Pere Clavé

The effect of bolus viscosity on swallowing function in neurogenic dysphagia

Publisher: Wiley

Date: 16-10-2006

DOI: 10.1111/J.1365-2036.2006.03118.X

Abstract: To assess the pathophysiology and treatment of neurogenic dysphagia. 46 patients with brain damage, 46 with neurodegenerative diseases and eight healthy volunteers were studied by videofluoroscopy while swallowing 3-20 mL liquid (20.4 mPa s), nectar (274.4 mPa s) and pudding (3931.2 mPa s) boluses. Volunteers presented a safe and efficacious swallow, short swallow response (< or =740 ms), fast laryngeal closure ( or =0.33 mJ). Brain damage patients presented: (i) 21.6% aspiration of liquids, reduced by nectar (10.5%) and pudding (5.3%) viscosity (P < 0.05) and (ii) 39.5% oropharyngeal residue. Neurodegenerative patients presented: (i) 16.2% aspiration of liquids, reduced by nectar (8.3%) and pudding (2.9%) viscosity (P or =806 ms) with a delay in laryngeal closure (> or =245 ms), and weak bolus propulsion forces (< or =0.20 mJ). Increasing viscosity did not affect timing of swallow response or bolus kinetic energy. Patients with neurogenic dysphagia presented high prevalence of videofluoroscopic signs of impaired safety and efficacy of swallow, and were at high risk of respiratory and nutritional complications. Impaired safety is associated with slow oropharyngeal reconfiguration and impaired efficacy with low bolus propulsion. Increasing bolus viscosity greatly improves swallowing function in neurological patients.

Purinergic and nitrergic junction potential in the human colon

Publisher: American Physiological Society

Date: 09-2008

DOI: 10.1152/AJPGI.00510.2007

Abstract: The aim of the present work is to investigate a putative junction transmission [nitric oxide (NO) and ATP] in the human colon and to characterize the electrophysiological and mechanical responses that might explain different functions from both neurotransmitters. Muscle bath and microelectrode techniques were performed on human colonic circular muscle strips. The NO donor sodium nitroprusside (10 μM), but not the P2Y receptor agonist adenosine 5′-O-2-thiodiphosphate (10 μM), was able to cause a sustained relaxation. N G -nitro-l-arginine (l-NNA) (1 mM), a NO synthase inhibitor, but not 2′-deoxy- N 6 -methyl adenosine 3′,5′-diphosphate tetraammonium salt (MRS 2179) (10 μM), a P2Y antagonist, increased spontaneous motility. Electrical field stimulation (EFS) at 1 Hz caused fast inhibitory junction potentials (fIJPs) and a relaxation sensitive to MRS 2179 (10 μM). EFS at higher frequencies (5 Hz) showed biphasic IJP with fast hyperpolarization sensitive to MRS 2179 followed by sustained hyperpolarization sensitive to l-NNA both drugs were needed to fully block the EFS relaxation at 2 and 5 Hz. Two consecutive single pulses induced MRS 2179-sensitive fIJPs that showed a rundown. The rundown mechanism was not dependent on the degree of hyperpolarization and was present after incubation with l-NNA (1 mM), hexamethonium (100 μM), MRS 2179 (1 μM), and NF023 (10 μM). We concluded that single pulses elicit ATP release from enteric motor neurons that cause a fIJP and a transient relaxation that is difficult to maintain over time also, NO is released at higher frequencies causing a sustained hyperpolarization and relaxation. These differences might be responsible for complementary mechanisms of relaxation being phasic (ATP) and tonic (NO).

Neuogenic and oropharyngeal dysphagia

Publisher: Wiley

Date: 10-2013

DOI: 10.1111/NYAS.12234

Abstract: Oropharyngeal dysphagia (OD) is a swallowing disorder caused by congenital abnormalities and structural damage and disease-associated damage of the oral cavity, pharynx, and upper esophageal sphincter. Patients with OD lack the protective mechanisms necessary for effective swallowing, exhibiting difficulty controlling food in the mouth and initiating a swallow, leading to choking, coughing, and nasal regurgitation. OD is a major risk factor for malnutrition, dehydration, and aspiration pneumonia. The following on OD includes commentaries on the application of simulation of oropharyngeal transient receptor potential vanilloid 1 (TRPV1) and maneuvers like the Shaker exercise to improve the safety and efficacy of swallow in OD patients the prevalence of esophageal pathologies in OD patients and the need to evaluate the esophagus, esophagogastric junction, and stomach and strategies for clinical screening to detect OD and aspiration among high-risk patients and to improve oral health care, maintain nutrition and hydration, and prevent aspiration pneumonia.

72nd Nestlé Nutrition Institute Workshop ‘Stepping stones to living well with dysphagia’. Concluding remarks.

Publisher: S. KARGER AG

Date: 2012

DOI: 10.1159/000340002

Effect of CCK-A receptor blockade on postprandial gastroesophageal reflux induced by endogenous CCK in healthy humans

Publisher: Elsevier BV

Date: 04-1998

DOI: 10.1016/S0016-5085(98)83008-4

Assessment, diagnosis, and treatment of dysphagia in patients infected with SARS-CoV-2: A review of the literature and international guidelines

Publisher: American Speech Language Hearing Association

Date: 12-11-2020

DOI: 10.1044/2020_AJSLP-20-00163

Abstract: Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers ostural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.

Pharmacologic Characterization of Intrinsic Mechanisms Controlling Tone and Relaxation of Porcine Lower Esophageal Sphincter

Publisher: American Society for Pharmacology & Experimental Therapeutics (ASPET)

Date: 22-11-2005

DOI: 10.1124/JPET.105.094482

Abstract: The neurotransmitters mediating relaxation of lower esophageal sphincter (LES) were studied using circular LES strips from adult pigs in organ baths. LES relaxation by sodium nitroprusside (1 nM-3 microM), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP 1 nM-1 microM), ATP (10 microM-30 mM), and tricarbonyldichlororuthenum dimer (1 microM-1 mM) was unaffected by tetrodotoxin (1 microM) or l-N(G)-nitroarginine methyl ester (l-NAME 100 microM). Calcitonin gene-related peptide (CGRP 1 nM-1 microM) did not affect LES tone. ATP relaxation was blocked by 1 microM apamin and the P2Y(1) antagonist MRS 2179 (N6-methyl 2'-deoxyadenosine 3',5'-bisphosphate 10 microM). Apamin inhibited PACAP relaxation. VIP and PACAP relaxation was blocked by 10 U/ml alpha-chymotrypsin. L-NAME (-62.52 +/- 13.13%) and 1H-[1,2,4]oxadiazole-[4,3-alpha]quinoxalin-1-one (ODQ 10 microM, -67.67 +/- 6.80%) similarly inhibited electrical LES relaxation, and apamin blocked non-nitrergic relaxation. Nicotine relaxation (100 microM) was inhibited by L-NAME (-60.37 +/- 10.8%) and ODQ (-41.90 +/- 7.89%), and apamin also blocked non-nitrergic relaxation. Non-nitrergic and apamin-sensitive LES relaxation by electrical stimulation or nicotine was strongly inhibited by MRS 2179, slightly inhibited by alpha-chymotrypsin and the P2X(1,2,3) receptor antagonist NF 279 (8,8 cent-[carbonylbis(imino-4,1-phenylenecarbonylimino-4,1-phenylenecarbonylimino)]bis-1,3,5-naphthalenetrisulfonic acid hexasodium salt 10 microM), and unaffected by tin protoporphyrin IX (100 microM). Porcine LES relaxation after stimulation of intrinsic inhibitory motor neurons is mediated by two main neuromuscular pathways: nitric oxide through guanylate cyclase signaling and apamin-insensitive mechanisms and by non-nitrergic apamin-sensitive neurotransmission mainly mediated by ATP, ADP, or a related purine acting on P2Y1 receptors and a minor contribution of purinergic P2X1,2,3 receptors and PACAP. Nitrergic and purinergic co-transmitters show parallel effects of similar magnitude without major interplay. Our study shows no role for CGRP and only a minor one for VIP and carbon monoxide in porcine LES relaxation.

Pharyngeal residue and aspiration and the relationship with clinical/nutritional status of patients with oropharyngeal dysphagia submitted to videofluoroscopy

Publisher: Springer Science and Business Media LLC

Date: 07-06-2016

DOI: 10.1007/S12603-016-0754-6

Abstract: The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration) swallowing and the clinical/nutritional status of patients with suspect of dysphagia. A cross-sectional study was conducted with patients submitted to videofluoroscopy. Data of 76 patients were analyzed between March 2011 and December 2014. The clinical history and VFS exams of patients ≥ 38 years were retrospectively analyzed. 88% patients presented Oropharyngeal Dysphagia (OD), 44.7% presented laryngeal penetration and 32% presented aspiration. 78% patients presented pharyngeal residue. Aspiration was associated with Head Neck Cancer (HNC) [Prevalence Ratio (PR): 2.27, p = 0.028] and cardiovascular disease (PR 1.96, p = 0.027). Underweight [Body Mass Index < 18.5 kg/m2] was not associated with the presence of aspiration. Underweight patients with OD had a higher prevalence rate of pharyngeal residue than those normally nourished (100% vs. 78%) (PR 1.34, p = 0.011). Pharyngeal residue was associated with male sex (PR 1.32, p = 0.040), neurodegenerative disease (PR 1.57, p = 0.021), stroke (PR 1.62, p = 0.009), cerebral palsy (PR 1.76, p = 0.006) and HNC (PR 1.73, p = 0.002). In the present study, neurologic diseases, HNC, male sex and underweight were associated to impaired swallowing efficacy. Underweight, independently of the other variables, was not associated with impaired swallowing safety.

