Prevalence Of Dysphagia Research Articles

The presence of dysphagia in patients with cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): a subjective and objective study.

The aim of this study was to determine the prevalence of dysphagia in patients with cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS), characterizing this condition, both in its objective dimension and in terms of quality of life (QoL). A cross-sectional study was developed in 11 patients diagnosed of CANVAS. In all patients, clinical records were reviewed and the Eating assessment tool 10 (EAT-10) was performed as screening of oropharyngeal dysphagia. To evaluate the QoL impairment secondary to dysphagia, we applied the swallowing quality of life questionnaire (SWAL-QOL) and the MD Anderson Dysphagia Inventory (MDADI). To evaluate the deglutition mechanisms impaired, two objective-instrumental studies were performed: the volume-viscosity swallow test (V-VST) and the fiberoptic endoscopic evaluation of swallowing (FEES). 82% of the patients presented an abnormal EAT-10 score. A correlation was found between the EAT-10 and MDADI and between both QoL questionnaires. After the FEES and V-VST analysis, all 11 patients presented some degree of swallow effectiveness impairment, and most of them safety alterations as well. CANVAS remains an underestimated and underdiagnosed condition and the prevalence of swallowing disorders in those patients is higher than expected. Despite the possibility that EAT-10 works as a useful screening test to predict the results in the QoL questionnaires, the absence of correlation between QoL test and instrumental results suggests that to properly evaluate the patients swallowing status, objective instrumental procedures must be conducted.

Self-reported Dysphagia and Pharyngeal Volume Following Whiplash Injury.

Difficulty swallowing has been reported following whiplash injury; however, the reasons remain poorly understood. A possible factor may be the observed changes in pharyngeal volume. The current exploratory study was designed to examine the prevalence of self-reported dysphagia after whiplash and the relationship with recovery status and change in pharyngeal volume. Data were available from a longitudinal study of adults with whiplash. Data included magnetic resonance imaging (MRI) of the cervical spine, the Dysphagia Handicap Index (DHI), and Neck Disability Index (NDI) collected over four timepoints (< 1week, 2weeks, 3 months, and 12 months post-injury). Initial cross-sectional analysis examined 60 patients with DHI data from at least one timepoint. A second, longitudinal analysis was conducted on 31 participants with MRI, NDI, and DHI data at both early (< 1-2weeks) and late (3-12months) timepoints. The pharynx was contoured on axial T2-weighted MRI slices using OsiriX image processing software and pharyngeal volume (mm3) was quantified. In the 60-patient cohort, prevalence of self-reported dysphagia (DHI ≥ 3) was observed in 50% of participants at least once in 12 months (M = 4.9, SD 8.16, range 0-40). In the longitudinal cohort (n = 31), mean total DHI significantly (p = 0.006) increased between early and late stages. There was no relationship (p = 1.0) between dysphagia and recovery status, per the NDI% score. Pharyngeal volume remained stable and there was no relationship between dysphagia and pharyngeal volume change (p = 1.0). This exploratory study supports the need for further work to understand the nature of dysphagia, extent of functional compromise, and the underlying pathophysiology post-whiplash.

Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis.

Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.

Dysphagia and Satisfaction Following Anterior Cervical Spine Surgery: A Prospective Observation Trial.

