Diagnosis Of Dysphagia Research Articles

Diagnosis and treatment of dysphagia

Background: Dysphagia refers to an abnormality in the process of transporting food from the mouth to the stomach. Patients with dysphagia have a high risk of airway aspiration, which can often lead to fatal complications such as pneumonia and asphyxia. Recently, interest in the clinical importance of dysphagia has increased in the medical community and society at large.Current Concepts: Dysphagia can be caused by neurological diseases such as stroke and brain injury, or by non-neurological diseases such as head and neck cancer or diverticulum. Diagnosis is mainly performed using videofluoroscopic swallowing study or endoscopic evaluation of swallowing based on a detailed history and physical examination, scintigraphy or esophageal manometry may also be helpful. Recently developed imaging technology using 3-dimensional computed tomography and dynamic magnetic resonance imaging has been implemented. Treatment of dysphagia can be divided into compensatory and facilitative rehabilitation techniques. The most important principle for successful treatment of dysphagia is that it should be performed with a multidisciplinary team approach.Discussion and Conclusion: Dysphagia is an important problem that can seriously impair the patients’ quality of life. Although the general public and medical professionals are interested in dysphagia, many unknown aspects exist regarding the mechanism of dysphagia, and few treatments have been sufficiently proven in terms of safety and effectiveness. Therefore, much attention and effort is still required.

P16.09.B NEUROGENIC DYSPHAGIA IN MENINGEOSIS NEOPLASTICA PATIENTS

Abstract BACKGROUND Meningeosis neoplastica (MN) occurs in 5-10 % of all cancers and is characterized by diffuse seeding of tumor cells in the cerebrospinal fluid (CSF) and meninges. Common clinical symptoms suggestive of MN include headache, cranial nerve (CN) deficits, psychiatric symptoms as well as paresthesia. Neurogenic dysphagia (ND) has been suggested a rare MN symptom resulting from affection of CN IX and X. The aim of this work was to investigate frequency, severity and pattern of malfunction of ND due to MN as well as to assess its impact on the rate of pneumonia and overall survival. MATERIAL AND METHODS The database of the Institute of Neurooncology of the University Hospital Frankfurt was screened for patients with MN diagnosed between March 2009 and July 2021 who received a systematic dysphagia assessment (DA). DA comprised a standardized clinical swallowing examination as well as an additional fiber optic endoscopic evaluation of the swallowing act (FEES) in case of suspected aspiration. Severity of dysphagia and extent of oral impairment were systematically recorded. In addition to demographics, clinical diagnoses, underlying cancer and treatment, information on radiological imaging including presence of contrast-enhancing lesions was collected. RESULTS A total of 262 patients with a diagnosis of MN were detected, 69 of whom (52 % women, mean age 61 ± 14 years) were included for further analysis. Underlying cancers included lung cancer (16 cases, 23 %), breast cancer (15, 22 %), as well as lymphoma and melanoma (each 7 cases, 10%). The remaining 24 patients suffered from cancer entities (ovarian cancer, gastrointestinal tumors or cancers of unknown primary). 46 patients (66.6 %) were diagnosed with ND, 15 of these patients required a feeding tube (FOIS 1-3). Dysphagic patients had an increased risk of pneumonia (p<0.001) and a shorter survival time compared to non-dysphagic patients (p=0.003). Affection of the cranial nerves affected CN V (n=6), CN VII (n=22), CN IX (n=21), CN X (n=7) and CN XII (n=12). There was no significant correlation between the presence of an ND and the above-mentioned cranial nerve deficits. CONCLUSION The results of this study show that ND is a common symptom in patients with MN and can also occur independently of paresis of CN IX and X. In addition, the presence of ND is associated with a higher rate of pneumonia and a shorter survival time. Therefore, patients with suspected or confirmed MN should receive a systematic dysphagia assessment. In addition, the presence of MN should also be considered in the differential diagnosis of unclear neurogenic dysphagia.

Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility.

