Risk Of Dysphagia Research Articles

Eating Assessment Tool (EAT-10) Scores to Detect Self-Reported Dysphagia in Brazilians.

The Eating Assessment Tool (EAT-10) detects swallowing impairments (dysphagia) self-reported by patients according to their perception. This noninvasive, inexpensive, self-administered instrument is quickly and easily filled out. The objective of this investigation was to evaluate the scores, sensitivity, and specificity of the method to define self-reported dysphagia in Brazilians. EAT-10 scores were evaluated in 443 healthy individuals (273 women and 170 men), aged 20 to 84years, with no swallowing difficulties or diseases, and 72 patients with diseases that cause dysphagia (35 women and 37 men), aged 29 to 88years. Each of the 10 instrument items has a 0-4 rating scale, in which 0 indicates no problem and 4, a severe problem; total results range from 0 to 40. The median EAT-10 score of healthy subjects was 0 (range: 0-20), and that of patients was 14.5 (range: 1-40). Considering a ≥ 3 cutoff score to define dysphagia risk, it was self-reported by 97.2% of patients with dysphagia and 9.5% of no-disease individuals (97.2% sensitivity and 90.7% specificity). The positive predictive value of the test was 63% and the negative predictive value was 99.5%. Healthy women had higher scores (median 0, range: 0-20) than healthy men (median 0, range: 0-8, p < 0.01) and more results indicative of self-reported dysphagia (11.7%) than healthy men (5.9%). The EAT-10 cutoff score to detect self-reported dysphagia in Brazilians should be 3, as previously considered. Healthy women complain more of self-reported dysphagia than healthy men. The test has high sensitivity and specificity.

Type II Odontoid Fractures: Is the Anterior Screw a Good Solution for all Patients? A Case Series of 60 Consecutive Patients

Type II odontoid fracture is the most common fracture type, and its treatment remains challenging. The objective of this study was to evaluate the results of anterior screw fixation for type II odontoid fractures in patients aged over and below 60 years. A retrospective analysis of consecutive patients diagnosed with type II odontoid fractures who were surgically treated using the anterior approach by a single surgeon was conducted. Demographic characteristics, including age, sex, type of fracture, time from trauma to surgery, length of stay (LoS), fusion rate, complications, and reoperation, were evaluated. Surgical outcomes were compared between patients over and below 60 years of age. Sixty consecutive patients underwent odontoid anterior fixation during the analysis period. The mean age of patients was 49.58 ± 23.22 years. Twenty-three (38.3%) patients were aged over 60 years, and the minimum follow-up period was two years. Of the patients, 93.3% developed bone fusion, which was observed in 86.9% of patients over 60 years. Complications related to hardware failure occurred in six (10%) patients. Transient dysphagia was observed in 10% of the cases. Three (5%) patients required reoperation. Patients over 60 years had a significantly increased risk of dysphagia compared with those below 60 years (P= 0.0248). There was no significant difference between the groups regarding nonfusion rate, reoperation rate, or LoS. Anterior fixation of the odontoid showed high fusion rates with a low rate of complications. It is a technique to be considered for treating type II odontoid fractures in selected cases.

RELATIONSHIP BETWEEN NUTRITIONAL STATUS, DYSPHAGIA, AND FUNCTIONAL EATING LEVEL IN ADULT PATIENTS WITH CEREBRAL PALSY IN LONG INSTITUTIONAL STAYS.

Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). : There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

Self-Reported Dysphagia and Psychosocial Health Among Community-Dwelling Older Adults: Results of a National Study.

The risk of dysphagia increases with age, affecting up to 33% of adults over the age of 65. Older adults with dysphagia are at increased risk for negative physical health outcomes such as aspiration pneumonia and death. However, the relationship between dysphagia and psychosocial health is uncertain in this population. We aimed to assess the associations between dysphagia and psychosocial health among older adults (≥ 65) with self-reported dysphagia. We performed a cross-sectional assessment of the National Health and Aging Trends Study (NHATS) conducted in 2019. Weighted logistic and linear regression models were used to assess the relationship between self-reported dysphagia and psychosocial health using established patient-reported outcome measures including those for depression, anxiety, and social isolation previously used in NHATS analyses, while adjusting for demographics, comorbid conditions, and risk factors for dysphagia identified by purposeful selection. Among the 4041 adults in this cohort, almost half (40%) were between 70 and 74years old, more than half were female (55%), and a significantly higher proportion were White, non-Hispanic respondents (78.1%, p < 0.01) compared with other races and ethnicities. There were 428 (10.5%) respondents reporting dysphagia symptoms within the previous month. In the multivariable model, dysphagia was associated with significantly increased odds of anxiety (OR 1.33 [1.06, 1.67]) and a significantly decreased sense of well-being (coefficient - 1.10 [- 1.66, - 0.54]), but no association was detected for social isolation. When accounting for factors associated with underlying physical health status, self-reported dysphagia is independently associated with negative psychosocial health and warrants attention by healthcare providers. Future studies should aim to identify causal factors and the extent to which interventions may mitigate these factors.

