Solid Bolus Research Articles

Swallowing in Obese Individuals before and after Bariatric Surgery.

To evaluate the oral and pharyngeal phases of swallowing in obese patients before and after bariatric surgery. Swallowing was evaluated by videofluoroscopy before and after 80 to 123days from bariatric surgery in 19 individuals with obesity (15 women), aged 25-60years. The body mass index (BMI) before surgery was from 40.1 to 57.0kg/m2. The surgical treatment was performed with laparoscopic Roux-en-Y gastric by-pass (RYGB). After surgery, the BMI ranged from 31.7 to 48.4kg/m2. The control group had 19 healthy volunteers (15 women), aged 22-56years and BMI from 19.4 to 29.7kg/m2. Swallowing was evaluated with swallows of 5mL of liquid and paste boluses in triplicate, and a solid bolus in duplicate. With swallowing of liquid bolus, individuals with obesity had, before and after surgery, an increased frequency of premature posterior spillage. Before the surgery, the obese subjects had longer pharyngeal clearance of liquid compared with the control group and with individuals after the surgery. After the surgery, obese individuals had longer duration of the hyoid movement with liquid and paste boluses, compared with before surgery. Also, there was a reduction of the interval between the bolus entering the phaynx and the onset of upward hyoid excursion. Non-operated obese patients had a longer pharyngeal clearance for liquid bolus compared with healthy controls. After bariatric surgery, there was an increase in hyoid movement duration.

Assessment of the Miniature Kramer Shear Cell to Measure Both Solid Food and Bolus Mechanical Properties and Their Interplay with Oral Processing Behavior.

This study assessed the usefulness of the miniature Kramer shear cell to determine relevant instrumental parameters of solid foods and bolus counterparts, examining their relationships with oral processing behaviors to obtain greater knowledge about the texture perception process. Six solid foods with different textural properties were tested. Bolus mechanical properties were also determined by means of cone penetration tests and rheological measurements, and their particle size distributions by sieving. Oral processing behavior (chewing time, number of chews, chewing rate, eating rate) and food saliva uptake (SU) of a young volunteer and a panel of 39 untrained participants were analyzed. The Kramer mechanical properties were very suitable for detecting different levels of food and bolus textural hardness and fracturability and the associated degrees of fragmentation achieved during mastication. Chewing time and number of chews were highly correlated with Kramer food and bolus mechanical properties for the single subject and for the panel’s oral processing behaviors. For the single subject, SU and eating rate also showed strong correlations with food and bolus mechanical properties, unlike chewing rate and food moisture content (FMC). In contrast, eating rate, FMC, and SU did not vary with the oral activities of the panel.

Swallowing evaluation in patients without restriction of oral food three months after ischemic stroke.

Our hypothesis was that even patients without complaints and without evident clinical signs of dysphagia three months after ischemic stroke, may have swallowing alterations. To evaluate, by videofluoroscopy, swallowing pattern of ischemic stroke patients without symptomatic dysphagia or restriction of food intake. Videofluoroscopic examinations were performed in 33 ischemic stroke patients three to five months after the accident, and 19 healthy volunteers. Oral and pharyngeal phases of swallowing were evaluated after swallowing of 5 mL and 10 mL of liquid and paste boluses, and after swallowing of a solid bolus, in duplicate and in a random sequence. Stroke patients had higher frequency of head movement, multiple swallows, premature spilage and vallecular residue than volunteers, after swallowing of 5 mL liquid bolus. There was no difference between patients and volunteers in oral and pharyngeal transit, except for a longer oral preparation for a 5 mL liquid bolus in patients. Changes in swallowing caused by increases in bolus volume and consistency were not different between patients and volunteers. No significant changes in swallowing dynamics were found in patients with no dysphagia symptoms and no restriction of food intake three months after isquemic stroke.