Limited research exists evaluating the impact of social determinants of health in influencing care pathways for patients with dysphagia. A better understanding of whether these determinants correlate to altered care and resource utilization is essential as it relates to patient outcomes. Retrospective chart review. All adult patients seen at a tertiary midwestern hospital were screened for ICD codes of dysphagia diagnoses from 2009 to 2019. Demographic information was collected from these patients with dysphagia including sex, race, ethnicity, and insurance status. Subgroup analysis was performed to assess referral pattern rates and types of diagnostic interventions ordered (none, videofluoroscopic swallow study, esophagram, and esophagogastroduodenoscopy). A total of 31,858 patients with dysphagia were seen at our institution during the study period, with a majority being female (56.36%), Caucasian (79.83%), and publicly insured (63.16%), at a median age of 60.35 years. There were no significant care delivery pattern differences based on geography/zip code analyses. African American patients were significantly more likely to have imaging or interventions performed (odds ratio [OR] 1.463, p = 0.005). Patients with public insurance also had higher rates of diagnostic study utilization (OR 1.53, p = 0.01). Only 3% of all patients with dysphagia were seen by laryngologists. No significant differences were seen in dysphagia evaluation modalities based on zip code analyses surrounding this tertiary care facility. African American patients and those with public insurance had significantly higher utilization of subsequent testing and intervention for dysphagia care. Further studies are necessary to delineate causes and outcome differences for these measurable differences in dysphagia care pathways. 4 Laryngoscope, 134:1139-1146, 2024.

Acute Antipsychotic Use and Presence of Dysphagia Among Older Veterans with Heart Failure.

Examine whether new antipsychotic (AP) exposure is associated with dysphagia in hospitalized patients with heart failure (HF). Retrospective cohort. AP-naïve Veterans hospitalized with HF and subsequently discharged to a skilled nursing facility (SNF) between October 1, 2010, and November 30,2019. We linked Veterans Health Administration (VHA) electronic medical records with Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) version 3.0 assessments and CMS claims. The exposure variable was administration of ≥1 dose of a typical or atypical AP during hospitalization. Our main outcome measure was dysphagia presence defined by (1) inpatient dysphagia diagnosis codes and (2) the SNF admission MDS 3.0 swallowing-related items to examine post-acute care dysphagia status. Inverse probability of treatment weighting was used for risk adjustment. The analytic cohort consisted of 29,591 Veterans (mean age 78.5±10.0years; female 2.9%; n= 865). Acute APs were administered to 9.9% (n= 2941). Those receiving APs had differences in prior dementia [37.1%, n= 1091, vs 22.3%, n= 5942; standardized mean difference (SMD)= 0.33] and hospital delirium diagnoses (7.7%, n= 227 vs 2.8%, n= 754; SMD= 0.22). Acute AP exposure was associated with nearly double the risk for hospital dysphagia diagnosis codes [adjusted (adj.) relative risk (RR) 1.9, 95% CI 1.8, 2.1]. At the SNF admission MDS assessment, acute AP administration during hospitalization was associated with an increased dysphagia risk (adj. RR 1.2, 95% CI 1.0, 1.5) both in the oral (adj. RR 1.7, 95% CI 1.2, 2.0) and pharyngeal phases (adj. RR 1.3, 95% CI 1.0, 1.7). In this retrospective study, AP medication exposure was associated with increased dysphagia coding and MDS assessment. Considering other adverse effects, acute AP should be cautiously administered during hospitalization, particularly in those with dementia. Swallowing function is critical to hydration, nutrition, and medical management of HF; therefore, when acute APs are initiated, a swallow evaluation should be considered.

Management Strategies for Dysphagia Complicating Laparoscopic Nissen Fundoplication, Systematic Review