Potential role of the gaseous mediator hydrogen sulphide (H2S) in inhibition of human colonic contractility

Publisher: Elsevier BV

Date: 03-2015

DOI: 10.1016/J.PHRS.2015.01.002

Abstract: Hydrogen sulphide (H2S) is an endogenous signalling molecule that might play a physiologically relevant role in gastrointestinal motility. Cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) are two enzymes responsible for H2S production. d,l-Propargylglycine (PAG) is a CSE inhibitor whereas both aminooxyacetic acid (AOAA) and hydroxylamine (HA) are CBS inhibitors. The characterization of H2S responses and its mechanism of action are crucial to define H2S function. Human colonic strips were used to investigate the role of H2S on contractility (muscle bath) and smooth muscle electrophysiology (microelectrodes). NaHS was used as a H2S donor. Combination of PAG and AOAA depolarized the smooth muscle (5-6mV, n=4) and elicited a transient increase in tone (260.5±92.8mg, n=12). No effect was observed on neural mediated inhibitory junction potential or relaxation. In the presence of tetrodotoxin 1μM, NaHS concentration-dependently inhibited spontaneous contractions (EC50=329.2μM, n=18). This effect was partially reduced by the guanylyl cyclase inhibitor ODQ 10μM (EC50=2.6μM, n=12) and by l-NNA 1mM (EC50=1.4mM, n=8). NaHS reversibly blocked neural mediated cholinergic (EC50=2mM) and tachykinergic (EC50=5.7mM) contractions. NaHS concentration-dependently reduced the increase in spontaneous mechanical activity (AUC) induced by carbachol (EC50=1.9mM) and NKA (EC50=1.7mM AUC). H2S might be an endogenous gasomediator regulating human colonic contractility. Its inhibitory effect is observed at high concentrations and could be mediated by a direct effect on smooth muscle with a possible synergistic effect with NO, as well as by an interaction with the cholinergic and tachykinergic neural mediated pathways.

Acute and subacute effects of oropharyngeal sensory stimulation with TRPV1 agonists in older patients with oropharyngeal dysphagia: a biomechanical and neurophysiological randomized pilot study

Publisher: SAGE Publications

Date: 2019

DOI: 10.1177/1756284819842043

Abstract: Older people with oropharyngeal dysphagia (OD) present a decline in pharyngeal sensory function. The aim of this proof-of-concept study was to assess the biomechanical and neurophysiological effects of acute and subacute oropharyngeal sensory stimulation with transient receptor potential vanilloid 1 (TRPV1) agonists (capsaicinoids) in older patients with OD. We studied the effect of a single dose versus multiple doses (2 weeks) of oral capsaicin treatment (10 –5 M) or placebo in 28 older patients with OD (81.2 ± 4.6 years) using videofluoroscopy (penetration-aspiration scale [PAS], timing of swallow response) and electroencephalography (EEG) (latency and litude of pharyngeal event-related potential [ERP]). Acute stimulation by capsaicinoids 10 –5 M did not improve swallow function and did not produce significant changes in pharyngeal ERP. In contrast, after 10 days of treatment, patients presented a clinically relevant and statistically significant reduction in the laryngeal vestibule closure (LVC) time (22.5%, p = 0.042), and in the PAS (24.2%, p = 0.038), compared with the placebo group. EEG results showed a reduction in the latency of the N1 peak (28.6%, p = 0.007) and an increase of the litude of the P1-N2 (59.4%, p = 0.038) and the N2-P2 (43.6%, p = 0.050) peaks. We observed a strong and significant correlation between the reduction in the latency of the N1 peak and change in LVC time after subacute treatment ( r = 0.750, p = 0.003). After 2 weeks of treatment, oropharyngeal sensory stimulation with capsaicinoids induced cortical changes that were correlated with improvements in swallowing biomechanics in older patients with OD. These results further show that sensory stimulation by TRPV1 agonists can become a useful pharmacological treatment for older patients with OD.

Measuring the Rheological and Textural Properties of Thick Purees Used to Manage Patients with Swallowing Disorders

Publisher: MDPI AG

Date: 28-08-2023

DOI: 10.3390/NU15173767

Abstract: Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the rheological and textural properties of ten thick purees (Texture C, British Dietetic Association), (b) understand the effect of oral processing, and (c) measure the properties of the ready-to-swallow bolus after oral processing in healthy adults. Shear viscosity at 50 s−1 and 300 s−1 and textural properties (maximum force, cohesiveness, and adhesiveness) of boluses of ten thick purees were analyzed with a rheometer and a texture analyzer before and after oral processing (ready-to-swallow) in five healthy volunteers. Viscosity varied by 81.78% at 50 s−1 (900–4800 mPa·s) among purees before oral processing. Maximum force varied by 60% (0.47–1.2 N) cohesiveness, 18% (0.66–0.82), and adhesiveness, 32% (0.74–1.1 N·s). The high variability of viscosity was also present in ready-to-swallow boluses, 70.32% among purees. Oral processing significantly reduced viscosity in most purees (French omelet, zucchini omelet, turkey stew, red lentils, noodles, and hake fish) and also significantly reduced maximum force (7–36%) and adhesiveness (17–51%) but hardly affected cohesiveness ( %). All thick purees met the qualitative textural descriptors for Level C texture. However, all ten purees showed significant differences in all parameters measured instrumentally and were affected differently by oral processing. This study demonstrates the need to use instrumental quality control using standardized protocols and SI units to narrow the variability and provide the optimal values for patients with dysphagia who require texture-modified diets.

Post‐stroke dysphagia: progress at last

Publisher: Wiley

Date: 11-03-2013

DOI: 10.1111/NMO.12112

Abstract: Oropharyngeal Dysphagia (OD) is both underestimated and underdiagnosed as a cause of malnutrition and respiratory complications following stroke. OD occurs in more than 50% of stroke patients. Aspiration pneumonia (AP) occurs in up to 20% of acute stroke patients and is a major cause of mortality after discharge. Systematic screening for OD should be performed on every patient with stroke before starting oral feeding, followed, if appropriate by clinical and instrumental (videofluroscopy and/or fiberoptic endoscopy) assessment. Bolus modification with adaptation of texture and viscosity of solids and fluids and postural adjustments should be part of the minimal treatment protocol, but they do not change the impaired swallow physiology nor promote recovery of damaged neural swallow networks in stroke patients. To this purpose, two new neurostimulation approaches are being developed to stimulate cortical neuroplasticity to recover swallowing function: (i) those aimed at stimulating the peripheral oropharyngeal sensory system by chemical, physical or electrical stimulus and (ii) those aimed at directly stimulating the pharyngeal motor cortex, such as repetitive transcranial magnetic stimulation (rTMS). The study of Park et al. in this issue of Neurogastroenterology and Motility evaluated the effect of rTMS in dysphagic stroke patients and showed a marked improvement in swallow physiology. Other studies also using rTMS showed plastic changes in pharyngeal motor cortical areas relevant to swallowing function. If further randomized controlled trials confirm these initial results, the neurorehabilitation strategies will be introduced to clinical practice sooner rather than later, improving the recovery of dysphagic stroke patients. Progress at last.

Shear-Viscosity-Dependent Effect of a Gum-Based Thickening Product on the Safety of Swallowing in Older Patients with Severe Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 24-07-2023

DOI: 10.3390/NU15143279

Abstract: Fluid thickening is a valid therapeutic strategy for patients with oropharyngeal dysphagia (OD). The main aim of this study was to determine the therapeutic effect of the xanthan-gum-based thickener Tsururinko Quickly (TQ, Morinaga Milk Co., Tokyo, Japan) in older patients with severe OD. A total of 85 patients (83.32 ± 6.75 y) with OD and a penetration–aspiration score (PAS) of n ≥ 3 were studied by videofluoroscopy while swallowing duplicate 10 mL boluses at mPa·s, 100, 200, 400, 800, and 1600 mPa·s, to assess the safety and efficacy of swallowing and the biomechanics of a swallowing response at each viscosity level. At mPa·s, only 16.25% patients swallowed safely, 45% had penetrations (PAS 3–5), and 38.75% had aspirations (PAS 6–8). Fluid thickening with TQ greatly increased the prevalence of patients with safe swallowing from 62.90% at 100 mPa·s to 95.24% at 1600 mPa·s in a shear-viscosity-dependent manner. The penetrations and aspirations were significantly reduced to 3.60% and 1.19%, respectively, at 1600 mPa·s. The threshold viscosity was 100 mPa·s and the increasing viscosity above 800 mPa·s did not further improve the therapeutic effect significantly. Increasing the shear viscosity significantly reduced the time to laryngeal vestibule closure (−16.70%), increased the time to upper oesophageal sphincter opening (+26.88%), and reduced the pharyngeal bolus velocity (−31.62%) without affecting the pharyngeal residue. TQ has a strong shear-viscosity-dependent effect on the safety of swallowing in older patients with severe OD without increasing the pharyngeal residue. The therapeutic range for TQ is 100–800 mPa·s, with 200 and 800 mPa·s being the optimal doses to cover the needs of older patients with OD.