Residue and clearing time: preliminary considerations in defining dysphagia severity in daily practice

Introduction and aim: In the consideration of swallowing, ‘time’ is a parameter of great interest. The pooling score (p-score), which considers the number of dry swallows needed to clear residue in the pharynx/larynx, can be made more complete by quantifying this parameter, attempting to give a more appropriate and functional criterion of the severity of an impaired swallow. The p-score, enhanced by the inclusion of the time needed to clear residue (timed p-score, tp-score) is put forward for use in clinical practice.Matherial and methods: Two experienced raters blindly evaluated 35 short video clips of 5 cc pureed, 5 cc liquid and 1/4 cracker bolus transits, recorded during the endoscopic evaluations of 16 patients with dysphagia of different aetiologies. For each patient, the time needed to complete the clearing of the boluses (maximum 5 swallows, total time – TT), was determined together with the FOIS and DOSS scales.Results: The average time necessary to clear residue for pureed, solid and liquid boluses was 22.5 s, 30.7 s and 16.6 s respectively. The inter-rater agreement between the 2 raters in applying the p-score was good (ICC > 0.800) for every consistency. A linear regression model documented a statistically significant correlation of the p-score total, the TT and the consistencies with the FOIS and the DOSS, respectively.Discussion and conclusion: The p-score total and the TT are correlated with the severity of dysphagia and the functional activities of the patients, so the pt-score can be useful in clinical practice to define the severity of dysphagia.

The differences in the esophageal motility between liquid and solid bolus swallows: A multicenter high-resolution manometry study in Chinese asymptomatic volunteers.

The results of the esophageal body motility differences between liquid and solid swallows from high-resolution manometry (HRM) studies are not consistent. The information of the frequency of ineffective liquid and solid bolus swallows in healthy individuals during HRM procedure is limited. The normative values of the HRM parameters of both liquid and solid swallows for Chinese population are lacking. The esophageal HRM data of 101 healthy volunteers from multicenters in China were analyzed. The values of the HRM parameters were summarized and compared between liquid and solid swallows. The frequencies of ineffective liquid and solid swallows were summarized. Esophagus contracted stronger and slower in solid bolus swallows than water swallows with HREM. Ineffective water swallow (DCI<450mmHg.s.cm) and ineffective bread swallow (DCI<800mmHg.s.cm) were frequently seen in asymptomatic individuals. The adding of bread swallows to the HREM procedure might cause diagnostic change in about 15.8% (16/101) of the asymptomatic individuals. The vigor and velocity of the esophageal peristalsis between liquid and solid bolus swallows are different. Ineffective water and solid bolus swallows are not rare. Adding solid bolus swallows brings diagnostic change, and it may be needed routinely for the HRM procedure.

Quantitative assessment of oral phase efficiency: validation of the Test of Masticating and Swallowing Solids (TOMASS).

The Test of Masticating and Swallowing Solids (TOMASS) has been developed to provide clinicians with objective data regarding the efficiency of oral phase function and solid bolus ingestion. To determine if the TOMASS will detect changes in the oral phase of swallowing imposed by topical anaesthesia, thus providing validation of its clinical utility. Per the standard protocol, 10 healthy participants ate one-quarter of an Arnotts SaladaTM biscuit. The number of bites per cracker, number of masticatory cycles, number of swallows and total time taken were recorded at baseline, following application of topical oral anaesthetic; this was additionally compared with a post-anaesthetic condition. Median and interquartile range (IQR) were calculated. Wilcoxon signed-rank tests were conducted to evaluate trial effect, and Friedman's tests were used to detect differences in the number of bites, number of swallows, number of chews and time taken to eat the crackers. Results indicated that the number of both bites and swallows did not significantly change across conditions (χ²(2) = 0.105, p = 0.949, χ²(2) = 1.357, p = 0.507); however, the number of chews for the anaesthetic condition was significantly higher when compared with the baseline (p = 0.02) and post-anaesthesia conditions (p = 0.02). Further, the durations of ingestion in the anaesthetic condition were significantly longer than the baseline (p = 0.01) and post-anaesthesia (p = 0.01) conditions. Across all measures, there were no differences between baseline and post-anaesthesia conditions. Although further exploration is required, these early data suggest the TOMASS is a sensitive measure in the evaluation of the oral-phase preparation of solid textures.

Proximal esophageal contraction after induction of ineffective distal contraction by sildenafil in healthy volunteers.