Abstract Background Gastroesophageal reflux disease (GERD) is a common global disorder. Manifestations of the disease range from occasional episodes of heartburn and regurgitation to the more serious complications of stricture and Barrett’s esophagus. Most patients manage their symptoms with a combination of dietary and lifestyle modifications and overthe-counter or prescription medications. Aim of the Work This study aims to assess the incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication. Patients and Methods Published studies discussing dysphagia as a complication of laparoscopic Nissen fundoplication. Patients developed dysphagia after laparoscopic Nissen fundoplication as primary anti-reflux surgery, the type of intervention was laparoscopic Nissen fundoplication. Types of outcome measures: Incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication. The published English-language literature will be searched in the databases PUBMED, EMBASE, Google Scholar, Science direct and Cochrane Register of Controlled Trails (The Cochrane Library). The search terms will be employed: “Nissen fundoplication” “early dysphagia” “ late dysphagia”. Results In our present systematic review, we observed that the incidence of post-operative dysphagia after laparoscopic Nissen fundoplication among the included studies ranged from 8.2% to 42.8% with average percent of 33.2%. Transient postoperative dysphagia was more prominent in most of the included studies with average 52.8%, while persistent dysphagia was in reported in 47.2% of cases. In the present systematic review and meta-analysis, 707 of patients who developed postoperative dysphagia responded to conservative management with percent of 92.4%, while the remaining 58 patients required more invasive modalities. Endoscopic dilatation was performed in 54 (7.1%) of patients, while the remaining 4 patients (0.5%) were indicated for surgical reintervention. Conclusion Post laparoscopic Nissen fundoplication dysphagia is one of the most common complications, most cases present with a transient course that require no more than conservative management. In few conditions, more invasive procedures maybe required to control that condition.

Improving The Accuracy of Screening Pharyngeal Dysphagia Using Ultrasonography in Acute Stroke Patient: A Case Report

Introduction: Dysphagia is a common complication in acute stroke patients that require early screening to reduce the risk of aspiration pneumonia, disability, and mortality. Bedside examinations such as the Gugging Swallowing Screen (GUSS) test and ultrasonography are non-invasive methods that may improve early diagnosis of dysphagia after stroke.
 Case Report: We report a 49-year-old man with a history of cerebrovascular event that had difficulty swallowing, followed by coughing and choking after drinking.
 Discussion Case: The GUSS score indicated moderate dysphagia with a high risk of aspiration. The swallowing ultrasonography showed conformity to the GUSS score and improved the screening accuracy for silent aspiration risk in the pharyngeal swallowing phase.
 Conclusion: In conclusion, ultrasonography examination may improve the screening accuracy of the GUSS test, particularly for the detection of silent aspiration in pharyngeal dysphagia.

Diagnosis of post-stroke dysphagia: towards better treatment

Diagnosis of post-stroke dysphagia: towards better treatment

Ultrasonography for Eating and Swallowing Assessment: A Narrative Review of Integrated Insights for Noninvasive Clinical Practice.

Dysphagia is a syndrome of abnormal eating function resulting from a variety of causative diseases, and is associated with malnutrition. To date, the swallowing function has been difficult to examine without the use of invasive and expensive methods, such as the videofluorographic swallowing study or fiberoptic endoscopic evaluation of swallowing. In recent years, progress has been made in the clinical application of ultrasound equipment for the evaluation of body compositions near the body surface, including the assessment of nutritional status. Ultrasound examination is a noninvasive procedure and relatively inexpensive, and the equipment required is highly portable thanks to innovations such as wireless probes and tablet monitoring devices. The process of using ultrasound to visualize the geniohyoid muscle, digastric muscle, mylohyoid muscle, hyoid bone, tongue, masseter muscle, genioglossus muscle, orbicularis oris muscle, temporalis muscle, pharynx, esophagus, and larynx, and the methods used for evaluating these structures, are provided in this study in detail. This study also aims to propose a protocol for the assessment of swallowing-related muscles that can be applied in real-world clinical practice for the diagnosis of sarcopenic dysphagia, which can occur in elderly patients with sarcopenia, and has received much attention in recent years.

The Swallowing Intelligent Assessment System Based on Tongue Strength and Surface EMG

Dysphagia is a very important issue in modern society, and it is common in stroke patients and the elderly. Many studies have shown that tongue strength can be used as an evaluation criterion for swallowing function. This work has implemented a methodology to assess and improvise the swallowing function of dysphagia patients. To execute the same, a tongue pressure instrument was used as a tool to assess tongue strength, and a surface electromyography instrument was used to collect electrical data on larynx muscles. In addition to this, an assessment task has been carried out that is combined with interesting games to increase users’ willingness. After completing the task, the system collects tongue pressure and muscle electrical data. We use the Scoring Function calculation to quantify the user’s swallowing performance quality. In addition to calculating the quality score of the motion, we also extract features from the collected data, build a variety of machine learning models to compare each model’s classification effectiveness and select the best model to correctly predict the level of the user’s swallowing function. Through this evaluation system, we hope to provide fast and accurate evaluation results, so that medical personnel can have more convenient and effective tools for dysphagia diagnosis and rehabilitation training.