Prospective observation. To assess the effect of dysphagia on patient satisfaction following anterior cervical discectomy and fusion. Difficulty with swallowing is a common complaint following anterior cervical spine surgery. The exact impact of this issue on the patient's overall satisfaction is unknown because of its often-transient nature. A prospective evaluation of all patients from a single surgeon undergoing an anterior cervical spine surgery. Dysphagia was evaluated both preoperatively and postoperatively at set intervals via a combination of 3 validated scoring systems. Mean satisfaction scores at 6 months was evaluated at 6 months via modified CSRS survey. Comparative analysis was performed to determine if there was any relationship between the 2 outcomes. A total of 96.77% (68/71) of enrolled patients completed all of their follow-up surveys. The prevalence of dysphagia was 32.4% at 2 weeks after surgery, 20.6% at 6 weeks, 13.2% at 3 months, and 13.2% at 6 months. In total, 82.35% (56/68) of patients were satisfied with their surgical outcome and only 5.88% (4/68) were dissatisfied with their outcome. There was no relationship between a patient's overall satisfaction level and the presence of dysphagia at any postoperative interval. The absence of neck pain at 6 months was the only significant predictor of patient satisfaction (P=0.003). Dysphagia is a common but often transient complaint following anterior cervical spine surgery. Fortunately, its presence does not seem to correlate with a patient's overall satisfaction level following surgery. Level I.

Reliable predicting factors for post-stroke dysphagia – Our experience

Dysphagia affects more than 50 % of stroke survivors. The most common consequences of post-stroke dysphagia are malnutrition, dehydration, aspiration pneumonia, choking, limited quality of life, increased mortality and morbidity rate. Patients with post-stroke dysphagia should be identified as soon as possible so that special measures can be taken to avoid these consequences. The objectives of our study were to evaluate the prevalence of post-stroke dysphagia in a tertiary care hospital, to analyse the reliability of predicting risk factors for dysphagia and to determine the stroke locations and brain regions respectively connected with post-stroke dysphagia. We included 207 patients who presented with acute stroke and were admitted to Department of Neurology – Stroke Unit from September 2016 to September 2017. Forty-three percent of patients had post-stroke dysphagia. We investigated patient's age, gender, arterial hypertension, diabetes mellitus, atrial fibrillation, previous statin therapy, severity of stroke and localisation of stroke as possible predicting factors for post-stroke dysphagia.Our results showed that the only reliable predicting factor for post-stroke dysphagia was the location of the brain lesion, which according to our study were Brodmann areas 4, 8, 24, 30 and pons lesions.

Oropharyngeal dysphagia and malnutrition in patients with Covid-19 at the Consorci Sanitari Del Maresme, Catalonia, Spain: Prevalence and needs of compensatory treatment

Rationale: COVID-19 may manifest with a wide range of symptoms and its degree of severity may be from mild to severe. Our aim was to assess the prevalence and pathophysiology of oropharyngeal dysphagia (OD), malnutrition (MN), nutritional risk, and the needs of compensatory treatments in patients admitted due to COVID-19 at the Consorci Sanitari del Marseme (CSdM), Catalonia, Spain. Methods: Prospective observational study with clinical assessment of OD (clinical symptoms, clinical observation and Volume-Viscotisy Swallowing Test) and nutritional screening with NRS2002 and GLIM criteria in consecutive COVID-19 patients admitted at the Hospital de Mataró (CSdM) during 2020 Covid-19 pandemics. Patient’s clinical characteristics and their needs of compensatory treatments for OD and MN were assessed at baseline and will be followed up at 3 and 6 months. Here we present the baseline data. Results: We included 268 hospitalized patients, 52.2% men, with a mean age of 70.2±17.0 yr, severity of disease was moderate-severe in 34%. At hospital admission prevalence of OD was 52.4% (49.4% had impaired efficacy and 44.9% impaired safety of swallow). Pathophysiology of OD includes ICU and post-extubating factors (16%), neurological factors (32%), respiratory insufficiency (42%) and interstitial pneumonia (74%). Up to 43.7% of patients needed thickeners to be safely hydrated (38.7% with 250mPa·s and 5.2% with 800mPa·s of Xanthan Gum thickeners) and 54.5% had mastication impairments needing texture-modified diets (27.7% easy mastication and 28.8% puree). 74.2% of patients presented a NRS2002>3 and were at risk of MN, 46% had MN and 73.8% of patients received ONS. Conclusion: Prevalence of OD, nutritional risk and MN in patients with COVID-19 at admission in a General Hospital is very high. Pathophysiology is multifactorial and not limited to ICU factors. Early treatment includes fluid thickening, texture modified foods and nutritional support.