Background:Proximal esophagus is composed of striated muscle replaced by smooth muscle in the distal section. Sildenafil, an inhibitor of phosphodiesterase type 5, causes a decrease in the amplitude of contractions in distal smooth muscle esophagus, with no effect on the proximal esophageal striated muscle. The aim of this investigation was to evaluate the hypothesis that proximal contractions are affected by changes in distal contractions caused by sildenafil.Methods:Esophageal motility was assessed by high resolution manometry in 22 healthy volunteers (12 women) aged 22-50 years (mean 38.1±7.7 years). All volunteers performed, in the sitting position, 10 swallows of liquid (5 mL of saline) and 10 swallows of solid boluses (1 cm3 pieces of bread), before and after ingestion of 50 mg of sildenafil. We evaluated the proximal esophageal contractions in response to the changes in distal esophageal motility induced by sildenafil.Results:Sildenafil caused a significant reduction in distal contractile integral and integrated relaxation pressure in the lower esophageal sphincter. In the proximal esophagus the alteration in distal esophageal contraction caused a significant increase in contraction length, contractile integral, and contraction duration.Conclusion:Induction of ineffective distal esophageal motility by sildenafil in healthy volunteers causes an increase in proximal esophageal motility, suggesting that proximal esophagus adapts to an induced impairment of distal esophageal motility.

Gender Differences in Normal Swallow

requires precise coordination between 34 pairs of muscles in just over one second. The rapid sequential and overlapping motions characterizing adult human swallowing behavior were better appreciated with the introduction of radiography, and especially video radiography. There are data suggesting that women swallow liquids at a lower flow rate and ingest smaller volumes in each swallow than men. Aim of the work: To assess the physiological difference between males and females in oropharyngeal and esophageal phases of swallowing in normal middle-aged individuals. Patients and Methods: Cross sectional study, included 30 healthy volunteers (15 males & 15 females) with normal swallowing, whose age ranged from 18-45 yrs. This study was conducted in SohagUniversityHospital, Phoniatric Unit. All volunteers were subjected to Video-Fluroscopic Swallowing Study (VFSS) in sitting position. Oral transit time (OTT), Pharyngeal transient time (PTT), Oropharyngeal transient time, Esophageal transit time (ETT), Total swallow time (TST) were measured. Also, hyoid peak was calculated. Results: There were nosignificant difference between males and females swallowing in both fluid and solid boluses. Conclusion: This study provided insights into normal swallowing physiology and defines measurement alternatives for evaluation of the dysphagic patients

High-resolution impedance manometry parameters in the evaluation of esophageal function of non-obstructive dysphagia patients.

High-resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We explored novel HRIM measures and assessed their temporal relationship to dysphagia symptoms for boluses of different volume and consistency in non-obstructive dysphagia (NOD) patients. Thirty-three NOD patients (n=19 minor or no disorder of peristalsis ("Normal") and n=14 esophagogastric junction outflow obstruction ("EGJOO")) were evaluated with HRIM. Patients were administered 5 and 10mL liquid, semisolid, and 2 and 4cm solid boluses and indicated bolus perception during individual swallows using a 5-point Likert scale. HRIM was analyzed to assess Chicago Classification and pressure flow metrics, esophageal impedance integral (EII) ratio, and bolus flow time (BFT). Overall, bolus perception increased with increasing bolus consistency (P<0.001), but did not differ significantly between EGJOO and Normal patients. EGJOO patients had higher IRP4, higher levels of bolus residual (ie, EII ratio and IR), and restricted esophageal emptying. The results for linking semisolid bolus perception to semisolid-derived measures revealed more biomechanically plausible and consistent patterns when compared to those derived for liquid boluses. In Normal patients, perception of boluses of heavier viscosity was related to higher bolus flow resistance during transport, whilst in EGJOO, perception was related to restriction of esophageal emptying. These novel pressure-impedance measures may aid in the evaluation of NOD patients by revealing abnormal motor patterns, which may explain symptom generation. Future studies are needed to evaluate which of these measures are worthy of calculation and to establish protocol settings that allow for their meaningful interpretation.

International standardisation of the test of masticating and swallowing solids in children