Quantifying the Healthcare Burden of Pediatric Feeding Disorder after Congenital Heart Surgery

To determine the health care costs and utilization burden of pediatric feeding disorder after congenital heart surgery. A retrospective, population-based cohort study using claims data (2009-2018) was performed. Participants include patients aged 0-18 years who had undergone congenital heart surgery and were included in the insurance database ≥1 year after surgery. The main exposure variable was presence of pediatric feeding disorder, defined as a need for a feeding tube at discharge or diagnosis of dysphagia or feeding-related difficulty within the study timeframe. Main outcomes include overall and feeding-related medical care utilization, defined as readmissions and outpatient utilization, and feeding-related cost of care within 1 year of surgery. A total of 10,849 pediatric patients were identified, with 3347 (30.9%) presenting with pediatric feeding disorder within 1 year of surgery. Patients with pediatric feeding disorder spent a median of 12 days (IQR 6-33 days) in the hospital, compared with 5 days (IQR 3-8 days) in patients without (p<0.001). Rate ratios for overall readmissions, feeding-related readmissions, feeding-related outpatient utilization, and cost of care over the first year after surgery were significantly increased at 2.9 (95% CI 2.5-3.4), 5.1 (95% CI 4.6-5.7), 7.7 (95% CI 6.5-9.1), and 2.2 (95% CI 2.0-2.3) among patients with pediatric feeding disorder as compared with those without. Pediatric feeding disorder after congenital heart surgery is associated with a significant health care burden. Multidisciplinary care for and research on this health condition is needed to identify optimal management strategies to reduce this burden and improve outcomes.

Effects of barium sulfate on rheological properties and IDDSI flow consistency of liquid stimuli prepared using commercial thickening powders.

During videofluoroscopic swallowing study (VFSS), barium sulfate (BaSO4 ) is commonly added into food samples as a radiopaque contrast media for bolus visualization and examination. Accordingly, the consistency and flow behavior of barium stimuli can differ significantly from their non-barium counterparts. Such differences may have a subsequent impact on the validity of VFSS. Therefore, in this study, effects of barium sulfate on the shear and extensional rheological properties and IDDSI (International Dysphagia Diet Standardization Initiative) flow consistency of liquids prepared using various commercial thickening powders were investigated. Results showed that all barium stimuli exhibited shear thinning behavior but with significantly higher shear viscosity compared to the non-barium counterparts. A shift factor of viscosity at shear rate 50 s-1 with values in range of 1.21-1.73 could be used to describe the increase in the viscosity for samples thickened with gum-based thickeners. However, the change in the viscosity was not invariant for the stimuli prepared starch-based thickener. The addition of BaSO4 had a negative impact on extensional properties of samples by demonstrating a faster filament rupture. The extent of impact on the decrease in filament breakup time was more pronounced in xanthan > guar gum ≈ tara gum-based thickeners. Based on the IDDSI flow test, no significant effect of BaSO4 was found on the gum-based thickeners, whereas there was a marked effect in the starch-based sample. These results can be used beneficially to assist clinicians in the dysphagia diagnosis for matching rheological properties of the barium stimuli to enhance effectiveness dysphagia interventions.