Relationship between Dysarthria and Oral-Oropharyngeal Dysphagia: The present evidence.

There is a high prevalence of dysphagia in patients with neuromuscular diseases and stroke, and consequences can be profound. However, the correlation of dysarthria and oral-oropharyngeal dysphagia remains unclear. This review aimed to define the clinical co-presentation of dysarthria and dysphagia in this population. A PubMed search to identify literature on the prevalence of dysarthria and dysphagia was systematically conducted in the English language literature since 1995. Subjective and objective outcomes instruments were identified for both dysarthria and dysphagia. Studies that included prevalence and co-presentation were included. Inclusion and exclusion criteria were applied according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). Of the 1,056 articles identified in the search, 20 articles met the search criteria. An additional 4 articles were examined for a total of 24 articles for analysis. Dysarthria and dysphagia were found to be highly prevalent among patients with neuromuscular disease (NMD). Overall, there was a higher prevalence of dysarthria than dysphagia. Of those patients with dysphagia, some reports estimate 76-90% of patients with NMD also had dysarthria. Dysarthria is a strong clinical clue to the presence of dysphagia. Existing subjective questionnaires may not reveal the presence of oropharyngeal dysphagia, but objective measures are more revealing. Further study to correlate the degree of dysarthria and severity of oral-oropharyngeal dysphagia are warranted.

Systematic Dysphagia Screening of Elderly Persons in the Emergency Department-A Feasibility Study.

Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.

Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial.

Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24h before, immediately after and 24h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P<0.001; 24h after TEE: P<0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P<0.001; 24h after TEE: P=0.007), for small (immediately after TEE: P=0.009) and large liquid boli (immediately after TEE: P=0.009; 24h after TEE: P=0.025). The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.

Translation and Validation of “Brief Bedside Dysphagia Screening Test” in a Greek Sample of Neurological Patients

Dysphagia may become a threatening condition if not diagnosed and treated at an early stage. Healthcare professionals require simple, rapid, and reliable tools for the immediate evaluation of dysphagia in their daily clinical practice. The aim of the present study was the translation and validation of the “Brief Bedside Dysphagia Screening Test-Revised (BBDST-R)” tool in the Greek language in a sample of patients with neurological disorders. The present study was designed as a cross-sectional study conducted with a convenience sample of 80 patients. The BBDST-R tool contains eight items, and a positive response to an item implies that the patient might have dysphagia. The bedside assessment using the BBDST-R tool was conducted by a researcher previously trained for the tool usage. The translation and validation were conducted by following the relevant international standards. The researcher’s final assessment concerning the presence or absence of dysphagia was compared to the medical diagnosis as determined by a physician, which was set as a benchmark. The evaluation of BBDST-R was conducted by researching its diagnostic accuracy according to the guidelines for measures of diagnostic accuracy. Internal consistency was determined through Cronbach’s Alpha. The English version of the BBDST-R tool has been reliably translated into the Greek language. The prevalence of dysphagia in our sample was 62.5% (95% CI: 50%-72%). The observed high sensitivity [Sen = 98%/87%-99% (95% CI)] and high negative predictive value [NPV = 89%/77%-95% (95% CI)] indicated high validity of the screening tool at the acceptable levels of &gt; 75% even for 95% CI. Cronbach’s Alpha internal consistency index for the 8 items of this tool presented an almost excellent value of 0.859. The results of the present study indicated that BBDST-R is a reliable and valid tool for application in the assessment of dysphagia in patients admitted in Greek hospitals and community-based individuals.

RS7: Palatability of Crushed Over-the-Counter Medications

Background: Dysphagia is a common concern for hospice patients, especially in the last several days of life. Due to the high prevalence of dysphagia, medications are often crushed for ease of admin...

Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study.

