, 75± 5years) underwent TCAR with a conduit, 5 (46%) for symptomatic disease, and 77 patients underwent TCAR with no conduit, 52 (60%) with symptomatic disease (P= .50). Other than a higher rate of prior coronary interventions in the conduit group (55% vs 47%; P= .007), no significant differences were found in age, gender, race, comorbidities, or high risk for carotid endarterectomy criteria. In the conduit group, the average skin to carotid artery depth was 4.2cm (range, 1.9-6.1cm). The average clavicle to bifurcation distance was 4.4cm (range, 3.3-4.9cm) vs 6.5cm (range, 3.3-9.7cm; P= .002) in the nonconduit group. Dacron was the most common conduit material used (73%). No differences were found in the mean procedure times (121± 32 vs 129± 53minutes; P= .785) or flow reversal times (14± 5 vs 19± 13minutes; P=.989) for the conduit and nonconduit cohorts, respectively. Technical success was achieved in 100% of the conduit and nonconduit cases. Excluding one outlier of a prolonged stay (7days) for management of unrelated medical issues (gastrostomy tube placement for chronic dysphagia after mass resection and neck radiation), the mean hospital stay was 2days (1.2± 0.4 intensive care unit days) compared with 3.8± 5.7days for our nonconduit cohort (P= .2). Hypotension was the most common reason for delayed discharge for the conduit group (n=3; 27%). The average follow-up was 2.7months (range, 1-10months). For all 11 conduit patients, the stent remained patent without stenosis, thrombus, or pseudoaneurysm at the conduit stump site on surveillance duplex ultrasound. No strokes or complications had occurred at 30days in the conduit group compared with four strokes or transient ischemic attacks (P= .469) and 18 minor complications in the nonconduit group (P= .091). For patients lacking a sufficient distance between the clavicle and carotid artery bifurcation, a prosthetic conduit facilitates safe use of flow reversal for stent delivery and can be ligated at procedural completion without consequences.

197. FIBROSING MEDIASTINITIS CAUSING CONCOMITANT FOCAL STRICTURE AND TRACTION DIVERTICULA OF THE ESOPHAGUS

Abstract Background Fibrosing mediastinitis, also known as mediastinal fibrosis or sclerosing mediastinitis, is a rare condition caused by an excessive fibrosing reaction of the mediastinum. The clinical presentation of fibrosing mediastinitis varies based on the mediastinal structures involved, which can include the great vessels, airway, thoracic duct, phrenic nerve, or esophagus. We present a unique case of a patient with fibrosing mediastinitis causing dysphagia due to esophageal involvement with both focal esophageal stricture and multiple traction diverticula. Case Report: 82-year-old man with a past medical history of treated pulmonary tuberculosis in his 20s, Crohn’s colitis and gastroesophageal reflux disease presented to clinic with worsening dysphagia for the past few years with chronic dysphagia symptoms for the past 50 years. Barium esophagram demonstrated a stricture in the upper to mid esophagus and a corkscrew pattern of the mid-esophagus (Figure 1). Esophagogastroduodenoscopy demonstrated an esophageal stricture and multiple traction diverticula distal to the stricture. Computed tomography of the chest showed homogeneous soft tissue encasing the trachea and esophagus consistent with fibrosing mediastinitis. Serial dilation of the esophageal stricture was performed, but mucosal disruption was never achieved with no improvement in stricture diameter. The case was discussed in a multi-disciplinary conference where esophageal stenting was not felt to be feasible given multiple traction diverticula, and esophageal resection would be high risk given the fibrosing mediastinitis. Risks and benefits were discussed with the patient, and the patient opted to do dietary modifications as he did not have dysphagia on a pureed diet. Discussion Fibrosing mediastinitis is often idiopathic but can be due to infectious/inflammatory processes, sarcoidosis, or radiation exposure. The most common cause of fibrosing mediastinitis is prior infection with Histoplasma capsulatum. In this case, fibrosing mediastinitis from remote Mycobacterium tuberculosis infection resulted in a focal stricture and traction diverticula of the esophagus causing dysphagia. Barium esophagram revealed a corkscrew pattern of the esophagus, a pattern usually seen in diffuse esophageal spasm but was due to multiple traction diverticula. Fibrosing mediastinitis causing dysphagia is rare, and no prior reports in the literature describe a case causing concomitant esophageal stricture and traction diverticula in a patient.

Unusual intra-tracheal migration of a corrosive esophageal foreign body.

Introduction: intra-tracheal migration of esophageal foreign body is very uncommon and dangerous. It is most often caused by a vulnerable foreign body accidentally swallowed. We report the first observation of intra-tracheal migration of corrosive battery in our practice, with review of the literature. Observation: It was a three-years-old girl received in ENT with dyspnea occurred on a chronic dysphagia. The chest x-ray revealed an endotracheal opacity. This proved to be a button battery that migrated into the trachea through an eso-tracheal perforation. Due to this situation, an emergency medico-surgical care was stored, with a favorable evolution at the cost of a laborious management of the residual fistula. Conclusion: Classically innocuous, esophageal foreign body can be unnoticed and became extra-esophageal through esophageal migration in general and tracheal in particular, thus transforming a chronic digestive problem into an expressive respiratory emergency.