Non-Contact Assessment of Swallowing Dysfunction Using Smartphone Captured Skin Displacements

Early and accurate dysphagia diagnosis is essential for reducing the risk of associated co-morbidities and mortalities. Barriers to current evaluation methods may alter the effectiveness of identifying at-risk patients. This preliminary study evaluates the feasibility of using iPhone X-captured videos of swallowing as a non-contact dysphagia screening tool. Video recordings of the anterior and lateral necks were captured simultaneously with videofluoroscopy in dysphagic patients. Videos were analyzed using an image registration algorithm (phase-based Savitzky–Golay gradient correlation (P-SG-GC)) to determine skin displacements over hyolaryngeal regions. Biomechanical swallowing parameters of hyolaryngeal displacement and velocity were also measured. Swallowing safety and efficiency were assessed by the Penetration Aspiration Scale (PAS), Residue Severity Ratings (RSR), and the Normalized Residue Ratio Scale (NRRS). Anterior hyoid excursion and horizontal skin displacements were strongly correlated with swallows of a 20 mL bolus (rs = 0.67). Skin displacements of the neck were moderately to very strongly correlated with scores on the PAS (rs = 0.80), NRRS (rs = 0.41–0.62), and RSR (rs = 0.33). This is the first study to utilize smartphone technology and image registration methods to produce skin displacements indicating post-swallow residual and penetration-aspiration. Enhancing screening methods provides a greater chance of detecting dysphagia, reducing the risk of negative health impacts.

Monophasic-quadri-burst stimulation robustly activates bilateral swallowing motor cortices.

A stable, reliable, non-invasive, quantitative assessment of swallowing function remains to be established. Transcranial magnetic stimulation (TMS) is commonly used to aid in the diagnosis of dysphagia. Most diagnostic applications involve single-pulse TMS and motor evoked potential (MEP) recordings, the use of which is not clinically suitable in patients with severe dysphagia given the large variability in MEPs measured from the muscles involved in swallowing. Previously, we developed a TMS device that can deliver quadripulse theta-burst stimulation in 16 monophasic magnetic pulses through a single coil, enabling the measurement of MEPs related to hand function. We applied a system for MEP conditioning that relies on a 5 ms interval-monophasic quadripulse magnetic stimulation (QPS5) paradigm to produce 5 ms interval-four sets of four burst trains; quadri-burst stimulation (QBS5), which is expected to induce long-term potentiation (LTP) in the stroke patient motor cortex. Our analysis indicated that QBS5 conditioned left motor cortex induced robust facilitation in the bilateral mylohyoid MEPs. Swallowing dysfunction scores after intracerebral hemorrhage were significantly correlated with QBS5 conditioned-MEP parameters, including resting motor threshold and amplitude. The degree of bilateral mylohyoid MEP facilitation after left side motor cortical QBS5 conditioning and the grade of severity of swallowing dysfunction exhibited a significant linear correlation (r = -0.48/-0.46 and 0.83/0.83; R2 = 0.23/0.21 and 0.68/0.68, P < 0.001; Rt./Lt. side MEP-RMT and amplitudes, respectively). The present results indicate that RMT and amplitude of bilateral mylohyoid-MEPs after left motor cortical QBS5 conditioning as surrogate quantitative biomarkers for swallowing dysfunction after ICH. Thus, the safety and limitations of QBS5 conditioned-MEPs in this population should be further explored.

Does Dysphagia Predict Inpatient Morbidity and Mortality in Geriatric Patients Admitted for Aspiration Pneumonia?

Background Aspiration pneumonia is common in older adults admitted for community-acquired pneumonia and is associated with significant morbidity and mortality. Factors that put this population at higher risk of aspiration include cognitive impairment, neuromuscular dysfunction, and dysphagia. This study aimed to determine whether a concurrent diagnosis of dysphagia conferred a higher risk of complications in the elderly admitted for aspiration pneumonia. Methods The National Inpatient Sample 2001-2013 database was queried for patients, aged 65 or older, with a diagnosis of aspiration pneumonia using International Classification of Diseases, Ninth Revision (ICD-9) codes. Sepsis, respiratory failure, and intubation were identified with their respective ICD-9 codes. A chi-square test and binary logistic regression analysis were used to examine socio-demographic and complication variables, with a significance level of α <0.001. Results A total of 1,097,325 patients were admitted for aspiration pneumonia, of which 349,861 (24.2%) had dysphagia. After incorporating socio-demographic variables, the dysphagia group had a significantly lower likelihood of having sepsis (OR=0.72), respiratory failure (OR=0.92), intubation (OR=0.52), and inpatient mortality (OR = 0.59). Patients with dysphagia had a significantly higher likelihood of increased length of stay (OR=1.24). Conclusions Elderly patients admitted with aspiration pneumonia with a co-diagnosis of dysphagia were less likely to have inpatient morbidity and mortality compared to their counterparts. This may be due to improved speech evaluation and treatment in patients with dysphagia allowing for better control of macro and micro aspiration. Future research is needed to examine if universal speech therapy can reduce hospitalization and long-term mortality for such patients.