BackgroundDysphagia is a common health care problem and poses significant risks including mortality and hospitalization. China has many unsolved long-term care problems, as it is a developing country with the largest ageing population in the world. The present study aimed to identify the prevalence and risk factors of dysphagia among nursing home residents in China to direct caregivers towards preventative and corrective actions.MethodsData were collected from 18 public or private nursing homes in 9 districts of Nanjing, China. A total of 775 older adults (aged 60 ~ 105 years old; 60.6% female) were recruited. Each participant underwent a standardized face-to-face interview by at least 2 investigators. The presence of risk of dysphagia was assessed using the Chinese version of the EAT-10 scale. The Barthel Index (BI) was used to evaluate functional status. Additionally, demographic and health-related characteristics were collected from the participants and their medical files. Univariate analyses were first used to find out candidate risk factors, followed by binary logistic regression analyses to determine reliable impact factors after adjusting for confounders.ResultsOut of 775 older adults, the prevalence of dysphagia risk was calculated to be 31.1%. A total of 85.0% of the older adults reported at least one chronic disease, and diseases with the highest prevalence were hypertension (49.5%), stroke (40.4%), diabetes (25.5%) and dementia (18.2%). Approximately 11.9% of participants received tube feeding. The mean BI score was 56.2 (SD = 38.3). Risk factors for dysphagia were texture of diet (OR = 2.978, p ≤ 0.01), BI level (OR = 1.418, p ≤ 0.01), history of aspiration, pneumonia and heart attack (OR = 22.962, 4.909, 3.804, respectively, p ≤ 0.01), types of oral medication (OR = 1.723, p ≤ 0.05) and Parkinson disease (OR = 2.566, p ≤ 0.05).ConclusionsA serious risk of dysphagia was observed among Chinese nursing home residents. Overall, nursing home residents were moderately dependent, according to the BI level. The risk for dysphagia increased with thinner diet texture, worse functional status, history of aspiration, pneumonia and heart attack, more oral medications and Parkinson disease. The findings of our study may serve to urge nursing home staff to pay more attention to the swallowing function of all residents and to take more actions in advance to prevent or reduce dysphagia.

Association of swallowing problems with frailty in Chinese hospitalized older patients

ObjectiveTo estimate the prevalence of dysphagia and frailty among hospitalized older patients and to analyze the relationship between dysphagia and frailty in these people. MethodsData were collected on 386 participants aged 65 and older in a general hospital from April to December 2017. Patients were asked to complete a self-designed demographic questionnaire. Frailty and swallowing function assessments were performed using the Fried frailty phenotype and the 30-ml water swallowing test, respectively. Multiple stepwise logistic regression analyses were used to identify the association between frailty and dysphagia. ResultsDysphagia developed in 31.1% of older people, and 24.4% developed frailty. Frailty was statistically significantly related with dysphagia. Dysphagia was more prevalent in frail and pre-frail patients (48.9% and 32.4%, respectively) than those who were non-frail (13.6%). In multivariate analyses, frail（OR, 5.420; 95% CI, 2.684–10.944；P＜0.001） and history of choking/coughing while drinking（OR, 2.954; 95% CI, 1.844–4.733；P＜0.001）were associated with dysphagia.result. ConclusionsFrailty is associated with dysphagia. More attention should be paid to frailty and dysphagia of the elderly and further studies are needed to evaluate the correlated mechanism and develop targeted nursing interventions.

Risk factors of dysphagia in patients with ossification of the anterior longitudinal ligament.