Early predictors of dysphagia in ischaemic stroke patients.

Post-stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia. Ischaemic stroke patients underwent clinical, cognitive and pre-morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale. In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05), pre-event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09-1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49-2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82-19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05-2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85-0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95% CI 1.04-1.56), admission NIHSS (OR 1.88, 95% CI 1.56-2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44-32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95-7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83-0.96) and thrombolysis (OR 0.77, 95% CI 0.23-0.95) had a protective role. The 6-point "NOTTEM" (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk. Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.

Clinical Risk Factors for Dysphagia and Esophageal Dysmotility in Systemic Sclerosis.

Systemic sclerosis (SSc) is often associated with dysphagia and esophageal dysmotility; however, only a few clinical studies on this topic have been conducted. Patients with SSc who underwent swallowing examinations and esophagography at our institution between 2010 and 2022 were included. A retrospective evaluation of the patients' backgrounds, autoantibody positivity, swallowing function, and esophageal motility was performed using medical charts. The association between dysphagia and esophageal dysmotility in patients with SSc and respective risk factors was investigated. Data were collected from 50 patients. Anti-topoisomerase I antibodies (ATA) and anti-centromere antibodies (ACA) were detected in 21 (42%) and 11 (22%) patients, respectively. Dysphagia was present in 13 patients (26%), and esophageal dysmotility in 34 patients (68%). ATA-positive patients had a higher risk for dysphagia (p = 0.027); ACA-positive patients had a significantly lower risk (p = 0.046). Older age and laryngeal sensory deficits were identified as risk factors for dysphagia; however, no risk factors for esophageal dysmotility were identified. No correlation was found between dysphagia and esophageal dysmotility. Esophageal dysmotility is more common in patients with SSc than in those with dysphagia. Autoantibodies can be predictors of dysphagia, and dysphagia must be carefully considered in ATA-positive and elderly patients with SSc.

A preliminary cross-sectional study to investigate the presence of sarcopenic dysphagia in a Portuguese geriatric population

The objective of this study is to investigate the presence of sarcopenia and the risk of oropharyngeal dysphagia (OD) in a geriatric population and to analyze the relationship between the factors associated with sarcopenic dysphagia. The cross-sectional study was carried out in two nursing homes. The presence of OD was screened using the gugging swallowing screen, and sarcopenia was assessed according to the European working group on sarcopenia in older people criteria. The sample (N=36; 23 women, 13 men) presents a mean age of 88.0±5.6, with 55.6% being at risk of OD, 52.8% with sarcopenia, and 36.1% with probable sarcopenic dysphagia. The score of the simple questionnaire to rapidly diagnose sarcopenia (SARC-F)≥4 was a significant predictor (odds ratio=9.0; confidence interval 95%=1.285-63.025) for the risk of having sarcopenic dysphagia. It was observed that sarcopenia was associated with higher odds of being at risk of OD. Also, an increase in age, poorly fitting prostheses, a higher level of dependence during activities of daily living, and a risk of malnutrition or malnourishment raised the potential of having probable sarcopenic dysphagia. We suggest including a speech and language therapist in the multidisciplinary geriatric teams to improve the prevention of sarcopenic dysphagia and to avoid its consequences.

Development and validation of a nomogram for predicting dysphagia in long-term care facility residents.