Critical Decision Making: Dysphagia

The differential diagnosis of dysphagia is broad. A thorough history and physical examination are of paramount importance in determining the etiology of the patient’s dysphagia and guiding their subsequent management. This article discusses our approach to the evaluation of a patient presenting with dysphagia.

Surface Electromyography of Pharyngeal Swallowing in Healthy Chinese Individuals: Establishment of a Timing and Amplitude Database.

This study determined the surface electromyography (sEMG) characteristics of healthy Chinese adults during swallowing to provide a reference for the clinical differential diagnosis of swallowing and dysphagia. sEMG was performed on 187 healthy adults to obtain quantitative information on normal pharyngeal swallowing. The evaluated parameters included the timing and amplitude of sEMG activity in the submental and infrahyoid muscles. A normative database was constructed for the timing and amplitude of muscle activity during pharyngeal swallowing. Results indicated that the duration of sEMG activity was related to the age of the patient; the duration gradually increasing with age. Similarly, the duration of the sEMG activity was associated with the type of swallowing. The duration of the sEMG activity was similar for dry and wet swallowing but was significantly different for excessive swallowing. The mean amplitude of sEMG activity for the submental and infrahyoid muscles was not significantly associated with patient age. A significant correlation between the mean amplitude of sEMG activity and the types of normal swallowing was observed in infrahyoid, but not in submental muscle activity. This study is the first report on the establishment of a normative database for the duration and amplitude of muscle activity based on sEMG analysis of pharyngeal swallowing in healthy Chinese adults.

The prevalence of Chiari malformation among children with persistent dysphagia

BackgroundBrain imaging has been utilized as a diagnostic tool in the workup of persistent pediatric dysphagia, yet the indications for imaging and the prevalence of Chiari malformation (CM) have not been established. Objectiveto evaluate the prevalence of CM anomalies in children who underwent brain magnetic resonance imaging (MRI) for pharyngeal dysphagia and to review the clinical findings in the CM group compared to the non-CM group. MethodsA retrospective cohort study of children who underwent MRI as part of the workup for the diagnosis of dysphagia in a tertiary care children's hospital between 2010 and 2021. Results150 patients were included. The mean age at diagnosis of dysphagia was 1 ± 3.4 years, and the mean age at MRI was 3.5 ± 4.2 years. Common comorbidities in our cohort included prematurity (n = 70, 46.7 %), gastroesophageal reflux (n = 65, 43.3 %), neuromuscular/seizure disorder (n = 53,35.3 %), and underlying syndrome (n = 16, 10.7 %). Abnormal brain findings were seen in 32 (21.3 %) patients, of whom 5 (3.3 %) were diagnosed with CM-I and 4 (2.7 %) patients with tonsillar ectopia. Clinical characteristics and dysphagia severity were similar between patients with CM-I/tonsillar ectopia and patients without tonsillar herniation. ConclusionsBrain MRI should be pursued as part of the work-up for persistent dysphagia in pediatric patients given the relatively higher prevalence of CM-I. Multi-institutional studies are required to establish the criteria and timing of brain imaging in patients with dysphagia.

A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis.

Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle-associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well-being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta-analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM). Four electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed. Thirty-nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: -0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility. Our findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.

Examining the frequency of dysphagia and the predictive factors of dysphagia that require attention in patients with Parkinson's disease

Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia.&#x0D; Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients.&#x0D; Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05.&#x0D; Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011).&#x0D; Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men.

Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia

Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients. Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options. Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia. The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization. In some cases, symptomatic ventral cervical spondylophytes can be arelevant differential diagnosis of neurogenic dysphagia. For amore precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, avideo fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, aresection of the bone spurs leads to asignificant improvement or even to acomplete restitution of the swallowing disorders.