Cervical ossification of the anterior longitudinal ligament (OALL) occasionally leads to dysphagia by the anterior osteophyte. A recent report explained that the dysphagia after an occipito-cervical fusion is caused by the narrowing of pharyngeal space due to the cranio-cervical malalignment. The purpose of this study was to evaluate the cranio-cervical alignment in patients with OALL complaining of the dysphagia. The subjects were 11 cases with complaining of dysphagia due to cervical OALL who underwent anterior cervical OALL resection and as control, age-matched 12 cases without dysphagia who have diffuse idiopathic skeletal hyperostosis in cervical spine. All subjects were male, and the mean age was 59.5 ± 9.1 years. The subjects were divided into two groups according to the symptoms of dysphagia (dysphagia, group A; control, group B). The O-C2 angle, C2-C7 angle, and the maximum thickness of OALL and the cranio-cervical alignment (pharyngeal inlet angle; PIA) and swallowing line (S-line) were measured before and after the operation on the lateral cervical radiogram at the sitting position. Group A showed significantly large maximum thickness of OALL, small cervical range of motion, small O-C2 angle, large C2-C7 angle, and small PIA. The S-line crossed the anterior apex of cervical osteophyte in group A. After OALL resection, dysphagia had improved, PIA had increased, and the S-line uncrossed the apex of cervical vertebrae in all cases. The prevalence of dysphagia in patients with cervical OALL was influenced by the thickness of osteophyte, cervical mobility, and cranio-cervical alignment.

Mechanisms of Impaired Swallowing on Thin Liquids Following Radiation Treatment for Oropharyngeal Cancer.

PurposeDysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer. Despite the high prevalence of dysphagia in patients with head and neck cancer, we lack understanding of the specific changes in swallowing physiology that arise in the short-term following radiation therapy and how these changes impact the key functions of swallowing safety and efficiency. This study sought to identify pathophysiological mechanisms underlying impairments in swallowing safety and efficiency on thin liquids following (chemo)radiation for oropharyngeal cancer.MethodVideofluoroscopic swallowing studies were completed in 12 male patients within 6 months following completion of (chemo)radiation and in 12 healthy male controls. To compare swallowing function and physiology between groups, we analyzed three discrete sips of 20% w/v thin liquid barium per participant. The videofluoroscopic swallowing study recordings were rated for swallowing safety, efficiency, timing parameters, and pixel-based measures of structural area or movement.ResultsThe oropharyngeal cancer cohort displayed significantly higher frequencies of penetration–aspiration, incomplete laryngeal vestibule closure, prolonged time-to-laryngeal vestibule closure, and poor pharyngeal constriction. Incomplete or delayed laryngeal vestibule closure was associated with airway invasion, while poor pharyngeal constriction was associated with pharyngeal residue.ConclusionsThis study highlights the primary mechanisms behind impaired safety and efficiency of the swallow in patients following (chemo)radiation for oropharyngeal cancer.

Chewing Screen and Interventions for Older Adults

Seeing older adults with nasogastric (NG) tubes in nursing homes is an unfortunately widespread phenomenon in Taiwan. NG tubes deprive the wearer of the tastes, smells, and joys of food and have been associated with malnutrition and increased susceptibility to aspiration pneumonia. In our studies, we found that 43% of nursing home residents in Taiwan are intubated with an NG tube and revealed a significant lower body mass index and hypoalbuminemia in these residents. In addition, the prevalence of dysphagia in residents of long-term care institutions was found to be greater than 60%. Older adults with dysphagia usually rely on liquid diets, which are frequently low in fiber, fruit, vegetable, and cereal contents. It is well known that diets low in fiber and vegetables increase the risks of constipation and cardiovascular events in older adults. A low intake of plant flavanols may also make older adults more susceptible to chronic inflammation. A high intake of red meats, eggs, or seafood may nurture gut microorganisms that catabolize carnitine and choline to trimethylamine-N oxide and which have been significantly linked to cardiovascular diseases and increased mortality. In contrast, eating plant vegetables and cereals is known to nurture better microbiota that produce short chain fatty acids, which, in turn, nurture enterocytes and improve immunity and brain health. Thus, the aims of this article are to demonstrate how to assess elders with chewing difficulty and dysphagia and to provide functional food scales for the classification, training, and care of active-aging nutrition. Through this article, we anticipate helping long-term care caregivers master key techniques for training and caring for elders with chewing difficulties and/or dysphagia. This article is also expected to 1) improve the nutrition of elders and satisfaction with feeding, 2) improve chewing and dysphagia care and training in long-term care institutions, and 3) avoid NG tube institution and aspiration pneumonia. The suggestions of this article may be used in the future to assist long-term care units across the interdisciplinary care providers teams to promote chewing instruction, swallowing care training, and active aging, appropriate nutrition, and health in older adult populations.