The Test of Masticating and Swallowing Solids (TOMASS) is a validated assessment tool measuring the efficiency of solid bolus intake by four quantitative parameters: discrete bites, masticatory cycles, swallows and time to ingest a single cracker. A normative database for adults (20-80+ years) has previously been established. The objective of this study was to investigate the applicability and reliability of the TOMASS in children and adolescents (TOMASS-C) and to establish the normative database for this younger population. We collected data from 638 participants (male: 311, female: 327) in five age groups (4-18years) with five different but very similar test crackers in four countries. Significant effects of bolus type (cracker), age group and gender on the TOMASS parameters were identified, requiring stratification of the TOMASS-C database by these variables. Intra-rater reliability was excellent (ICC>0.94) for all parameters; inter-rater reliability was moderate for "number of swallows" (ICC=0.54), good for "bites" (ICC=0.78) and "time" (ICC=0.82), and excellent for "masticatory cycles" (ICC=0.96). The "Test of Masticating and Swallowing Solids in Children (TOMASS-C)" was identified to be a reliable diagnostic tool for the comprehensive measurement of discrete oral stage components of solid bolus ingestion, standardised by a large normative database that covers age groups from preschoolers to young adults. While differences between gender groups were less pronounced than in the adult population, previous results relating to changes in masticatory and swallowing as a function of age are confirmed by our data.

Longitudinal Objective Speech and Swallow Function after Treatment with Definitive Radiation Therapy (RT) for Larynx Cancer in the Intensity Modulated Radiation Therapy (IMRT) Era

Although definitive radiation therapy (RT) for advanced larynx/hypopharynx cancer can allow for structural preservation of the larynx, longitudinal data on functional preservation is lacking. We sought to quantitatively define subdomains in laryngeal function that RT continued to impact following treatment cessation. Swallowing metrics were retrospectively assessed for patients treated with definitive RT ± concomitant chemotherapy (CT) for larynx/hypopharynx cancers in the IMRT era. Patients who subsequently developed local recurrence (LR) were excluded. Patients undergoing RT were assessed at baseline with modified barium swallow (MBS). Post-RT evaluations were done primarily when prompted by symptoms. The Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) were used to assess swallowing at 4 time points following post-RT baseline measurements: <90d, 90d–1yr, 1–2yrs, and >2yrs. Assessments were made by speech pathologists with expertise in head/neck cancer. Mean change from baseline was used for statistical significance using the unpaired t test. A total of 96 patients were treated with IMRT from 2004-2014. 91% received CT. Twenty-one developed LR and were excluded, leaving 75 patients. Dedicated follow-up for swallowing ranged from 29-39% in the <1yr period and 15-25% >1yr. Relative to baseline, increased (worse) PAS scores were seen with thin and nectar boluses at all time points (p<0.05, nectar; p<0.01, thin at 2yrs), with a median PAS score of 5 for both at 2yrs (material enters airway and contacts vocal cords, but is not ejected). PAS scores of ≥6 (aspiration during MBS) manifested strongly with thin liquids as opposed to puree consistencies and were found in 64% of patients at <90d, 45% at 90d-1yr, 26% at 1-2yrs, and 50% at >2yrs. PAS scores did not increase significantly for puree or solid boluses across any time point post-RT. Thin and nectar PAS scores were most elevated <90d (p<0.001) and did not show restoration to baseline at 2yrs post-RT (p>0.2 for thin, p>0.4 for nectar). FOIS scores were lower (worse) at all time points (p<0.01 at 2yrs) with a median score of 5 at 2yrs (oral diet requiring special preparation/compensations). FOIS scores of ≤3 (required non-oral nutrition) were identified in 43% of patients at <90d, 24% at 90d-1yr, 16% at 1-2yrs, and 31% at >2yrs. No significant change was observed in FOIS scores between the <90d and later periods. Patients with T4 cancers showed an overall trend toward higher (worse) PAS scores and lower (worse) FOIS scores relative to those with T1-3 tumors. Statistical significance was only evident in the 90d-1yr period (p<0.005). Patients, particularly those with T4 cancers, undergoing definitive RT for larynx/hypopharynx cancer remain at risk for chronic dysphagia with thin liquids but not solids, and have quantifiable deficits in diet.

Improving High-resolution Impedance Manometry Using Novel Viscous and Super-viscous Substrates in the Supine and Upright Positions: A Pilot Study.