Advances in a Multimodal Approach for Dysphagia Analysis Based on Automatic Voice Analysis

Publisher: Springer International Publishing

Date: 2016

DOI: 10.1007/978-3-319-33747-0_20

Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life

Publisher: Elsevier BV

Date: 12-2007

DOI: 10.1016/J.CLNU.2007.08.006

Abstract: To determine the prevalence of dysphagia in head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy. To study the impact of dysphagia on food habits, nutritional status, and quality of life. Retrospective cross-sectional study of 87 head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy from January 2000 through May 2005. Time since surgery was 28.5+/-17.8 months. A clinical test was used to detect dysphagia. A nutritional assessment was performed in all patients. A questionnaire was used to evaluate quality of life. Oropharyngeal dysphagia was present in 50.6% of patients, mostly to solid foods (72.4%). Patients with total glossectomy and chemoradiotherapy had the highest rate of dysphagia. Nutritional support was necessary in 57.1% of patients. Malnutrition was present in 20.3% of patients, mainly marasmus (81%). Fifty-one percent of patients reported a decrease in their quality of life due to dysphagia. We found a high prevalence of dysphagia in head and neck cancer patients treated with surgery and coadjuvant treatment. This problem negatively affects their quality of life. It is important that nutritional surveillance be provided to detect it and to prevent malnutrition.

α,β-meATP mimics the effects of the purinergic neurotransmitter in the human and rat colon

Publisher: Elsevier BV

Date: 10-2014

DOI: 10.1016/J.EJPHAR.2014.06.048

Abstract: The purine receptor involved in inhibitory responses in the gastrointestinal tract has been recently identified. P2Y1 receptor activation mediates the fast component of the inhibitory junction potential (IJPf) and the non-nitrergic relaxation. The aim of the present work has been to investigate which purinergic agonist better mimics endogenous responses. We used different agonist and antagonist of P2 receptors. Contractility and microelectrode experiments were used to compare the effects of exogenously added purines and electrical field stimulation (EFS)-induced nerve mediated effects in rat and human colonic strips. In rat colon, the IJPf and EFS-induced inhibition of contractions were concentration-dependently inhibited by the P2Y1 antagonist MRS2500 but not by iso-PPADS or NF023 (P2X antagonists) up to 1 μM. In s les from human colon, EFS-induced inhibition of contractions was inhibited by either MRS2500 or apamin (1 μM) but not by iso-PPADS. In both species, α,β-meATP, a stable analog of ATP, caused inhibition of spontaneous contractions. α,β-meATP effect was concentration-dependent (EC50: 2.7 μM rat, 4.4 μM human) and was antagonized by either MRS2500 or apamin but unaffected by P2X antagonists. ATP, ADP, β-NAD and ADP-ribose inhibited spontaneous contractions but did not show the same sensitivity profile to purine receptor antagonists as EFS-induced inhibition of contractions. The effect of α,β-meATP is due to P2Y1 receptor activation leading the opening of sKca channels. Accordingly, α,β-meATP mimics the endogenous purinergic mediator. In contrast, exogenously added putative neurotransmitters do not exactly mimic the endogenous mediator. Quick degradation by ecto-nuclease or different distribution of receptors (junctionally vs extrajunctionally) might explain these results.

Bowel Dysfunction in Patients with Motor Complete Spinal Cord Injury: Clinical, Neurological, and Pathophysiological Associations

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2006

DOI: 10.1111/J.1572-0241.2006.00729.X

Abstract: Abnormal bowel function is a key problem in patients with spinal cord injury (SCI). Previous works provided only partial information on colonic transit time (CTT) or anal dysfunction but did not identified a comprehensive neurogenic bowel pattern. To evaluate clinical, neurological, and pathophysiological counterparts of neurogenic bowel in patients with motor complete SCI. Fifty-four patients (56% men, mean age 35 yr) with chronic motor complete SCI (mean evolution time 6 yr) were evaluated: 41% with injuries above T7 (> T7) and 59% with injuries below T7 ( T7 injuries, characterized by very frequent constipation (86%) with significant defecatory difficulty and not very severe incontinence (Mean Wexner score 4.5) it was related to moderate delay in CTT (mainly in the left colon and recto-sigma), incapacity to increase the intra-abdominal pressure, and the absence of anal relaxation during the defecatory maneuvre Pattern B, present in < T7 injuries with preserved sacral reflexes, characterized by not so frequent constipation (50%) but very significant defecatory difficulty and not very severe incontinence (Wexner 4.8) the pathophysiological counterpart was a moderate delay in CTT, capacity to increase intra-abdominal pressure, increased anal resistance during the defecatory maneuver, and presence of external anal sphincter (EAS) contraction when intra-abdominal pressure increased and during rectal distension Pattern C, present in < T7 injuries without sacral reflexes, characterized by not very frequent constipation (56%) with less defecatory difficulty and greater severity of incontinence (Wexner 7.2) this was associated with severe delay in CTT (mainly in the left colon), capacity to increase intra-abdominal pressure, absence of anal resistance during the defecatory maneuver, and absence of EAS contraction when intra-abdominal pressure increased and during rectal distension. In patients with motor complete SCI, we were able to define three different neuropathophysiological patterns that are associated with bowel function abnormalities and clinical complaints this might be of help when designing therapeutic strategies.

Chloroquine Stabilizes Pancreatic Lysosomes and Improves Survival of Mice with Diet-Induced Acute Pancreatitis

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 04-1997

DOI: 10.1097/00006676-199704000-00007

Abstract: Activation of digestive zymogens by lysosomal enzymes has been suggested as a triggering event in acute pancreatitis (AP). chloroquine (CQ), a weak base that accumulates in the lysosomes and increases their pH, can inhibit the activity of lysosomal enzymes. In the present study, we examined the effect of CQ on choline-deficient, ethionine-supplemented (CDE) diet-induced AP. CQ-diphosphate (15-50 mg.kg-1) or vehicle was given intraperitoneally at 0, 24, and 48 h to female CD1 mice that were fed with either normal diet or CDE diet. For mortality studies, animals were observed for 168 h. Serum and pancreas s les were collected from animals sacrificed 56 h after the start of the CDE diet. Treatment with CQ at 50 mg.kg-1 significantly (p < 0.05) improved the survival of mice with CDE diet-induced AP. In the normal pancreas, CQ decreased the specific activity of lysosomal enzymes cathepsin B1, beta-hexosaminidase, beta-glucuronidase, and acid phosphatase. In the pancreas with AP, CQ did not modify the activity of cathepsin B1, whereas it increased the latency of all enzymes. In conclusion, our results confirm the beneficial effect of CQ on survival of mice with CDE diet-induced AP and suggest that this effect of CQ may be due to its stabilizing action on lysosomes.

HIV-Associated Polymyositis With Life-Threatening Myocardial and Esophageal Involvement

Publisher: American Medical Association (AMA)

Date: 10-05-1999

DOI: 10.1001/ARCHINTE.159.9.1012

Mast cell degranulation inhibits motor patterns of human ileum and sigmoid colon in vitro: relevance for postoperative ileus

Publisher: Wiley

Date: 13-05-2015

DOI: 10.1111/NMO.12589

Abstract: Local release of mast cell proteases during gastrointestinal surgery is associated with the inhibition of motility and postoperative ileus (POI). We determined whether activation of intramuscular mast cell affects the motor patterns of the human ileum and colon and whether proteases are involved. Motor response of ileal and colonic circular muscle strips was measured in organ bath. Mast cell degranulation was induced by compound 48/80 (c48/80 25-675 μg/mL). Motor response was quantified as tone, rhythmic phasic contractions (RPCs) and contractions to electric field stimulation (EFS 40 Hz), and bethanechol-evoked contractions. Ketotifen (10(-6) mol/L) and a protease inhibitor cocktail (P8340) were used to evaluate the role of mast cell mediators. (a) c48/80 impaired the spontaneous and the electrically evoked motor response in small bowel and colonic strips (sigmoid colon EC50 : 460.0 μg/mL for RPCs and 8.9 μg/mL for electrically evoked contraction litudes) and bethanechol-evoked contractions. (b) Preincubation with ketotifen (10(-6) mol/L, 1 h) prevented the impairment of RPCs and EFS-evoked contractions in the sigmoid colon and ileum but not in the right colon. (c) Preincubation with P8340 also prevented the impairment of contractions in the sigmoid colon but not in the ileum or the right colon. Mast cell degranulation by c48/80 inhibits the spontaneous and the nerve-mediated motor response in the human ileum and colon. The effect is partially mediated by mast cell proteases and could be relevant in the pathophysiology of POI.

