Onset Of Dysphagia Research Articles

Time to Onset of Dysphagia Following Head and Neck Radiation.

To evaluate the time of onset of dysphagia in a cohort of head and neck cancer patients treated with radiation or chemoradiation. Retrospective chart review of adult patients. 237 patients met inclusion criteria for the study. The average age at cancer diagnosis was 62 years (± 12.6) in a predominantly male cohort (n = 198, 83.5%). The most common subsite was oropharyngeal (n = 146, 60.8%) and squamous cell carcinoma in origin (n = 232, 97.9%). Of head and neck cancer patients diagnosed with new onset dysphagia or a dysphagia related diagnosis, nine (3.8%) were diagnosed at six months to 1 year, 12 (5.1%) at 1-2 years, and 17 (7.1%) at greater than 2 years. The mean radiation dose to the larynx was 43.8Gy (Gy) (± 14.5) and statistically significant across time the periods (p = 0.018, η2 = 0.161). No difference was found between age, HPV status, T stage, smoking history, or tumor site. The majority of head and neck cancer patients treated with chemoradiation who developed dysphagia did so within the acute time period (during treatment and up to 6 months post treatment). However, a substantial proportion of patients also developed dysphagia in later time periods (16%). The incidence of dysphagia in certain time periods may be impacted by laryngeal radiation dose. Therefore, we recommend long term monitoring/screening of these patients so early intervention can occur.

Dysphagia and chest pain in a 7-year-old girl.

Dysphagia is a common gastrointestinal complaint in the pediatric population and should raise concern for oropharyngeal as well as esophageal disorders. We describe a 7-year old patient who was admitted to the hospital for sudden onset dysphagia, abdominal pain, and decreased oral intake. Extensive evaluations including endoscopy eventually revealed herpes simplex esophagitis as well as eosinophilic esophagitis. Herpes simplex esophagitis is a rare condition in the immunocompetent population and is typically self-resolving. Eosinophilic esophagitis is a chronic, inflammatory condition characterized by esophageal eosinophilia and signs of esophageal dysfunction. The concurrent presentation of both conditions in the pediatric population has rarely been described.

How effective is our current follow-up for patients with hypopharyngeal carcinoma?

The study aimed to evaluate the diagnostic efficacy of routine follow-up in detecting recurrent disease in hypopharyngeal carcinoma. Data from 76 patients with a total of 620 follow-up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms. All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients' symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001). Symptom assessments and clinical examinations are highly efficient for detection of local failures.

Esophageal food bolus impaction in pediatric age.

Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children. We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation. Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication,and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food. Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.

Early and severe onset of esophageal dysfunction after laparoscopic sleeve gastrectomy: a case report and review of literature

After bariatric surgery one of the most common complications is dysphagia. The etiology of this disease has not been fully elucidated but it is known that it may be due to structural changes due to surgery. This case describes a 65-year-old female with early and severe onset of dysphagia following laparoscopic sleeve gastrectomy. The patient's final diagnosis was postobesity surgery esophageal dysfunction and laparoscopic proximal gastrectomy with esophagojejunal Roux-en-Y anastomosis was performed. Physicians should be aware of this condition in order to offer early diagnosis and treatment.

Abstract 094: Sudden Onset Dysphagia: A Symptom To Be Aware of During Code Strokes