Dysphagia is a common problem that can seriously affect the health of elderly residents in long-term care facilities. Early identification and targeted measures can significantly reduce the incidence of dysphagia. This study aims to establish a nomogram to evaluate the risk of dysphagia for elderly residents in long-term care facilities. A total of 409 older adults were included in the development set, and 109 were included in the validation set. Least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables, and logistic regression was used to establish the prediction model. The nomogram was constructed based on the results of logistic regression. The performance of the nomogram was evaluated by receiver operating characteristic (ROC) curve, calibration, and decision curve analysis (DCA). Internal validation was performed using tenfold cross-validation with 1000 iterations. The predictive nomogram included the following variables: stroke, sputum suction history (within one year), Barthel Index (BI), nutrition status, and texture-modified food. The area under the curve (AUC) for the model was 0.800; the AUC value for the internal validation set was 0.791, and the AUC value for the external validation set was 0.824. The nomogram showed good calibration in both the development set and validation set. Decision curve analysis (DCA) demonstrated that the nomogram was clinically valuable. This predictive nomogram provides a practical tool for predicting dysphagia. The variables included in this nomogram were easy to assess. The nomogram may help long-term care facility staff identify older adults at high risk for dysphagia.

Gut dysmotility in children with neurological impairment: the nutritional management.

Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.

Incidence of dysphagia requiring medical attention in various types of cancers: A nationwide population-based cohort study

Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea. This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia. People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94). The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.

Surface Electromyography for Evaluating the Effect of Aging on the Coordination of Swallowing Muscles

Swallowing function can deteriorate with age, leading to a risk of dysphagia. Swallowing evaluation by surface electromyography (sEMG) can be easily and extensively applied for an elderly population. This study evaluated the temporal events observed by sEMG to clarify how aging affects the coordination among the masticatory and suprahyoid muscles. We recruited elderly individuals (over 65 years old) who denied dysphagia. The sEMG activities of anterior temporalis, masseter, and suprahyoid muscles were recorded during 3, 15, and 30 ml water swallowing tests (WST). We calculated the time interval between anterior temporalis and suprahyoid peak activity (T-SH interval) and masseter and suprahyoid peak activity (M-SH interval) and analyzed their correlation with age. The subjects who could and could not swallow 30 ml of water in one gulp were further assigned into the one-gulp and piecemeal groups, respectively, for subgroup analysis. We recruited 101 subjects, among whom 75 (26 males and 49 females) were analyzed after excluding those with suspected dysphagia or low-quality sEMG recordings. Age was significantly correlated with the bilateral T-SH (left: r = 0.249, p = 0.031; right: r = 0.412, p < 0.01) and right M-SH (r = 0.242, p = 0.037) intervals in the 30 ml WST. The correlation between intervals and age were observed in both subgroups. sEMG can be used to investigate the effect of aging on the temporal coordination between masticatory and suprahyoid contraction. Further studies are needed to verify the validity of screening subclinical dysphagia in the elderly.

Adherence of older people to a multidimensional program to improve health-related quality of life and functional capacity

BackgroundThe adherence of the elderly to therapeutic programs, either they are pharmacological or psychosocial, is generally low. ObjectiveIdentifying predictive variables of adherence of a social program from elderly with multifunctional independence or mild dependence. MethodProspective longitudinal design with 104 elderly participants in a social program. The inclusion criteria were: to participate in a social program for elderly, present functional independence or mild dependence, without depression clinically confirmed. Descriptive analyzes were performed with the study variables in addition to hypothesis testing and linear and logistic regression models to identify predictive variables of adherence. Results22% of the participants met the minimum adherence, observing better compliance in younger people (p = 0.004), among those who had a better Health-Related Quality of Life (p = 0.036) and better health literacy levels (p = 0.017). According to a linear regression model, the variables associated with adherence were: social program of origin (OR = 5,122), perception of social support (OR = 1,170), cognitive status (OR = 2,537). ConclusionThe level of adherence of the older people of the study can be evaluated as low, which is consistent with the findings of the specialized literature. The variables identified with predictive capacity on adherence were social program of origin, a condition that can be incorporated into the design of the interventions in order to facilitate territorial equity. It is also important to highlight the importance of health literacy and the risk of dysphagia in the level of adherence.

Post-stroke dysphagia: Clinical characteristics and evolution in a single-primary stroke center.

Dysphagia is a common manifestation after stroke and seems to play a major role in clinical and functional outcomes. To identify clinical predictors of higher degrees of dysphagia, as well as assess its burden in our hospital, in order to understand how to improve the approach to this symptom. We included 311 patients admitted in an acute stroke unit in a year-long period. The relationship of dysphagia with different outcomes, both in acute phase and within the first year after stroke, were investigated. Using the Pearson Correlation Coefficient, NIHSS score at admission was positively correlated with the degree of dysphagia (r = 0,783; p < 0,001) and total anterior circulation infarcts and age (> 70 years) were also associated with higher risk of dysphagia (p < 0.001). During hospitalization both respiratory infections and mortality occurred at significantly higher rates for dysphagic patients (p < 0.001) and we observed an increasing trend towards a higher mortality rate, the higher the degree of dysphagia. These patients stayed longer in the stroke unit, with less chance to be discharged home and more frequently transferred to inpatient rehabilitation care. One year after admission, dysphagic patients were more frequently readmitted due to pneumonia and we observed a higher mortality rate compared to patients without dysphagia (p < 0.001). The presence of the above-mentioned dysphagia predictive factors should alert us to the need for an early approach, starting in the stroke unit, but also after discharge, taking into account its impact on clinical outcomes, mortality and healthcare costs.