Effect of Aging, Gender and Sensory Stimulation of TRPV1 Receptors with Capsaicin on Spontaneous Swallowing Frequency in Patients with Oropharyngeal Dysphagia: A Proof-of-Concept Study

Publisher: MDPI AG

Date: 07-03-2021

DOI: 10.3390/DIAGNOSTICS11030461

Abstract: Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) ided into three groups: GI—18–39 yr, GII—40–59 yr, and GIII— yr. OD was assessed by the Volume–Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10−5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min p = 0.0385) and GIII (0.50 ± 0.31 swallows/min p 0.0001) compared to GI (1.03 ± 0.62 swallows/min), and there was a moderate significant correlation between age and SFF (r = −0.3810 p 0.0001). No effect of gender on SSF was observed. Capsaicin caused a strong and significant increase in SSF after the TRPV1 stimulation when comparing to basal condition (pre-capsaicin: 0.41 ± 0.32 swallows/min vs post-capsaicin: 0.81 ± 0.51 swallow/min p = 0.0003). OD in patients with post-stroke OD and acute stimulation with TRPV1 agonists caused a significant increase in SSF, further suggesting the potential role of pharmacological stimulation of sensory pathways as a therapeutic strategy for CPG activation in patients with OD.

Oral health in older patients with oropharyngeal dysphagia

Publisher: Oxford University Press (OUP)

Date: 2014

DOI: 10.1093/AGEING/AFT164

Abstract: oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S) (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis) and (iii) the presence of dental caries. 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.

The effects of a xanthan gum‐based thickener on the swallowing function of patients with dysphagia

Publisher: Wiley

Date: 13-03-2014

DOI: 10.1111/APT.12696

Abstract: Increasing bolus viscosity of thin liquids is a basic therapeutic strategy to protect patients with oropharyngeal dysphagia (OD) from aspiration. However, conventional starch thickeners increase post-deglutitive residue. To assess the therapeutic effect of a new xanthan gum-based thickener, Resource ThickenUp Clear (Nestlé Health Science, Vevey, Switzerland) on patients with oropharyngeal dysphagia. We studied the effect of Resource ThickenUp Clear using a clinical method and videofluoroscopy on 120 patients with oropharyngeal dysphagia (66 with stroke, 41 older and 13 with neurodegenerative diseases) and 14 healthy volunteers while swallowing thin-liquid, nectar-like and spoon-thick boluses. We assessed the prevalence of signs of impaired safety and efficacy of swallow and the physiology of the swallow response. Increasing bolus viscosity with Resource ThickenUp Clear: (i) improved safety of swallow demonstrated by a reduction in the prevalence of cough and voice changes in the clinical study and penetrations and aspirations during video fluoroscopy. Prevalence of aspirations was 12.7% with thin liquid, 7.7% with nectar-like (P < 0.01) and 3.4% with spoon-thick (P < 0.01) viscosities. Penetration-Aspiration Scale was reduced from 3.24 ± 0.18 at thin liquid to 2.20 ± 0.18 at nectar-like (P < 0.001) and to 1.53 ± 0.13 at spoon-thick (P < 0.001) viscosities (ii) did not enhance pharyngeal residue (iii) nectar-like viscosity did not affect bolus velocity nor timing of swallow response and (iv) spoon-thick viscosity reduced bolus velocity. Resource ThickenUp Clear improves the safety of swallow without increasing residue providing a viscosity-dependent therapeutic effect for patients with oropharyngeal dysphagia. At nectar viscosity, the effect is due to intrinsic texture properties, spoon-thick viscosity adding changes in swallow physiology. NCT01158313.

Increased levels of substance P in patients taking beta‐blockers are linked with a protective effect on oropharyngeal dysphagia

Publisher: Wiley

Date: 24-07-2018

DOI: 10.1111/NMO.13397

Abstract: We have recently found a potential protective effect of beta-blockers on oropharyngeal dysphagia (OD). The action mechanism by which beta-blockers could wield this protective effect is unknown, but the neurotransmitter substance P (SP) could play a key role. The aim of this study was to analyze serum and saliva SP levels in patients taking beta-blockers (TBB), and to explore its relationship with OD. Adult (>50 year) patients TBB were randomly recruited from the primary care setting and 1:1 matched by age, sex, and Barthel Index (BI) with patients not taking beta-blockers (NTBB). Serum and saliva s les were taken and analyzed for their SP levels using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic and clinical variables were collected. Dysphagia was evaluated in all patients using the clinical volume-viscosity swallow test (V-VST). We studied 28 patients TBB (64.96 ± 7.31 years, 57.1% women, BI 99.6 ± 1.31, carvedilol-equivalent dose 24.11 ± 18.12 mg) and 28 patients NTBB (65.61 ± 6.43 years, 57.1% women, BI 99.6 ± 1.31). SP serum levels were significantly higher in patients TBB (260.68 ± 144.27 vs 175.46 ± 108.36 pg/mL, P = .009) as were SP saliva levels (170.34 ± 146.48 vs 102.73 ± 52.28 pg/mL, P < .001) compared with patients NTBB. The prevalence of OD was 32.1% in patients TBB and 67.9% in patients NTBB (P = .015). Moreover, patients with OD had significantly lower SP saliva levels in comparison with patients without clinical signs of OD (98.39 ± 43.25 vs 174.69 ± 147.21 pg/mL) P < .001. We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD.

The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews

Publisher: MDPI AG

Date: 16-06-2022

DOI: 10.3390/NU14122497

Abstract: Background: The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it. Methods: Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE. Results: (R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19–100% prevalence of dehydration (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements. Conclusions: Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.

The effect of sodicity on cotton: does soil chemistry or soil physical condition have the greater role?

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/CP13078

Abstract: Soil sodicity is widespread in the cracking clays used for irrigated cotton (Gossypium hirsutum L.) production in Australia and worldwide and sometimes produces nutrient imbalances and poor plant growth. It is not known whether these problems are due primarily to soil physical or to soil chemical constraints. We investigated this question by growing cotton to maturity in a glasshouse in large s les of a Grey Vertosol in which the exchangeable sodium percentage (ESP) was adjusted to 2, 13, 19, or 24. A soil-stabilising agent, anionic polyacrylamide (PAM), was added to half the pots and stabilised soil aggregation at all ESPs. Comparison of the effect of ESP on cotton in the pots with and without PAM showed that, up to ESP of 19, the soil physical effects of sodicity were mainly responsible for poor cotton performance and its ability to accumulate potassium. At ESP , PAM amendment did not significantly improve lint yield, indicating that soil chemical constraints, high plant sodium concentrations ( .2%), and marginal plant manganese concentrations limited plant performance. Further research into commercial methods of amelioration of poor physical condition is warranted rather than application of more fertiliser.

Characterization of Dysphagia Thickeners Using Texture Analysis—What Information Can Be Useful?

Publisher: MDPI AG

Date: 09-07-2022

DOI: 10.3390/GELS8070430

Abstract: Besides shear viscosity, other texture parameters (adhesiveness or cohesiveness) might be relevant for safe swallowing in people suffering from oropharyngeal dysphagia. Shear viscosity is assessed through protocols developed using a viscometer or a rheometer. In contrast, protocols and instruments (capillary break-up rheometer) to assess adhesiveness and cohesiveness are less common and much less developed. Other equipment such as texture analyzers can provide useful information on food properties. Here, we aimed to explore different texture analyzer settings (type of test, probe, and protocol) to characterize four commercial dysphagia thickeners at the shear viscosity levels recommended by manufacturers. Among the tests used (extrusion or penetration) with the different probes (disc, cone and shape holder, sphere, or cylinder), cone extrusion provided information about adhesivity, disc extrusion about s le cohesiveness, and sphere about penetration and s le elasticity. The test speeds used influenced the results, but only one speed is needed as the different speeds provided the same fluid information for easiness, it is proposed to use 1 mm/s. Comparing the texture analyzer results with viscosity values obtained at different shears, the texture analyzer parameters reflected information that differ from shear viscosity. This information could be relevant for the therapeutic effect of thickening products and food characterization.

Kegel Exercises, Biofeedback, Electrostimulation, and Peripheral Neuromodulation Improve Clinical Symptoms of Fecal Incontinence and Affect Specific Physiological Targets: An Randomized Controlled Tri

Publisher: The Korean Society of Neurogastroenterology and Motility

Date: 30-01-2021

DOI: 10.5056/JNM20013

Patterns of impaired internal anal sphincter activity in patients with anal fissure

Publisher: Wiley

Date: 27-03-2013

DOI: 10.1111/CODI.12095

Abstract: The patterns of impaired internal anal sphincter activity were studied in patients with anal fissure (AF). Twenty healthy controls and 61 patients with acute AF were studied, using anorectal manometry with electromyography (EMG), and 53 patients with chronic AF using high-resolution manometry and ultrasonography. Mean and maximal resting anal pressure (MRAP), spontaneous rhythmic slow and ultraslow waves (USW) and relaxation induced by rectal distension were measured. Patients with acute AF had higher mean (106.4 ± 28.1 mmHg) and maximal resting anal pressure (161.5 ± 43.7 mmHg) than those with chronic AF (P < 0.05) 95% of patients had slow waves (SW) and 67% ultraslow waves. Patients with chronic AF had higher mean (92.4 ± 22.6 mmHg) and maximal resting anal pressure (117.5 ± 32.0 mmHg) than controls and 94% of patients had slow waves and 69% ultraslow waves. Patients with ultraslow waves (with either acute or chronic AF) had increased internal sphincter hypertonicity (mean and maximal resting pressure), decreased internal sphincter relaxation and increased after-contraction following rectal distension. Patients with acute AF had higher hypertonicity than those with chronic AF and both had increased spontaneous rhythmic activity (waves). Patients with AF and ultraslow waves had higher internal anal sphincter hypertonicity and reduced internal sphincter relaxation and enhanced after-contraction following rectal distension.