Confronting Presbyphagia and Oropharyngeal Dysphagia

The ability to swallow efficiently and safely is essential to maintaining nutrition, hydration, health status, and quality of life. The process of swallowing requires coordination among a complex series of psychological, sensory, and motor behaviors that are both voluntary and involuntary (Balou, Herzberg, Kamelhar, & Molfenter, 2019). Presbyphagia refers to the changes associated with natural, healthy aging in the head and neck anatomy and in the physiologic and neural mechanisms that underpin the function of swallowing (Cichero, 2018). This progression of change contributes, in part, to a natural decline in the ability of the body to adapt to physiological stress. Chewing impairment and dysphagia are syndromes that are most-often associated with old age. The World Health Organization included oropharyngeal dysphagia in the International Statistical Classification of Diseases and Related Health Problems (ICD) under subordinate codes 787.2 ICD9 and R13.10 ICD10 (Centers for Disease Control and Prevention, 2015). The reported prevalence of oropharyngeal dysphagia among older adults has varied widely among studies, subjects, and locations (Ortega, Cabré, & Clavé, 2014). For example, the reported prevalence of chewing and swallowing disorders among community-healthy elders ranges between 11%~60% (Di Pede, Mantovani, Del Felice, & Masiero, 2016). Oropharyngeal dysphagia is an important factor that causes malnutrition and aspiration pneumonia in the elderly (Imaizumi et al., 2020). In view of the increasing prevalence of chewing and swallowing difficulties, PEACE has been adopted as the theoretical framework for this column "Perspectives on Chewing and Swallowing Care". The ultimate goal is to enable people to live long and enjoy a satisfactory quality of life (Enjoyment). To achieve this goal, people must have the ability to preserve in good condition the muscle groups and mechanisms related to swallowing (Preservation). However, preservation depends on three strategies: (1) Enhancing the knowledge and care skills related to chewing and swallowing difficulties, such as addressed in the four articles in this column: "Chewing screen and interventions for the elders", "The triangular relationship among swallowing disorder, aspiration pneumonia, and poor oral hygiene", "International classification systems of texture-modified foods", and "Innovative development of texture-softened foods for older adults living in residential care". (2) Holding a positive attitude (Attitude), especially regarding the potential for thoroughly implementing oral hygiene to break the vicious cycle of dysphagia-related aspiration pneumonia. Trust that people have the ability to maintain the strength of chewing and swallowing muscle groups and to resolve the comorbidities associated with sarcopenia and presbyphagia. (3) Practicing consistency in knowledge and action. Chewing and swallowing-related knowledge and care skills and positive attitudes may still be insufficient if knowledge and action are not united. When knowledge and action are united, the body may maintain to a good state of function and patients may enjoy peace through their life journey.

Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results

BackgroundRefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected.MethodsIn a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for 1 year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-h pH monitoring, and reduction in average daily PPI usage and subject satisfaction.ResultsThere were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p < 0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH < 4 from 16.35 to 0.80% at the 6-month visit (p < 0.001), with 98% of subjects showing normal 24-h pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects.ConclusionThe new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.Trial registrationClinicalTrials.gov, NCT02759094. Registered 3 May, 2016,

Issue Highlights

Issue Highlights

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis

BackgroundDysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. ObjectiveTo identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. MethodDysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. ResultsThe mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS.There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). ConclusionMS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.