Management of hangman's fractures using anchored anterior cervical cages.

Hangman's fractures comprise approximately 20% of C2 fractures and often require surgery to correct significant angulation and/or subluxation. Recently, anchored anterior cervical cages (ACCs) have been used to fuse C2-3 as they reduce the risks of soft-tissue dissection, bone drilling, operative time, and postoperative dysphagia. This single-center and retrospective study (2012-2019) included 12 patients (3 type I, 6 type II, and 3 type IIa fractures) undergoing C2-3 ACCs (zero profile, half plate, full plate). Preoperative and postoperative radiographic and clinical data were analyzed. The 12 patients demonstrated the following findings: a mean operative time of 106 ± 21 min, blood loss averaging 67 ± 58 mL, and mean length of stay of 9.8 ± 7.7 days (6.4 ± 5.5 days in intensive care). The mean differences in preoperative versus postoperative radiographs showed an increase in disc angle (9.0° ± 9.4° vs. 14.0° ± 7.2°), reduction of subluxation (18.5% ± 13.6% vs. 2.6% ± 6.2%), and maintenance of C2-7 lordosis (14.3° ± 9.5° vs. 14.4° ± 9.5°). All patients demonstrated fusion on dynamic films obtained >6 months postoperatively. In addition, only one patient had Grade 0 subsidence, three had transient postoperative dysphagia, whereas none had either intraoperative complications or 90-day readmissions. ACCs proved to be a viable alternative to traditional anterior cervical discectomy/fusion to treat 12 patients with C2-3 hangman's fractures in this preliminary study.

Characterizing Swallowing Impairment in a Post-Lung Transplant Population.

Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.

Thyroid metastasis from cervical carcinoma

There have been very few reports of thyroid metastasis from cervical carcinoma. This article reports a case of metastasis from cervical carcinoma. A 69-year-old woman with a history of cervical cancer presented to our department with right cervical swelling. She had suffered from paralysis of the left recurrent laryngeal nerve after undergoing left hemithyroidectomy 16 years ago. Computed Tomography (CT) and magnetic resonance imaging scans revealed a right thyroid tumor with bilateral enlargement of the cervical lymph nodes. Fluorodeoxyglucose positron emission tomography/CT imaging revealed high uptake in the right thyroid tumor, cervical lymph nodes, and right iliac bone. Fine-needle aspiration cytology revealed atypical epithelial cells with a high nuclear/cell ratio and hyperchromatic nuclei, which resembled cervical cancer cells. Given the risk of airway obstruction and dysphagia, the patient underwent tracheostomy, right hemithyroidectomy, and neck dissection for preserving the quality of life. Pathological examination revealed normal thyroid tissue with p16-positive atypical epithelial cells, which suggested thyroid metastasis from the cervical cancer. The patient has remained alive without any symptoms for 5 postoperative months.

Association between swallowing muscle mass and dysphagia in older adults: A case-control study.

Swallowing function is formed by the synergistic, coordinated, and complex movements of approximately 30 muscles. However, There is no study on which one(s) of these muscles can predict the possibility of dyspfagia. The purpose of this study was to investigate whether there is a relation between dysphagia and ultrasonographic measurements of swallowing muscles mass, and to determine which muscle mass would predict the possibility of dysphagia. This prospective and controlled study was performed on 87 older people (aged >65 years). Clinical (Eating assessment tool-10 and The Gugging Swallowing Screen test), endoscopic, electrophysiological (dysphagia limit and swallowing intervals), and ultrasonographic (masseter [MM], genioglossus [GGM], geniohyoid [GHM], myohyoid [MH] and anterior digastric muscles [ADM]) evaluations were performed on all patients. The relationship between ultrasound measurements and demographic/swallowing characteristics and presence of dysphagia were investigated. The muscle mass measurement which was associated with dysphagia was contracted masseter muscle. In terms of diagnostic performance, the sensitivity was the highest in GHM (92.3%) and the specificity was the highest in contracted MM thickness (90.3%). The probability of dysphagia increases from 54% to 80-89% with a decrease in contracted MM thickness, and the probability of dysphagia increased from 48% to 72% with a decrease in contracted GGM thickness. In addition, the highest AUC level was detected in contracted MM and contracted GGM muscles. Moreover, it was determined that the risk of dysphagia increased from 9.6 to 14.1 times with one unit decrease in muscle thickness in contracted MM muscles, and the risk of dysphagia increased 9.1 times with one unit decrease in contracted GGM muscles. Decreased swallowing muscle mass in older adults are independent risk factors for dysphagia. Especially the decrease in the thickness of the contracted MM increases the possibility of dysphagia at high rate.