Endogenous cholecystokinin enhances postprandial gastroesophageal reflux in humans through extrasphincteric receptors

Publisher: Elsevier BV

Date: 09-1998

DOI: 10.1016/S0016-5085(98)70139-8

Abstract: Exogenous cholecystokinin (CCK) decreases lower esophageal sphincter (LES) pressure and increases transient LES relaxations (TLESRs) in humans. The aims of this study were to determine whether endogenous CCK increases gastroesophageal reflux in humans and whether this is a direct effect on the LES. Esophageal pH, LES pressure, and gallbladder volume were measured in 8 healthy volunteers after ingestion of a 181-kcal meal alone or adding 12 g cholestyramine to increase endogenous CCK release. In 7 additional volunteers, the effect of cholestyramine was studied during intravenous perfusion of saline or the CCK-A receptor antagonist loxiglumide. In circular LES strips from 9 transplant donors, we measured the effect of CCK-8 (10(-11) to 3 x 10(-8) mol/L) on basal tension and on electrical field-induced relaxation. Cholestyramine increased gallbladder emptying, reflux episodes, TLESRs, and time of esophageal pH of <4. Loxiglumide inhibited postprandial gallbladder emptying, reflux episodes, TLESRs, and time of pH of <4 and prevented the decrease in LES pressure induced by cholestyramine. In vitro, CCK-8 contracted LES strips through a tetrodotoxin-insensitive pathway but did not modify electrical field-induced LES relaxations. Endogenous CCK enhances postprandial gastroesophageal reflux in humans by increasing the rate of TLESRs and reduces postprandial LES pressure. These actions seem mediated by extrasphincteric CCK-A receptors that override a direct contractile effect of CCK on the LES muscle.

Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review

Publisher: MDPI AG

Date: 31-03-2023

DOI: 10.3390/NU15071714

Abstract: Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost–utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed.

Aspiration pneumonia: management in Spain

Publisher: Elsevier BV

Date: 07-2011

DOI: 10.1016/J.EURGER.2011.03.004

Oropharyngeal Dysphagia in Older People is Associated with Reduced Pharyngeal Sensitivity and Low Substance P and CGRP Concentration in Saliva

Publisher: Springer Science and Business Media LLC

Date: 12-03-2021

DOI: 10.1007/S00455-021-10248-W

Abstract: Substance P (SP) and Calcitonine gene-related peptide (CGRP) are released by sensory nerve fibers in the oropharynx. Patients with oropharyngeal dysphagia (OD) present reduced oropharyngeal sensitivity and low SP concentration in saliva. We aimed to assess the concentration of salivary SP and CGRP in healthy volunteers, and older people without and with OD, and the relationship with pharyngeal sensory threshold. We included 15 healthy volunteers, 14 healthy elderly and 14 elderly with OD. Swallow function was assessed by videofluoroscopy (VFS). Pharyngeal sensory threshold was assessed by intrapharyngeal electrical stimulation. Hydration and phase angle were assessed by bioimpedance. Saliva s les were collected with a Salivette® to determine SP and CGRP concentration by ELISA. Elderly patients with OD presented impaired safety of swallow (PAS 4.38 ± 0.77 p < 0.0001 vs. healthy volunteers = 1 and healthy elderly = 1.43 ± 0.51). Healthy elderly and elderly with OD presented a reduction in intracellular water and saliva volume (healthy elderly, 592.86 ± 327.79 μl, p = 0.0004 elderly with OD, 422.00 ± 343.01 μl, p = 0.0001 vs healthy volunteers, 1333.33 ± 615.91 μl, r = 0.6621, p < 0.0001). Elderly patients with OD presented an impairment in pharyngeal sensory threshold (10.80 ± 3.92 mA vs. healthy volunteers, 5.74 ± 2.57 mA p = 0.007) and a reduction in salivary SP (129.34 pg/ml vs. healthy volunteers: 173.89 pg/ml p = 0.2346) and CGRP levels (24.17 pg/ml vs. healthy volunteers: 508.18 pg/ml p = 0.0058). There was a negative correlation between both SP and CGRP concentrations and pharyngeal sensory threshold (r = - 0.450, p = 0.024 r = - 0.4597, p = 0.036, respectively), but only SP identified elderly patients with OD with higher pharyngeal sensory threshold. Elderly patients with OD presented hydropenia and sarcopenia, reduced salivary SP and CGRP and impaired pharyngeal sensitivity. Our study suggests SP levels in saliva as a potential biomarker to monitor pharyngeal sensitivity in elderly patients with OD.

Physiology of the upper segment, body, and lower segment of the esophagus

Publisher: Wiley

Date: 10-2013

DOI: 10.1111/NYAS.12250

Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration

Publisher: Elsevier BV

Date: 12-2008

DOI: 10.1016/J.CLNU.2008.06.011

Abstract: To determine the accuracy of the bedside volume-viscosity swallow test (V-VST) for clinical screening of impaired safety and efficacy of deglutition. We studied 85 patients with dysphagia and 12 healthy subjects. Series of 5-20 mL nectar (295.02 mPa.s), liquid (21.61 mPa.s) and pudding (3682.21 mPa.s) bolus were administered during the V-VST and videofluoroscopy. Cough, fall in oxygen saturation > or =3%, and voice changes were considered signs of impaired safety, and piecemeal deglutition and oropharyngeal residue, signs of impaired efficacy. Videofluoroscopy showed patients had prolonged swallow response (> or =1064 ms) 52.1% had safe swallow at nectar, 32.9%, at liquid (p<0.05), and 80.6% at pudding viscosity (p<0.05) 29.4% had aspirations, and 45.8% oropharyngeal residue. The V-VST showed 83.7% sensitivity and 64.7% specificity for bolus penetration into the larynx and 100% sensitivity and 28.8% specificity for aspiration. Sensitivity of V-VST was 69.2% for residue, 88.4% for piecemeal deglutition, and 84.6% for identifying patients whose deglutition improved by enhancing bolus viscosity. Specificity was 80.6%, 87.5%, and 73.7%, respectively. The V-VST is a sensitive clinical method to identify patients with dysphagia at risk for respiratory and nutritional complications, and patients whose deglutition could be improved by enhancing bolus viscosity. Patients with a positive test should undergo videofluoroscopy.

Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly

Publisher: European Respiratory Society (ERS)

Date: 26-07-2012

DOI: 10.1183/09031936.00019012

Abstract: The aim of this study was to explore whether oropharyngeal dysphagia is a risk factor for community-acquired pneumonia (CAP) in the elderly and to assess the physiology of deglutition of patients with pneumonia. In the case-control study, 36 elderly patients (aged ≥ 70 years) hospitalised with pneumonia were matched by age and sex with two independently living controls. All subjects were given the volume-viscosity swallow test to identify signs of oropharyngeal dysphagia. In the pathophysiological study, all cases and 10 healthy elderly subjects were examined using videofluoroscopy. Prevalence of oropharyngeal dysphagia in the case-control study was 91.7% in cases and 40.3% in controls (p<0.001). Adjusting for functionality and comorbidities, dysphagia showed an independent effect on pneumonia (OR 11.9, 95% CI 3.03-46.9). Among cases in the pathophysiological study, 16.7% showed safe swallow, 30.6% high penetrations, 36.1% severe penetrations and 16.7% silent aspirations during videofluoroscopy, while in the healthy elderly subjects these percentages were 80%, 20%, 0% and 0%, respectively (p<0.001). A delay in closure of the laryngeal vestibule (0.414 ± 0.029 s versus 0.200 ± 0.059 s, p<0.01) was the main mechanism of impaired airway protection. In elderly subjects, oropharyngeal dysphagia is strongly associated with CAP, independently of functionality and comorbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia.

Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study

Publisher: Oxford University Press (OUP)

Date: 05-02-2012

DOI: 10.1093/AGEING/AFS006

Abstract: to assess the role of oropharyngeal dysphagia (OD) as a risk factor for malnutrition and/or lower respiratory tract infection (LRTI) in the independently-living population of 70 years and over. a population-based cohort study. persons 70 years and over in the community (non-institutionalised) were randomly selected from primary care databases. the volume-viscosity swallow test (V-VST) was administered by trained physicians at baseline to identify subjects with clinical signs of OD and impaired safety or efficacy of swallow. At the one year follow-up visit, hand grip, functional capacity (Barthel score), nutritional status (mini nutritional assessment, MNA) and LRTI (clinical notes) were assessed. two hundred and fifty-four subjects were recruited (46.5% female mean age, 78 years) and 90% of them (227) were re-evaluated one year later. Annual incidence of 'malnutrition or at risk of malnutrition' (MNA <23.5) was 18.6% in those with basal signs of OD and 12.3% in those without basal signs of OD (P = 0.296). However, prevalent cases of 'malnutrition or at risk of malnutrition' at follow up were associated with basal OD (OR = 2.72 P = 0.010), as well as with basal signs of impaired efficacy of swallow (OR = 2.73 P = 0.015). Otherwise, LRTI's annual incidence was higher in subjects with basal signs of impaired safety of swallow in comparison with subjects without such signs (40.0 versus 21.8% P = 0.030 OR = 2.39). OD is a risk factor for malnutrition and LRTI in independently living older subjects. These results suggest that older persons should be routinely screened and treated for OD to avoid nutritional and respiratory complications.

Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 23-06-2020

DOI: 10.3390/NU12061873

Abstract: Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener® (FCT)] on four phenotypes of OD patients: G1) 36 older G2) 31 head/neck cancer (HNC) G3) 30 Parkinson’s disease and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5/20 mL boluses, at four levels of shear-viscosity ( , 250, 1000 and 2000 mPa·s). The effect of α-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 ± 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 250–1000 mPa·s (74.19–96.67%, safe swallows in G1, G3, G4, and 58.06% in G2), without increasing pharyngeal residue. Viscosity was unaffected by α-amylase. Increasing shear-viscosity with FCT causes a strong viscosity-dependent therapeutic effect on the safety of swallow. This effect depends on the phenotype and is similar among older, Parkinson’s and post-stroke patients.

Corrigendum

Publisher: Wiley

Date: 21-12-2015

DOI: 10.1111/NMO.12731

A retrospective and prospective 12-month observational study of the socioeconomic burden of moderate to severe irritable bowel syndrome with constipation in Spain

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.GASTROHEP.2018.10.008

Abstract: The socioeconomic burden of irritable bowel syndrome with constipation (IBS-C) has never been formally assessed in Spain. This 12-month (6-month retrospective and prospective periods) observational, multicentre study assessed the burden of moderate-to-severe IBS-C in Spain. Patients were included if they had been diagnosed with IBS-C (Rome III criteria) within the last 5 years and had moderate-to-severe IBS-C (IBS Symptom Severity Scale score [IBS-SSS] ≥175) at inclusion. The primary objective was to assess the direct cost to the Spanish healthcare system (HS). A total of 112 patients were included, 64 (57%) of which had severe IBS-C at inclusion. At baseline, 89 (80%) patients reported abdominal pain and distention. Patient quality of life (QoL), measured by the IBS-C QoL and EQ-5D instruments, was found to be impaired with a mean score of 59 and 57 (0-100, worst-best), respectively. Over the 6-month prospective period the mean IBS-C severity, measured using the IBS-SSS showed some improvement (315-234 [0-500, best-worst]). During the year, 89 (80%) patients used prescription drugs for IBS-C, with laxatives being the most frequently prescribed (n=70 63%). The direct cost to the HS was €1067, and to the patient was €568 per year. The total direct cost for moderate-to-severe IBS-C was €1635. The majority of patients reported continuous IBS-C symptoms despite that 80% were taking medication to treat their IBS-C. Overall healthcare resource use and direct costs were asymmetric, with a small group of patients consuming the majority of resources.

Treatment of IBS-D with 5-HT3 receptor antagonists vs spasmolytic agents: similar therapeutical effects from heterogeneous pharmacological targets

Publisher: Wiley

Date: 18-11-2011

DOI: 10.1111/J.1365-2982.2011.01808.X

Abstract: There is still no agreement over optimal pharmacological treatment for irritable bowel syndrome (IBS). Patients with IBS and diarrhea (IBS-D) demonstrate both visceral hypersensitivity and impaired colonic motility with increased frequency and litude of giant migrating contractions (GMCs) which cause mass movements, propulsion of stools and initiation of defecation. Both antispasmodics and 5-HT3 receptor antagonists can improve the symptoms and the impaired colonic motility of patients with IBS-D though through very different mechanisms. Antispasmodics act by directly relaxing the colonic smooth muscle cells or antagonizing the excitatory neuromuscular neurotransmission. In contrast, the mechanism of action of 5HT3 antagonists is much more complex and subtle as they inhibit the ascending excitatory component of the peristaltic reflex and GMCs. There are some concerns about the safety of 5HT3 antagonists in long-term treatment. Most of the studies on the treatment of IBS have followed the pharmacological strategy of looking for big clinical effects acting on a single receptor/target. We propose a pharmacologic strategy which uses different drugs for pain and dysmotility in the same patient and includes specific drugs acting on smooth muscle cells, neuromuscular transmission, synaptic transmission and intrinsic afferents. The clinical effect on IBS symptoms would be found in the sum of all these smaller effects on multiple targets.

A randomized clinical trial on the acute therapeutic effect of TRPA1 and TRPM8 agonists in patients with oropharyngeal dysphagia

Publisher: Wiley

Date: 16-02-2020

DOI: 10.1111/NMO.13821

A Comparative Study of Structure and Function of the Longitudinal Muscle of the Anal Canal and the Internal Anal Sphincter in Pigs

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2009

DOI: 10.1007/DCR.0B013E3181B160BE

Effect of cholecystokinin‐A receptor blockade on postprandial insulinaemia and gastric emptying in humans

Publisher: Wiley

Date: 10-2002

DOI: 10.1046/J.1365-2982.2002.00355.X

Abstract: Our aim was determine the relationship between cholecystokinin (CCK)-A receptor blockade, glucose levels, insulin secretion and gastric emptying in humans, and to assess the effect of CCK-A blockade on pancreatic polypeptide secretion. After a 12-h fast, six healthy volunteers were given [99mTc]iminodiacetic acid monosodium salt (IDA) intravenously (5 mCi). One hour later they were offered a 577 kcal liquid meal containing [99mTc]diethylenetriaminepentaacetic acid (DTPA) (2 mCi) and glucose (105 g). Scintigraphic gastric and gallbladder activity, and plasma glucose, insulin and pancreatic polypeptide responses were monitored. In a second experiment, a continuous intravenous infusion of loxiglumide (7.5 mg kg h(-1)) was started 60 min before and continued until 120 min after test meal ingestion to block the CCK-A receptors. Gallbladder emptying was blocked by loxiglumide. Loxiglumide accelerated gastric emptying, increased insulin secretion without alteration of glucose profiles, and abolished all phases of the postprandial pancreatic polypeptide response. Blockade of peripheral CCK-A receptors accelerates gastric emptying of liquids with an increase in postprandial insulin levels. The lack of changes in glycaemia suggests that alternative homeostatic mechanisms also control postprandial glucose levels. Inhibition of pancreatic polypeptide release may reflect an independent effect of loxiglumide on vagal control involved in pancreatic polypeptide release.

Oropharyngeal Dysphagia is a Risk Factor for Readmission for Pneumonia in the Very Elderly Persons: Observational Prospective Study

Publisher: Oxford University Press (OUP)

Date: 05-07-2013

DOI: 10.1093/GERONA/GLT099

Abstract: To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly in iduals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All in iduals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of in iduals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in in iduals without dysphagia and 6.7 (5.5-7.8) in those with dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons.

Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction

Publisher: Wiley

Date: 12-08-2013

DOI: 10.1111/NMO.12211

Abstract: Chronic poststroke oropharyngeal dysfunction (OD) is a common condition, leading to severe complications, including death. Treatments for chronic poststroke OD are scarce. The aim of our study was to assess and compare the efficacy and safety of treatment with surface electrical stimulation (e-stim) at sensory and motor intensities in patients with chronic poststroke OD. Twenty chronic poststroke patients with OD were randomly assigned to (i) sensory e-stim (treatment intensity: 75% of motor threshold) or (ii) motor e-stim (treatment intensity: motor threshold). Patients were treated during 10 days, 1 h/day. Videofluoroscopy was performed at the beginning and end of the study to assess signs of impaired efficacy and safety of swallow and timing of swallow response. Patients presented advanced age (74.95 ± 2.18), 75% were men. The mean days poststroke was 336.26 ± 89.6. After sensory stimulation, the number of unsafe swallows was reduced by 66.7% (p < 0.001), the laryngeal vestibule closure time by 22.94% (p = 0.027) and maximal vertical hyoid extension time by 18.6% (p = 0.036). After motor stimulation, the number of unsafe swallows was reduced by 62.5% (p = 0.002), the laryngeal vestibule closure time by 38.26% (p = 0.009) and maximal vertical hyoid extension time by 24.8% (p = 0.008). Moreover, the motor stimulus reduced the pharyngeal residue by 66.7% (p = 0.002), the upper esophageal sphincter opening time by 39.39% (p = 0.009), and increased bolus propulsion force by 211.1% (p = 0.008). No serious adverse events were detected during the treatment. Surface e-stim is a safe and effective treatment for chronic poststroke dysphagic patients.

Differential functional role of purinergic and nitrergic inhibitory cotransmitters in human colonic relaxation

Publisher: Wiley

Date: 10-11-2014

DOI: 10.1111/APHA.12408

Abstract: ATP and nitric oxide (NO) are released from enteric inhibitory motor neurones and are responsible for colonic smooth muscle relaxation. However, how frequency of neural stimulation affects this cotransmission process and the post-junctional responses has not been systematically characterized in the human colon. The dynamics of inhibitory cotransmission were studied using different protocols of electrical field stimulation (EFS) to characterize the inhibitory junction potentials (IJP) and the corresponding relaxation in colonic strips obtained from 36 patients. Single pulses elicited a fast IJP (IJPf(MAX) = -27.6 ± 1.6 mV), sensitive to the P2Y1 antagonist MRS2500 1 μm, that ran down with frequency increase leaving a residual hyperpolarization at high frequencies (IJPf∞ = -3.7 ± 0.6 mV). Accordingly, low frequencies of EFS caused purinergic transient relaxations that cannot be maintained at high frequencies. Addition of the P2Y1 agonist MRS2365 10 μm during the purinergic rundown did not cause any hyperpolarization. Protein kinase C (PKC), a putative P2Y1 desensitizator, was able to reduce the litude of the IJPf when activated, but the rundown was not modified by PKC inhibitors. Frequencies higher than 0.60 ± 0.15 Hz were needed to evoke a sustained nitrergic hyperpolarization that progressively increased reaching IJPs∞ = -13 ± 0.4 mV at high frequencies and leading to a sustained inhibition of spontaneous motility. Changes in frequency of stimulation possibly mimicking neuronal firing will post-junctionally determine purinergic vs. nitrergic responses underlying different functional roles. NO will be responsible for sustained relaxations needed in physiological processes such as storage, while purinergic neurotransmission evoking sharp transient relaxations will be dominant in processes such as propulsion.