Clinical Significance of Surgical Intervention to Restore Swallowing Function for Sustained Severe Dysphagia.

Owing to rapid population aging, patients with dysphagia are significantly increasing in society. Dysphagia treatment is aimed at the restoration of the swallowing function and the prevention of recurrent aspiration-induced pulmonary infection. However, despite intensive rehabilitation, oral food intake remains inadequate in many patients with severe dysphagia, which results in the deterioration of patients' quality of life and joy of living. Surgical intervention may serve as a useful therapeutic strategy to restore swallowing function in these patients. The study included 25 patients (mean, 70.4 years; male/female ratio, 20:5) with chronic dysphagia. Dysphagia was associated with cerebrovascular diseases in sixteen patients; with age-induced physiological deterioration in five patients; and with miscellaneous etiologies in four cases. Cricopharyngeal and infrahyoid myotomies were performed in all patients. Laryngeal elevation and the medialization of the paralyzed vocal fold were performed in 15 and 3 patients, respectively. The Food Intake Level Scale (FILS) and videoendoscopic examination score (VEES) were used to evaluate swallowing function. The FILS showed a restoration of oral food intake alone in 72% of patients, and 64% of patients maintained this improvement at their last follow-up visit. We observed significantly improved VEES scores postoperatively. However, patients with cognitive impairment or advanced age showed poor outcomes. In conclusion, surgical intervention may be an effective therapeutic option to restore swallowing function in cases of sustained severe dysphagia; however, surgical indications require careful consideration.

Dysphagia in Neurological Disorders.

Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.

Management of acute sloughing of the esophageal lining in patients with dystrophic epidermolysis bullosa-A series of six pediatric patients.

Dystrophic epidermolysis bullosa (DEB) is a subtype of an inherited skin disorder characterized by skin and mucosal fragility due to collagen VII (COL7A1) gene mutations. Esophageal strictures leading to chronic dysphagia and acute episodes are well recognized complications within this subtype. Sloughing of esophageal mucosa and the treatment of this emergency have heretofore received limited attention in the EB literature. We retrospectively reviewed the electronic medical records of the patients who had an acute episode of sloughing of the esophageal lining between 2008 and 2021 and extracted the information regarding their clinical presentation and management. Six patients out of 210 with recessive DEB severe (RDEB-S) (n = 4), RDEB intermediate (RDEB-I) (n = 1) and dominant DEB (DDEB) (n = 1) were identified. The mean age at the time of the episode was 2.7 years. All patients had early-onset severe gastroesophageal reflux. Clinically, they presented with a coughing episode (n = 6), hematemesis (n = 6), vomiting (n = 6), and choking (n = 3), followed by coughing up a string like tissue of variable length, part of the esophageal mucosal lining. Four patients recovered with medical management only, two patients required gastrostomy insertions for feeding due to severe persistent dysphagia and one also required a Nissen's fundoplication to manage severe reflux. One patient had aspiration pneumonia. Sloughing of varying lengths of segments of the esophagus is an emergency. The lining coughed up needs to be cut at the mouth not pulled and the emergency services called immediately for urgent assessment and management. Expert multidisciplinary care is needed to manage this rare but serious condition.

A rare cause of dysphagia due to retropharyngeal foregut duplication cyst: case report and review of the literature

BackgroundThe retropharyngeal space is a deep compartment of the head and neck region which extends from the base of the skull to the mediastinum, between the posterior pharyngeal wall and vertebral muscles, delimited laterally by carotid sheaths. Pathological processes of the retropharyngeal space are rarely encountered, generally are isolated and painless masses often cystic, and they usually originate from branchial arch anomalies, but only in rare cases, they turn out to be foregut duplication cysts. Foregut duplication cyst is rare congenital malformations arising along primitively derived alimentary tract during the first trimester in the developing embryo, mostly seen in the thorax and abdomen, with just few cases reported in the head and neck region. We report an extremely rare case of a foregut duplication cyst lined with respiratory epithelium located in the retropharyngeal space, at the level of the oropharynx, of an adult patient with dysphagia surgically treated, and we also made an analysis of the published literature about this very uncommon condition.Case presentationA 63-year-old male patient with chronic dysphagia was diagnosed with a retropharyngeal cystic lesion, which was surgically treated. Final pathologic evaluation confirmed the diagnosis of a rare foregut duplication cyst lined with respiratory epithelium. A review of the pertaining published literature about the head and neck foregut duplication cysts was made, with a particular emphasis on retropharyngeal ones.ConclusionsRetropharyngeal foregut duplication cysts are a very rare congenital cyst of the head and neck. Clinical symptoms such as dysphagia and dyspnea should be evaluated with fibrolaryngoscopy, and CT and MRI scans are of great significance for definitive diagnosis, which should include the possibility of a foregut duplication cyst in the differential diagnosis. Surgical excision is the elective treatment for this lesion, in order to prevent complications including infection and compression symptoms or eventually malignant transformation.