Background/AimsSwallows with viscous or solid boluses in different body positions alter esophageal manometry patterns. Limitations of previous studies include lack of standardized viscous substrates and the need for chewing prior to swallowing solid boluses. We hypothesize that high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions improves sensitivity for detecting esophageal motility abnormalities when compared with traditional saline swallows. To establish normative values for these novel substrates, we recruited healthy volunteers and performed HRiM.MethodsStandardized viscous and super-viscous substrates were prepared using “Thick-It” food thickener and a rotational viscometer. All swallows were administered in 5-mL increments in both supine and upright positions. HRiM metrics and impedance (bolus transit) were calculated. We used a paired two-tailed t test to compare all metrics by position and substrate.ResultsThe 5-g, 7-g, and 10-g substrates measured 5000, 36 200, and 64 700 mPa sec, respectively. In 18 volunteers, we observed that the integrated relaxation pressure was lower when upright than when supine for all substrates (P < 0.01). The 10-g substrate significantly increased integrated relaxation pressure when compared to saline in the supine position (P < 0.01). Substrates and positions also affected distal contractile integral, distal latency, and impedance values.ConclusionsWe examined HRiM values using novel standardized viscous and super-viscous substrates in healthy subjects for both supine and upright positions. We found that viscosity and position affected HRiM Chicago metrics and have potential to increase the sensitivity of esophageal manometry.

Dysphagia characteristics in Huntington's disease patients: insights from the Fiberoptic Endoscopic Evaluation of Swallowing and the Swallowing Disturbances Questionnaire.

Huntington's disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined. To characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients' self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL). A retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington's Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire. Fourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score. HD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.

A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery.

The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived. Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005). In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.

SWALLOWING IN PATIENTS WITH LARYNGITIS.

Dysphagia is described as a complaint in 32% of patients with laryngitis. The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

Semi-Solid and Solid Bolus Swallows in High-Resolution Oesophageal Manometry for the Detection of Motility Disorders

Background/Aims: High-resolution oesophageal manometry utilises water swallows to evaluate oesophageal function. However, small volumes of water are not representative of normal eating and as a result often produce normal manometry studies in patients with dysphagia. This study sets out to establish optimal diagnostic thresholds for semi-solid solid swallows and evaluate their ability to uncover motility abnormalities in patients with motility disorders. Method: Manometry was performed using ten 5-mL single water swallows followed by two semi-solid and two solid swallows in the upright position. Normative values for the adjunctive tests were obtained from patient controls while patients with major motility disorders were used to establish the optimal diagnostic thresholds. Diagnostic thresholds identified were prospectively tested in patients with normal water swallows but oesophagus related symptoms and in those with minor and major motility disorders. Results: Normal values for semi-solid and solid were determined in patient controls (n = 100). Development of diagnostic thresholds included 120 patients with major motility disorders. Optimal diagnostic thresholds identified for oesophagogastric junction dysfunction in semi-solid and solid swallows (IRP > 15.5 mmHg). Hypercontractilty and spasm used existing thresholds (>8000 mmHg-s-cm and

The Test of Masticating and Swallowing Solids (TOMASS): reliability, validity and international normative data.

Clinical swallowing assessment is largely limited to qualitative assessment of behavioural observations. There are limited quantitative data that can be compared with a healthy population for identification of impairment. The Test of Masticating and Swallowing Solids (TOMASS) was developed as a quantitative assessment of solid bolus ingestion. This research programme investigated test development indices and established normative data for the TOMASS to support translation to clinical dysphagia assessment. A total of 228 healthy adults (ages 20-80+ years) stratified by age and sex participated in one or more of four consecutive studies evaluating test-retest and interrater reliability and validity to instrumental assessment. For each study the test required participants to ingest a commercially available cracker with instructions to 'eat this as quickly as is comfortably possible'. Further averaged measures were derived including the number of masticatory cycles and swallows per bite, and time per bite, masticatory cycle and swallow. Initial analyses identified significant differences on salient measures between two commercially available crackers that are nearly identical in shape, size and ingredients, suggesting the need for separate normative samples for specific regional products. Additional analyses on a single cracker identified that the TOMASS was sensitive at detecting changes in performance based on age and sex. Test-retest reliability across days and interrater reliability between clinicians was high, as was validation of observational measures to instrumental correlates of the same behaviours. Therefore, normative data are provided for the TOMASS from a minimum of 80 healthy controls, stratified by age and sex, for each of seven commercially available crackers from broad regions worldwide. Analyses on a single cracker identified Arnott's Salada, and that TOMASS measures were sensitive for detecting changes in performance based on age and sex. Interrater and test-retest reliability across days were high, as was validation of observational measures to instrumental correlates of the same behaviours. Significant differences were identified between two commercially available crackers, nearly identical in shape, size and ingredients, thus normative samples for specific regional products were required. Normative data were then acquired for the TOMASS from a minimum of 80 healthy controls, stratified by age and sex, for each of seven commercially available crackers from broad regions worldwide. The TOMASS is presented as a valid, reliable and broadly normed clinical assessment of solid bolus ingestion. Clinical application may help identify dysphagic patients at bedside and provide a non-invasive, but sensitive, measure of functional change in swallowing.