Dysphagia: current reality and scope of the problem

Publisher: Springer Science and Business Media LLC

Date: 07-04-2015

DOI: 10.1038/NRGASTRO.2015.49

Abstract: Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

Gastrointestinal peptides, gastrointestinal motility, and anorexia of aging in frail elderly persons

Publisher: Wiley

Date: 13-12-2012

DOI: 10.1111/NMO.12055

Abstract: The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty. Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non-frail elderly (>70 years) persons, and (c) healthy adults (aged 25-65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0-60 min) and late (60-240 min) postprandial periods. Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non-gallbladder contractors showed no CCK peak in younger and non-frail groups, but the same high CCK peak as contractors in the frail. Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.

High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia

Publisher: Wiley

Date: 28-09-2015

DOI: 10.1111/NMO.12690

Abstract: Aspiration pneumonia (AP) is caused by dysfunctional swallowing resulting in aspiration of material colonized by respiratory pathogens. The aim of this study was to assess and compare the swallowing physiology, health status, oral health status, and oral/nasal microbiota in frail older patients (FOP) with oropharyngeal dysphagia (OD) and a control group. We studied 47 FOP (>70 year) with OD by videofluoroscopy (17 with acute pneumonia -APN-, 15 with prior pneumonia-PNP- and 15 without) and 14 older controls without OD (H). Oral/nasal colonization by five respiratory pathogens was evaluated by qPCR, whereas commensal microbiota composition was assessed by pyrosequencing. (i) Frail older patients with OD presented similar comorbidities, poor functionality, polymedication, and prevalent videofluoroscopic signs of impaired safety of swallow (33.3-61.5%). However, patients with OD-APN also presented malnutrition, delayed laryngeal vestibule closure (409.23 ± 115.6 ms p 10(8) CFU/mL) than in the nose (<10(6) CFU/mL) (p < 0.0001). Colonization by respiratory pathogens was very high: 93% in OD patients (p < 0.05 vs H) 93% in OD-PNP (p < 0.05 vs H) 88% in OD-APN (p = 0.07 vs H), and lower in controls (67%). Frail older patients with OD had impaired health status, poor oral health, high oral bacterial load, and prevalence of oral colonization by respiratory pathogens and VFS signs of impaired safety of swallow, and were therefore at risk for contracting AP.

European Society for Swallowing Disorders &ndash; European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Publisher: Informa UK Limited

Date: 10-2016

DOI: 10.2147/CIA.S107750

In vitro motor patterns and electrophysiological changes in patients with colonic diverticular disease

Publisher: Springer Science and Business Media LLC

Date: 24-05-2013

DOI: 10.1007/S00384-013-1716-7

Abstract: The underlying mechanism responsible for motility changes in colonic erticular disease (DD) is still unknown. In the present study, our aim was to investigate the structural and in vitro motor changes in the sigmoid colon of patients with DD. Muscle bath, microelectrodes and immunohistochemical techniques were performed with s les obtained from the left and sigmoid colon of patients with DD and compared with those of patients without DD. The litude and area under the curve of the spontaneous rhythmic phasic contractions were greatly reduced in patients with DD whereas their frequency and tone remained unaltered. Electrical field stimulation induced a neurally mediated, enhanced ON-contraction ( litude) in patients with DD and increased the duration of latency of OFF-contractions. The resting membrane potential of smooth muscle cells was hyperpolarized and the litude of the inhibitory junction potential was increased in patients with DD. In contrast, no significant histological differences were observed in patients with DD as smooth muscle (circular and longitudinal layers), interstitial cells of Cajal, glial cells and myenteric neurons densities remained unaltered. Sigmoid strips from patients with asymptomatic DD showed an altered motor pattern with reduced spontaneous motility and enhanced neurally mediated colonic responses involving both excitatory and inhibitory motor pathways. No major neural and muscular structural elements were detected at this stage of the disease. These findings could be valuable in understanding the pathophysiology of this prevalent digestive disease.

Pharmacological characterization of purinergic inhibitory neuromuscular transmission in the human colon

Publisher: Wiley

Date: 17-05-2011

DOI: 10.1111/J.1365-2982.2011.01725.X

Abstract: In the present study, we further characterize the purinergic receptors mediating the inhibitory junction potential (IJP) and smooth muscle relaxation in the human colon using a new, potent and selective agonist (MRS2365), and antagonists (MR2279 and MRS2500) of the P2Y(1) receptor. The P2Y(12) antagonist AR-C66096 was tested as well. Using this pharmacological approach, we tested whether β-nicotinamide adenine dinucleotide (β-NAD) fulfilled the criteria to be considered an inhibitory neurotransmitter in the human colon. We carried out muscle bath and microelectrode experiments on circular strips from the human colon and calcium imaging recordings on HEK293 cells, which constitutively express the human P2Y(1) receptor. Both the fast component of IJP and non-nitrergic relaxation was concentration-dependently inhibited by MRS2279 and MRS2500. This antagonism was confirmed in HEK293 cells. However, AR-C66096 did not modify either inhibitory response. Adenosine 5'-Ο-2-thiodiphosphate and MRS2365 caused a smooth muscle hyperpolarization and transient inhibition of spontaneous motility that was antagonized by MRS2279 and MRS2500. β-Nicotinamide adenine dinucleotide inhibited the spontaneous motility (IC(50) = 3.3 mmol L(-1) ). Nevertheless, this effect was not antagonized by high concentrations of P2Y(1) antagonists. Inhibitory purinergic neuromuscular transmission in the human colon was pharmacologically assessed by the use of new P2Y(1) receptor antagonists MRS2179, MRS2279, and MRS2500. The rank order of potency of the P2Y(1) antagonists is MRS2500 > MRS2279 > MRS2179. We found that β-NAD partially fulfills the criteria to be considered an inhibitory neurotransmitter in the human colon, but the relative contribution of each purine (ATP/ADP vsβ-NAD) requires further studies.

Regional functional specialization and inhibitory nitrergic and nonnitrergic coneurotransmission in the human esophagus

Publisher: American Physiological Society

Date: 05-2011

DOI: 10.1152/AJPGI.00514.2009

Abstract: The aim of this study was to explore the myenteric mechanisms of control of human esophageal motility and the effect of nitrergic and nonnitrergic neurotransmitters. Human circular esophageal strips were studied in organ baths and with microelectrodes. Responses following electrical field stimulation (EFS) of enteric motoneurons (EMNs) or through nicotinic acetylcholine receptors were compared in the esophageal body (EB) and in clasp and sling regions in the lower esophageal sphincter (LES). In clasp LES strips: 1) sodium nitroprusside (1 nM to 100 μM), adenosine-5′-[β-thio]diphosphate trilithium salt (1–100 μM), and vasoactive intestinal peptide (1 nM to 1 μM) caused a relaxation 2) 1 mM N ω -nitro-l-arginine (l-NNA) shifted the EFS “on”-relaxation to an “off”-relaxation, partly antagonized by 10 μM 2′-deoxy- N 6 -methyladenosine 3′,5′-bisphosphate tetrasodium salt (MRS2179) or 10 U/ml α-chymotrypsin and 3) nicotine-relaxation (100 μM) was mainly antagonized by l-NNA, and only partly by MRS2179 or α-chymotrypsin. In sling LES fibers, EFS and nicotine relaxation was abolished by l-NNA. In the EB, l-NNA blocked the latency period, and MRS2179 reduced “off”-contraction. The litude of cholinergic contraction decreased from the EB to both LES sides. EFS induced a monophasic inhibitory junction potential in clasp, sling, and EB fibers abolished by l-NNA. Our study shows a regional specialization to stimulation of EMNs in the human esophagus, with stronger inhibitory responses in clasp LES fibers and stronger cholinergic excitatory responses in the EB. Inhibitory responses are mainly triggered by nitrergic EMNs mediating the inhibitory junction potentials in the LES and EB, EFS on-relaxation in clasp and sling LES sides, and latency in the EB. We also found a minor role for purines (through P2Y 1 receptors) and vasoactive intestinal peptide-mediating part of nonnitrergic clasp LES relaxation.