Current Treatment of Laryngopharyngeal Reflux.

Objectives: Laryngopharyngeal reflux (LPR) is a complex syndrome characterized by the reflux of gastroduodenal contents into the pharynx or larynx, resulting in a range of symptoms, including chronic cough, throat clearing, pain, dysphagia, hoarseness, and dysphonia. Despite the lack of a gold standard for diagnosis or treatment, various strategies have been proposed to manage LPR. However, the effectiveness of these treatments is compromised by the lack of a uniform treatment protocol, which places a burden on patients, physicians, and the healthcare system. This study aims to systematically review the treatments of LPR and provide updated and useful clinical information to clinical physicians. Methods: The literature with an emphasis on LPR and related keywords is searched and reviewed in PubMed. Results: Treatment of LPR includes health education, lifestyle modification, dietary changes, medications, and surgery, as well as the emergence of a novel treatment method involving external upper esophageal sphincter compression devices. Conclusions: Currently, medication is the main treatment, supplemented with lifestyle and dietary changes, but there is still a lack of effective means for patients with drug-resistant or intolerant LPR. More high-quality and rigorous trials must continue to be conducted to determine the best treatment options and find novel treatments. Taking into account the complexity of LPR, this study proposes a simple algorithm to help clinicians with the initial management of this disease.

Utilizing Trans-Oral Robotic Surgery (TORS) in head and neck malignancy – is it practical in oropharyngeal squamous cell carcinoma (OPSCC)? A case report

Introduction: Oropharyngeal squamous cell carcinoma (OPSCC) is often managed by multimodal methods, including open surgical resection and reconstruction in advanced cases. Trans-oral Robotic Surgery (TORS) was introduced to minimize and avoid complications caused by the open surgery method and chemo-radiation therapy in treating oropharyngeal squamous cell carcinoma (OPSCC). In Malaysia, TORS is still a new, rare, and limited surgical technique practiced in our healthcare system. Case Presentation: We present a case of the base of tongue lesion which presented with chronic globus sensation for four months associated with chronic dysphagia and cough. Endoscopy examination revealed a lobulated mass situated at the left side base of the tongue. Contrast Enhanced Computed Tomography (CECT) of the neck revealed an enhancing lesion at the same site. There were multiple subcentimeter cervical lymph nodes bilaterally from level II to level V. The patient underwent a TORS procedure using the da Vinci Surgery System for incisional biopsy. By using TORS, we were able to obtain a good tumor sample including the margins for the biopsy. Histopathology examination (HPE) of the sample reported moderate to poorly differentiated squamous cell carcinoma. Based on the HPE and CECT results, the patient was diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) with a clinical stage of T3N2cMx. Conclusion: Management strategies for patients with OPSCC continue to evolve to minimize the morbidities and complications of treatments. Minimally invasive surgical techniques such as TORS offer impressive functional and oncologic outcomes particularly for patients (therapeutic function) compared to the traditional method of treatments.

Progressive Dysphagia and Chronic Abdominal Pain From Vascular Anomalies: A Case Report and Literature Review.

Median arcuate ligament syndrome and symptomatic aberrant right subclavian artery are uncommon in the pediatric population and are rarely found in the same individual. We present the case of a teenager with 2 rare vascular anomalies leading to chronic postprandial abdominal pain, dysphagia, and weight loss. The purpose of this case report is to raise awareness about these rare anomalies and their presentations in the pediatric population.

Solely Ultrasound-guided Botulinum Toxin Injection in the Cricopharyngeus Muscle: Successful Treatment in a Patient of Chronic Dysphagia Following Lateral Medullary Syndrome

Botulinum toxin (BTX) injection is a widely used procedure for the treatment of the dysfunction of the upper oesophageal sphincter. Although injection can be guided by ultrasound (US), electromyography or computed tomography, the most convenient option will be solely US-guided injection. No studies yet observed the effectiveness of solely US-guided BTX injection in the cricopharyngeus muscle (CPM) in dysphagia following lateral medullary syndrome (LMS). In this report, 50 U of BTX type-A was given in the right CPM in a patient of right LMS with chronic severe dysphagia, under the guidance of US. Dysphagia Outcome Severity Scale score improve from 1 to 6, Functional Oral Intake Scale score improved from 1 to 6 and penetration-aspiration scale score improved from 7 to 2 at 2 months follow-up. Solely US-guided BTX injection may be a feasible option for many rehabilitation units in managing dysphagia following LMS.