Introduction Lateral medullary infarction (LMI) can present with dysphagia, dysphonia, dysarthria, vertigo, nausea, skew deviation, and ipsipulsion. Patients may also exhibit sensory loss and ipsilateral Horner’s syndrome. LMS often develops because of an acute infarct from the vertebral arteries or posterior inferior cerebellar arteries (PICA). The most common mechanism of stroke usually is atherothrombosis, followed by cardioembolic, dissection and embolic source of undetermined source (ESUS). While dysphagia often accompanies the constellation of LMS symptoms, it is rarely the first symptom and has only been reported in a few cases in the literature. In this report we describe the case of a man in his 40s with acute onset dysphagia as the presenting finding ahead of an LMS diagnosis. Methods The patient was identified in routine clinical practice. Results A man in his 40s with medical history of HTN, type 2 DM and polycystic kidney disease, presented with sudden‐onset dysphagia which started while he was drinking alcohol. Later he noticed that he was unable to keep his balance. His National Health Institute Stroke Scale was 4. Neurologic exam was pertinent for left‐sided miosis, ptosis, and dysmetria. Pinprick and temperature sensation were decreased on the right arm and leg. Facial sensation to light touch was diminished on the left. Brain MRI showed an acute infarct in the left lateral medulla (Figure A). CTA showed calcified atherosclerosis of the V4 segment of left vertebral artery (Figure B). Mechanism of ischemic stroke was artery to artery thromboembolism from the left V4 segment of vertebral artery. For secondary prevention, dual antiplatelet therapy, high intensity statin, and optimization of his risk factors were initiated. Conclusion This case report demonstrates that dysphagia can be the initial symptom of an acute ischemic stroke. Diagnosis and recognition of an atypical presentation of lateral medullary syndrome can pose a particular challenge especially in this era of “time is brain” but is of the utmost importance to facilitate good outcomes. Patients presenting with dysphagia who have risk factors for stroke and no other obvious etiology for their symptoms should be worked up for possible cerebrovascular etiology.

The Effect of Dysphagia on Quality of Life in Stroke Patients

Purpose: Dysphagia is a prevalent condition following a stroke. Dysphagia and its implications negatively affect quality of life (QOL) aspects. The purpose of this study was to measure the effect of dysphagia on QOL aspects, and to explore its association with sociodemographic factors.Methods: This cross-sectional study included 31 stroke patients with dysphagia. The effect of dysphagia on QOL aspects was measured using the Dysphagia Handicap Index (DHI). Demographic variables included gender, age, educational level, annual family income and the time of onset of dysphagia.Results: The majority of the participants (61.3%) were male, and 67.7% were between 60-70 years old. The onset of dysphagia was less than three months for most of the patients (61.3%). The mean±SD of the DHI total score was 53.5±9.6. Furthermore, the study’s findings revealed significant mean differences in the physical subscale (&lt;i&gt;p&lt;/i&gt;=0.003), emotional subscale (&lt;i&gt;p&lt;/i&gt;=0.020), and the DHI total score (&lt;i&gt;p&lt;/i&gt;=0.005) between groups with different onsets of dysphagia. This means that the effect of dysphagia on physical and emotional aspects, as well as overall quality of life, diminishes over time following a stroke.Conclusions: This study’s results underscore the adverse effect of dysphagia on QOL aspects in stroke patients, with a gradual reduction in this impact over the post-stroke period.