On the potential of drug repurposing in dysphagia treatment: New insights from a real-world pharmacovigilance study and a systematic review.

Background: Polypharmacy is common in patients with dysphagia. Routinely used drugs may influence swallowing function either improving or worsening it. We aimed to explore the potential effects of three commonly used drug classes on dysphagia and aspiration pneumonia through a systematic review and a real-world data analysis to probe the possibility of drug repurposing for dysphagia treatment. Material and Methods: Five electronic databases were searched. Studies on adults at risk for dysphagia, treated with Dipeptidyl-Peptidase IV Inhibitors (DPP-4i), Adrenergic Beta-Antagonists (beta-blockers), or Angiotensin-Converting Enzyme Inhibitors (ACEi), and reporting outcomes on dysphagia or aspiration pneumonia were included. A nested case/non-case study was performed on adverse events recorded in the FDA Adverse Event Reporting System (FAERS) on patients >64years. Cases (dysphagia or aspiration pneumonia) were compared between patients only treated with Levodopa and patients who were concomitantly treated with the drugs of interest. Results: Twenty studies were included in the review (17 on ACEi, 2 on beta-blockers, and 1 on DPP-4i). Contrasting findings on the effects of ACEi were found, with a protective effect mainly reported in Asian studies on neurological patients. Beta-blockers were associated with a reduced dysphagia rate. The study on DPP-4i suggested no effect on dysphagia and an increased risk of aspiration pneumonia. The FAERS analysis showed a reduction of the risk for dysphagia/aspiration pneumonia with ACEi, beta-blockers, and DPP-4i. Conclusion: Our study explores the potential drug repurposing of ACEi, beta-blockers and DPP-4i in neurological patients with dysphagia to improve swallowing function and reduce aspiration pneumonia risk. Future randomized controlled studies should confirm these results and clarify the underlying mechanisms of action.

Weighing up the pros and cons of dysphagia triage in South Africa.

Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap. To establish the reliability and validity of a researcher-developed dysphagia triage checklist. A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist. Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes. The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia.Contribution:The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.

The role of esophageal area for dysphagia after anterior cervical corpectomy fusion: Change trends and risk factors.

The objective of this study is to assess the change trends of perioperative esophageal area for anterior cervical corpectomy fusion (ACCF) and to analyze the risk factors of the area for postoperative dysphagia. We retrospectively analyzed 309 patients who underwent ACCF due to degenerative cervical diseases between November 2015 and September 2019 at our hospital. Patients were divided into 2 groups named the dysphagia group and the normal swallowing function group, according to the swallowing function after ACCF. The esophageal area was measured at T1 level using computed tomography axial plane images before and after surgery (1 week, 1 month, 8 months, and 12 months), in order to assess the change trends of esophageal area perioperatively and analyze risk factors of the area for dysphagia after ACCF. The area was highest at 1 week after surgery and would be decreased over time in both groups, which was recovered to the preoperative levels in 12 months after surgery. The incidence of dysphagia after ACCF was 41.1%. In the dysphagia group, 127 patients (mean age 59.299 years) had dysphagia after ACCF. In the normal-swallowing function group, 182 patients (mean age 59.8352 years) had normal swallowing function after ACCF. The preoperative esophageal area was larger in the dysphagia group than in the normal-swallowing function group. Preoperative esophageal area was correlated with postoperative dysphagia (odds ratio: 1.3457, 95% confidence interval: 1.106-1.637). When the esophageal area at preoperation was above 3.388 cm2, the risk of postoperative dysphagia was higher. The esophageal area was the biggest at 1 week postoperatively, significantly decreased over time and would be recovered to the normal size at 12 months after surgery. Preoperative esophageal area should be considered when evaluating the risk factor for dysphagia after ACCF.