Oesophageal manometry with a solid test meal: ready for prime time?

The decrement in quality of life to a patient with unexplained oesophageal symptoms cannot be overemphasised. A life lived with dysphagia or chest pain, without a specific diagnosis, can affect a patient on a daily basis (or even every meal). Evaluation usually begins with routine upper endoscopy. The addition of advanced imaging, a biopsy, or specialised brushing all too often fails to result in a conclusive diagnosis. Promising technologies to assess inflammation (ie, tissue impedance), 1 Ates F Yuksel ES Higginbotham T Mucosal impedance discriminates GERD from non-GERD conditions. Gastroenterology. 2015; 148: 334-343 Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar lower oesophageal sphincter distensibility, and motility (ie, endolumenal functional imaging probe) 2 Carlson DA Kahrilas PJ Lin Z et al. Evaluaiton of esophageal motility utilizing the functional lumenal imaging probe. Am J Gastroenterol. 2016; 111: 1726-1735 Crossref PubMed Scopus (137) Google Scholar are not ready for widespread use. The barium swallow is a lost art, providing variable information on motility, and is often performed without a solid bolus, limiting its usefulness. Diagnostic yield of high-resolution manometry with a solid test meal for clinically relevant, symptomatic oesophageal motility disorders: serial diagnostic studyThe diagnostic sensitivity of HRM for major motility disorders is increased with use of the STM compared with SWS, especially in patients with dysphagia. Observations made during STM can establish motility disorders as the cause of oesophageal symptoms. Full-Text PDF Pharyngeal swallowing and oesophageal motility during a solid meal test: a prospective study in healthy volunteers and patients with major motility disordersOur results show normative values for pharyngeal swallowing and oesophageal motility in healthy volunteers. Detailed analysis of HRM data acquired during an STM shows that the rate-limiting factor for intake of solids in health is the frequency of pharyngeal swallowing and not oesophageal contractility. The reverse is true in patients with oesophageal motility disorders, in whom the frequency of effective oesophageal contractions determines eating speed. Full-Text PDF

An anchored dynamic time-warping for alignment and comparison of swallowing acoustic signals.

Properties of signals captured by contact accelerometers assist the evaluation of human organs involved in the swallowing process. Here we present a novel method to account the alignment between two different swallowing signals based on two steps: first, a scaled cross-correlation determines an anchor point of maximum similarity between the signals, dividing both signals in two parts; next, dynamic time warping aligns the left and right parts of both signals. Additional filtering procedures are used smooth the swallowing signals due to their low SNR. The results show that this technique can be used to assess similarities between liquid and solid boluses of a subject.

Fiberoptic Endoscopic Evaluation of Swallowing as possible index of ALS clinical development

Our purpose was to assess the relationship between the disease severity of Amyotrophic Lateral Sclerosis (ALS) and the main parameters of Fiberoptic Endoscopic Evaluation of Swallowing (FEES), indirectly hypothesizing for FEES a role as clinical indicator of the progression of ALS. We studied 220 patients (101 women, 119 men) with ALS; of these, 148 had spinal and 72 bulbar onset. They were analyzed according to the Amyotrophic Lateral Sclerosis Functioning Rating Scale (ALSFRS) and the b-ALSFRS subscale (bulbar scale). All subjects underwent FEES. Post-swallowing residue was classified into four classes (0-3); premature spillage and aspiration were considered either present or absent. An in-depth statistical analysis revealed a highly significant relationship between the FEES parameters studied and the severity of the disease assessed through ALSFRS and b-ALSFRS (p < 0.0001), no matter what bolus texture was used. Moreover, statistical analysis showed a highly significant association between the classes of severity in bulbar forms and all the FEES parameters, no matter what type of bolus was administered (p <0.0001), whereas a significant correlation in spinal forms only for post-swallowing residue with solid (p= 0.025) and semisolid (p= 0.034) boluses. FEES is a good indicator of the severity of dysphagia and of its progression in patients with ALS, as well as of the clinical progression of the disease.