474. MANOMETRIC IDENTIKIT OF A FUNCTIONING AND EFFECTIVE FUNDOPLICATION IN THE HIGH-RESOLUTION MANOMETRY ERA

Abstract Background Assessing patients following Laparoscopic Fundoplication (LF) can be challenging. Functional information provided by pathophysiological testing—which can shed light on the cause of recurrent symptoms—could be key to clinical decision making. The value of performing High-Resolution Manometry (HRM) after LF is still unclear and debated. We sought to establish the HRM parameters indicative of a functioning fundoplication, and whether HRM could distinguish it from a tight or defective one. Methods We studied patients with gastroesophageal reflux disease (GERD) who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication between 2010–2022. HRM and pH monitoring were performed before and 6 months after surgery. LF failure was defined as GerdQ score ≥ 8 and abnormal 24 h-pH study or just abnormal 24 h-pH study. The study population was divided into 5 groups: LN and LT patients with normal pH monitoring (LNpH- and LTpH-, respectively); LN and LT patients with pathological pH monitoring (LNpH+ and LTpH+ groups, respectively); and patients with postoperative severe dysphagia (Dysphagia group). The novel Hiatal Morphology (HM) classification was applied, envisaging 3 subtypes: HM1 (normal morphology); HM2 (intrathoracic fundoplication); and HM3 (slipped fundoplication). Results We recruited 132 patients: 46 in the LNpH- group, 51 in the LTpH- group, 15 in the LNpH+ group, 7 in the LTpH+ group, and 5 in the Dysphagia group (Figure 1). Eight patients with GerdQ score ≥ 8 and normal 24 h-pH findings were excluded. At univariate analysis, postoperative lower esophageal sphincter (LES) basal pressure (p = 0.011), total and abdominal LES length (p = 0.014, p &amp;lt; 0.001) were correlated with LF failure. At multivariate analysis, postoperative abdominal LES length (p = 0.001) and HM2 (p &amp;lt; 0.001) were independently associated with surgical failure. Integrated relaxation pressure (IRP) was significantly higher in the Dysphagia group than in the LNpH- group. Conclusion This study generated reference HRM values for an effective LF and confirms that using HRM to assess the abdominal portion of the neo-sphincter and abnormal hiatal morphology (HM2) improves the clinical assessment of recurrent symptoms. HRM can distinguish patients with a well-functioning wrap from those developing recurrent GERD due to an ineffective wrap. Postoperative IRP also correlated significantly with the onset of dysphagia after surgery.

Primary thyroid tuberculosis mimicking papillary carcinoma of thyroid: a rare case report.

A 54-year-old female presented with recent onset dysphagia and foreign body sensation in the throat for 3 months, and anterior neck swelling since last 10 years. A single nodular firm anterior neck swelling was present which moves with deglutition. Thyroid function test was normal. Ultrasonography thyroid revealed TIRADS-3. Fine-needle aspiration cytology was suggestive of papillary carcinoma of thyroid. Total thyroidectomy with central compartment neck dissection was performed. Histopathology of the thyroid specimen revealed tubercular thyroiditis. Postoperatively, Mantoux test and interferon gamma radioassay were positive. Antitubercular therapy was given for total of 6 months. With ultrasonography-guided fine-needle aspiration cytology, preoperative diagnosis of primary thyroid tuberculosis is quite challenging even in tuberculosis endemic countries. So, it should be considered one of the differential diagnoses despite negative relevant history and without clinical cervical lymph nodes involvement with cytology proven suspicious papillary thyroid cancer before proceeding for surgical intervention.

Immune Checkpoint Inhibitors Related New Onset Myasthenia Gravis: Case Series (P4-5.028)

<h3>Objective:</h3> Immune checkpoint inhibitors (ICI), such as cytotoxic lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) axis are treatment for several malignancies. Myasthenia gravis (MG) is a rare but life-threatening adverse event of ICI. <h3>Background:</h3> With ICI single agent use, 42 cases of new-onset MG are reported in literature, among those, 14 patients developed severe respiratory failure and required intubation whereas 10 patients died. Combination ICI-induced MG was reported in 7 cases, with at least 2 cases complicated by respiratory failure and 1 death. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms). <h3>Design/Methods:</h3> Case series and literature review <h3>Results:</h3> <h3>Case 1:</h3> 87-year-old woman with stage IV adenocarcinoma of colon received pembrolizumab. Ten days after second dose she presented with worsening new onset bilateral ptosis (left&gt;right) and dysphagia, seropositive with acetylcholine receptor antibodies. There was no significant improvement after a course of IVIG in combination with high dose steroids. A trial of pyridostigmine could not be completed due to symptomatic bradycardia and hospice care was started thirty-eight days after first dose of pembrolizumab. <h3>Case 2:</h3> 73-year-old man with metastatic melanoma, received 2 doses of combined ipilimumab and nivolumab. Fifteen days after second dose, he presented with worsening dysphagia, dysarthria, fatigable generalized weakness and shortness of breath, seronegative for MG antibodies. Symptoms improved dramatically with IVIG. His course was complicated by rostral brainstem ischemic stroke and discharged to hospice ninety-four days after the first dose of combined ipilimumab and nivolumab <h3>Conclusions:</h3> Evidence is limited and data from a large cohort of patients is needed to recognize and manage this fatal complication. <b>Disclosure:</b> Dr. Habib has nothing to disclose. Dr. Ahmed has nothing to disclose. Dr. Al-Awwad has nothing to disclose. Sarah Sung, MD has nothing to disclose.

Asystole, A Rare Cardiac Complication of Lateral Medullary Infarction: Case report and Literature Review. (P2-5.010)

<h3>Objective:</h3> We report a case of lateral medullary infarction leading to asystole, and we discuss the diagnosis, management, and prognosis of patients with this rare complication. <h3>Background:</h3> Clinical presentations of lateral medullary stroke vary. Wallenberg syndrome is the most common presentation, which includes vertigo with nystagmus, ataxia, ipsilateral sensory deficits in the face, bulbar muscle weakness, and ipsilateral Horner’s syndrome. The nucleus tractus solitarius, the dorsal vagal nucleus, and the nucleus ambiguous in the lateral medulla oblongata play a critical role in autonomic regulation and have centers for respiratory, cardiac, and vasomotor reflexes. Despite this, cardiac arrhythmias such as asystole are a rare clinical manifestation of lateral medullary stroke. <h3>Design/Methods:</h3> Case report and literature review. <h3>Results:</h3> A 64-year-old man with hypertension, previously involved in a motor vehicle accident, presented with acute onset dysphagia, left facial droop, and left eye ptosis. CT of the head did not show any acute stroke or hemorrhage. CT angiography of the head and neck showed left vertebral artery (V3/V4 segment) occlusion. He received IV thrombolysis. Post thrombolysis, he had bradycardia evolving to asystole and brief cardiac arrest. MRI of the brain revealed acute left posterior lateral medullary stroke and MR angiography showed left vertebral artery dissection. Cardiac work-up was unrevealing, and he eventually required placement of a dual-chamber pacemaker. Given the absence of respiratory factors and structural heart disease, the bradycardia and asystole were attributed to the lateral medullary stroke. <h3>Conclusions:</h3> Despite the recognized role of the lateral medulla in autonomic regulation, cardiac arrhythmias are rarely associated with lateral medullary infarction. Precise mechanisms are yet to be elucidated, but it remains important to recognize them as a potential complication of this stroke. <b>Disclosure:</b> Dr. Gutierrez Quiceno has nothing to disclose. Dr. Gowda has nothing to disclose. Dr. Kakadia has nothing to disclose.

Subepithelial hematoma of the esophagus: an unusual cause of chest pain and dysphagia.

A 68-year-old man presented to the emergency department with sudden onset retrosternal pain and dysphagia. He was taking acetylsalicylic acid (100 mg once daily), ticagrelor (90 mg every 12 h), rosuvastatin (10 mg once nightly) and long-acting metoprolol (47.5 mg once daily) for coronary artery

DYSPHAGIA FOLLOWING HOSPITALIZATION IN NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS

Abstract Dysphagia frequently occurs in nursing home (NH) residents with Alzheimer’s Disease and Related Dementias (ADRD), often leading to serious health outcomes (e.g., pneumonia, malnutrition, reduced quality of life). While it is known that hospitalized NH residents with ADRD experience high rates of iatrogenic complications, dysphagia following discharge has not been examined. A retrospective cohort of all NH residents in the US (older adults aged ≥66) with advanced ADRD (Cognitive Function Scale ≥2), hospitalized between 2013-2017, and without a feeding tube or reported dysphagia on a Minimum Data Set (MDS) 3.0 assessment within 120 days prior to hospitalization was constructed. Treatment with intermittent mandatory ventilation (IMV) or non-invasive ventilation (NIV) during hospitalization and dysphagia status on the first post-hospitalization MDS was recorded. Data were analyzed using descriptive statistics and random effects multivariate logistic models that adjusted for age, gender, race/ethnicity, CFS score, ADL score, and comorbidities. Among the 805,199 residents with ADRD who survived the hospitalization and returned to the NH, new onset dysphagia occurred in 53,807 (6.7%; 95% CI 6.6-6.7) of residents. After adjustment, invasive mechanical ventilation (IMV) use was associated with increased risk of new onset of dysphagia (AOR 1.5; 95% CI 1.4-1.6) and non-invasive mechanical ventilation (NIMV) only slightly increased the risk (AOR 1.3; 95% 1.2-1.3). NH residents with ADRD are at risk for dysphagia following hospitalization. These findings emphasize the importance of swallowing evaluation and dysphagia treatment during hospitalization for ADRD patients, especially those treated with IMV or NIV, to prevent further negative health outcomes.

Dysphagia in progressive supranuclear palsy: A scoping review protocol

BACKGROUND: One of the most prevalent types of atypical Parkinsonian syndrome is progressive supranuclear palsy (PSP). PSP is associated with early onset of dysphagia which can result in malnutrition, dehydration, and aspiration pneumonia, affecting quality of life and increasing mortality rate. To date, research describing dysphagia in PSP and its impact is scant. OBJECTIVE: The objective of this scoping review is to determine the characteristics of dysphagia in PSP, differences in dysphagia presentation according to PSP subtype, principal methods used for identifying and diagnosing dysphagia and the impact dysphagia has on quality of life in individuals with PSP. METHODS: The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of the review (Tricco et al., 2018). Articles completed at any time, which include participants with dysphagia and a clinical diagnosis of PSP will be included. Studies involving participants who have a co-morbidity/morbidities which could cause dysphagia and secondary research will be excluded. Relevant electronic databases, trial registries and grey literature without any date or language restrictions will be searched. Two independent reviewers will assess articles for eligibility and will extract relevant data. CONCLUSIONS: This scoping review will provide important evidence on dysphagia and PSP. It will describe the principal methods used for identifying and diagnosing dysphagia in this population. The results will guide future research in dysphagia and PSP.

Invasive squamous cell carcinoma causes trigeminal nerve dysfunction in a horse

SummaryA 12‐year‐old Irish Sports Horse gelding was presented for investigation of a 4‐month history of recurrent right sided corneal ulceration and sudden onset dysphagia and inappetence. Cranial nerve examination revealed dysfunction of the right oculomotor nerve and trigeminal nerve. Computed tomography of the skull demonstrated a mass in the region of the orbital fissure, in close association with the oculomotor and trigeminal nerves. Following the assessment, the gelding was euthanised and post‐mortem examination was performed. Histopathology of the mass confirmed that the tumour was a squamous cell carcinoma. This case report highlights the benefits of detailed clinical examination to localise a neurological lesion, and the need for histology to confirm the diagnosis.

Facet Distraction and Dysphagia: A Prospective Evaluation of This Common Postoperative Issue Following Anterior Cervical Spine Surgery.

Prospective cohort study. Our primary study was to investigate whether the degree of postoperative facet and disk space distraction following anterior cervical discectomy and fusion (ACDF) affects the rate of postoperative dysphagia. Although ACDF is safe and well tolerated, postoperative dysphagia remains a common complication. Intervertebral disk space distraction is necessary in ACDF to visualize the operative field, prepare the endplates for fusion, and facilitate graft insertion. However, the degree of distraction tolerated, before onset of dysphagia, is not well characterized ACDF. A prospective cohort study was conducted of 70 patients who underwent ACDF between June 2018 and January 2019. Two independent reviewers measured all preoperative and postoperative radiographs measured for interfacet distraction distance and intervertebral distraction distance, with intrareviewer reproducibility measurements after one month. For multilevel surgery, the level with the greatest distraction was measured. Primary outcomes were numerical dysphagia (0-10), Eating Assessment Tool 10, and Dysphagia Symptom Questionnaire score collected at initial visit and two, six, 12, and 24 weeks postoperatively. A total of 70 patients were prospectively enrolled, 59 of whom had adequate radiographs. An average of 1.71 (SD: 0.70) levels were included in the ACDF construct. Preoperatively, 13.4% of patients reported symptoms of dysphagia, which subsequently increased in the postoperative period at through 12 weeks postoperatively, before returning to baseline at 24 weeks. Intrareviewer and interreviewer reliability analysis demonstrated strong agreement. There was no relationship between interfacet distraction distance/intervertebral distraction distance and dysphagia prevalence, numerical rating, Eating Assessment Tool 10, or Dysphagia Symptom Questionnaire. Patients who had an ACDF have an increased risk of dysphagia in the short term, however, this resolved without intervention by six months. Our data suggests increased facet and intervertebral disk distraction does not influence postoperative dysphagia rates. 3.

Abstract 11378: Spontaneous Esophageal Hematoma in Chronically Anticoagulated Atrial Fibrillation

Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.

DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: A US-BASED INSURANCE CLAIMS DATA ANALYSIS

<h3>Introduction</h3> Real-world data on demographics and clinical characteristics of patients with eosinophilic esophagitis (EoE) are limited. We described patient characteristics, clinical symptoms, and comorbidities in US patients with newly-diagnosed EoE. <h3>Methods</h3> Retrospective analysis of 2017–2021 US MarketScan Commercial and Medicare administrative claims data including EoE patients with ≥12 months' continuous health plan enrollment pre- and post-first observed EoE diagnosis (index date). Demographic characteristics, clinical symptoms, and comorbidities pre-index in patients with incident (newly diagnosed) EoE were reported overall and stratified by age at EoE index date: <12 years (children), ≥12–17 years (adolescents) and ≥18 years (adults). Statistics were descriptive. <h3>Results</h3> 12,694 patients with incident EoE were identified and included (63.5% male; mean [SD] age 38.2 [16.5] years). The most common symptoms observed pre-index were dysphagia (38.0%), acid reflux (36.5%), and abdominal pain (25.9%). Mean (SD) days from first recorded chest pain and abdominal pain diagnosis to EoE diagnosis were 150.1 (114.6) and 146.3 (114.9), respectively, longer than EoE-specific symptoms such as dysphagia (82 [90.2]). Time from onset of dysphagia to EoE diagnosis was shorter in adults than in children and adolescents. Common comorbidities at index are presented in the <b>Figure</b>. Children and adolescents have a higher frequency of concomitant allergic diseases compared with adults. <h3>Discussion</h3> The presence of concomitant diseases and symptoms such as dysphagia and abdominal pain suggests a high disease burden. Comorbidities, presence of non-specific symptoms, duration of symptoms and patient age should be considered for a timely diagnosis of EoE.

A rare young case of Foix Chavany Marie syndrome

Foix Chavany Marie syndrome, also called as bilateral opercular syndrome (OPS) was first described in 1837 by Magnus and further defined by Foix, Chavany and Marie in 1926 after whom it was named so. Here, we present a case of 37-year-old female, with known recurrent CVA who presented with sudden onset aphasia, dysphagia and difficulty in opening and closing her mouth and drooling of saliva. On imaging, patient was found to have ischemia of bilateral operculum.

Dysphagia in the Presence of Varicella-Zoster Virus and SARS-CoV-2: A Case Report on the Role of Speech-Language Pathology

Purpose: Dysphagia due to cranial nerve neuritis is a rare complication of varicella-zoster virus reactivation. In this case report, we describe a single patient diagnosed with varicella-zoster virus meningitis with acute onset dysphagia, the instrumental assessments and interventions employed by speech-language pathologists (SLPs), and discuss the role of these clinicians in the management of these patients. Conclusion: The results of this case study demonstrate the importance of a multidisciplinary team approach and the vital role of SLPs in the evaluation and treatment of dysphagia of unknown etiology.