Imaging of Pelvic Floor Disorders

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2014

DOI: 10.1097/DCR.0000000000000201

A Comparative Study Between Modified Starch and Xanthan Gum Thickeners in Post-Stroke Oropharyngeal Dysphagia

Publisher: Springer Science and Business Media LLC

Date: 25-11-2015

DOI: 10.1007/S00455-015-9672-8

Abstract: Thickeners are used in post-stroke oropharyngeal dysphagia (OD) as a compensatory therapeutic strategy against aspirations. To compare the therapeutic effects of modified starch (MS) and xanthan gum (XG) thickeners on swallow safety and efficacy in chronic post-stroke OD patients using clinical and videofluoroscopic (VFS) assessment. Patients were studied by clinical assessment (volume-viscosity swallow test, V-VST) and VFS using 3 volumes (5, 10, 20 mL) and 3 viscosities (liquid, nectar and spoon thick), comparing MS and XG. We studied 122 patients (46MS, 76XG). (A) V-VST showed that both thickeners similarly improved safety of swallow. Prevalence of safe swallowing significantly increased with enhanced viscosity (P < 0.001 vs liquid), MS: 47.83 % at liquid, 84.93 % at nectar and 92.96 % at spoon thick XG: 55.31 % at liquid, 77.78 % at nectar and 97.84 % at spoon thick. Patients on MS reported higher prevalence of pharyngeal residue at spoon-thick viscosities. (B) VFS: increasing bolus viscosity with either thickener increased prevalence of safe swallows (P < 0.001 vs liquid), MS: 30.25 % liquid, 61.07 % nectar and 92.64 % spoon thick XG: 29.12 % liquid, 71.30 % nectar and 89.91 % spoon thick. Penetration-aspiration scale score was significantly reduced with increased viscosity with both thickeners. MS increased oral and pharyngeal residues at nectar and spoon-thick viscosities but XG did not. Timing of airway protection mechanisms and bolus velocity were not affected by either thickener. Increasing bolus viscosity with MS and XG thickeners strongly and similarly improved safety of swallow in chronic post-stroke OD by a compensatory mechanism in contrast only MS thickeners increased oropharyngeal residue.

Is otilonium bromide globally effective in irritable bowel syndrome? authors’ reply

Publisher: Wiley

Date: 20-09-2011

DOI: 10.1111/J.1365-2036.2011.04821.X

Mechanisms controlling function in the clasp and sling regions of porcine lower oesophageal sphincter

Publisher: Oxford University Press (OUP)

Date: 06-2007

DOI: 10.1002/BJS.5831

Abstract: Characterization of functional differences between lower oesophageal sphincter (LOS) clasp and sling muscles might aid the development of more specific pharmacological and surgical approaches for the treatment of motility disorders. Circular LOS strips from 25 adult pigs were studied in organ baths to compare the physiology of clasp and sling fibres. Sling strips developed greater tone than clasp fibres (mean(s.e.m.) 7·59(0·89) versus 4·72(0·67) g P = 0·017). LOS tone was more dependent on extracellular calcium in clasp strips and on the activity of cholinergic enteric motor neurones (EMNs) in sling strips. The litude of maximal relaxation caused by electrical field stimulation (EFS, 3Hz) of EMNs was greater in clasp strips (mean(s.e.m.) 74·5(2·3) versus 58·1(2·2) per cent of tone P & 0·001). EFS-induced relaxation was reduced in clasp fibres and fully blocked in sling fibres by nitrergic blockade with 10 µmol/l 1H-[1,2,4]oxadiazole-[4,3-α]quinoxalin-1-one (ODQ). The litude of EFS cholinergic responses was significantly greater in sling fibres. In the clasp region, relaxation caused by stimulation of EMNs with 100 µmol/l nicotine was reduced by ODQ. In sling fibres, nicotine induced relaxation at rest and cholinergic contraction following ODQ. Clasp and sling fibres of the porcine LOS show marked intrinsic functional differences. This should be considered when developing more specific approaches to human LOS motility disorders.

The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative.

Publisher: Springer Science and Business Media LLC

Date: 24-08-2013

DOI: 10.1007/S40141-013-0024-Z

Pharmacodynamics of TRPV1 Agonists in a Bioassay Using Human PC-3 Cells

Publisher: Hindawi Limited

Date: 2014

DOI: 10.1155/2014/184526

Abstract: Purpose . TRPV1 is a multimodal channel mainly expressed in sensory neurons. We aimed to explore the pharmacodynamics of the TRPV1 agonists, capsaicin, natural capsaicinoids, and piperine in an in vitro bioassay using human PC-3 cells and to examine desensitization and the effect of the specific antagonist SB366791. Methods . PC-3 cells expressing TRPV1 were incubated with Fluo-4. Fluorescence emission changes following exposition to agonists with and without preincubation with antagonists were assessed and referred to maximal fluorescence following the addition of ionomycin. Concentration-response curves were fitted to the Hill equation. Results . Capsaicin and piperine had similar pharmacodynamics ( E max 204.8 ± 184.3% piperine versus 176.6 ± 35.83% capsaicin, P = 0.8814 , Hill coefficient 0.70 ± 0.50 piperine versus 1.59 ± 0.86 capsaicin, P = 0.3752 ). In contrast, capsaicinoids had lower E max (40.99 ± 6.14% capsaicinoids versus 176.6 ± 35.83% capsaicin, P 0.001 ). All the TRPV1 agonists showed significant desensitization after the second exposition and their effects were strongly inhibited by SB366791. Conclusion . TRPV1 receptor is successfully stimulated by capsaicin, piperine, and natural capsaicinoids. These agonists present desensitization and their effect is significantly reduced by a TRPV1-specific antagonist. In addition, PC-3 cell bioassays proved useful in the study of TRPV1 pharmacodynamics.

Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation

Publisher: Elsevier BV

Date: 08-2017

DOI: 10.1016/J.CLNU.2016.07.009

Abstract: Oropharyngeal dysphagia (OD) is a prevalent risk factor for malnutrition (MN) in older patients and both conditions are related to poor outcome. To explore the nutritional status in older patients with OD in a chronic and an acute clinical situation. We examined 95 older (≥70 years) patients with OD associated to chronic neurological diseases or aging, and 23 older patients with OD and acute community-acquired pneumonia (CAP) with videofluoroscopy and 15 older people without OD. We collected nutritional status, measured with the Mini Nutritional Assessment (MNA 1) Taking into consideration patients with OD with chronic conditions, 51.1% presented a MNA Prevalence of impaired nutritional status (malnutrition risk, and sarcopenia) among older patients with OD associated with either chronic or acute conditions is very high. In patients with OD and chronic diseases, poor nutritional status further impairs OD with an increase in oropharyngeal residue at spoon-thick viscosity. In the acute setting there is inflammation and an additional protein deficiency. These findings will help develop specific products both for OD and nutritional status in each specific clinical situation.

Specific and complementary roles for nitric oxide and ATP in the inhibitory motor pathways to rat internal anal sphincter

Publisher: Wiley

Date: 03-10-2010

DOI: 10.1111/J.1365-2982.2010.01602.X

Abstract: The neurotransmitters mediating inhibitory pathways to internal anal sphincter (IAS) have not been fully characterized. Our aim was to assess the putative release of nitric oxide, purines and vasoactive intestinal peptide (VIP) from inhibitory motor neurons (MNs) and their role in the myogenic tone, resting membrane potential (RMP) of smooth muscle cells (SMC), spontaneous inhibitory junction potentials (sIJP), mechanical relaxation, and IJP induced by electrical field stimulation (EFS) or nicotine. Rat IAS strips were studied using organ baths, microelectrodes, and immunohistochemistry. Internal anal sphincter strips developed active myogenic tone (0.31 g), enhanced and stabilized by prostaglandin F(2α) (PGF2α). L-NNA (1 mmol L(-1)) depolarized SMC and increased tone but did not modify sIJP. In contrast, the specific P2Y(1) receptor antagonist MRS2500 (1 μmol L(-1)) did not modify the RMP or the basal tone but abolished sIJP. Electrical field stimulation and nicotine (10 μmol L(-1)) caused IAS relaxation (-45.9%VS-52.2%), partially antagonized by L-NNA (35%-45%, P ≤ 0.05) and fully abolished by MRS2500 (P ≤ 0.001). Electrical field stimulation induced a biphasic inhibitory junction potential (IJP), the initial fast component was selectively blocked by MRS2500 and the sustained slow component was blocked by L-NNA. Vasoactive intestinal peptide 6-28 (0.1 μmol L(-1)) or α-chymotrypsin (10 U mL(-1)) did not modify the RMP, sIJP, EFS-induced IJP, or relaxation. P2Y(1) receptors were immunolocalized in the circular SMC of IAS. The effects of inhibitory MNs on rat IAS are mediated by a functional co-transmission process involving nitrergic and purinergic pathways through P2Y(1) receptors with specific and complementary roles on the control of tone, sIJP, and hyperpolarization and relaxation of IAS following stimulation of inhibitory MNs.

Sensory Stimulation Treatments for Oropharyngeal Dysphagia

Publisher: Springer International Publishing

Date: 2018

DOI: 10.1007/174_2017_166

Effect of age and frailty on ghrelin and cholecystokinin responses to a meal test

Publisher: Elsevier BV

Date: 05-2009

DOI: 10.3945/AJCN.2008.27076

Abstract: Ghrelin and cholecystokinin (CCK) are among the peripheral signals that regulate hunger and satiety. The objective was to assess whether ghrelin and CCK responses to a standard nutritional load are related to age and frailty. Ghrelin, CCK, insulin, glucose, and 4-h visual analog hunger scale curves after a standard nutritional load test (380 kcal) were described and compared between 3 groups: old (>75 y) and frail persons (group A), old (>75 y) but nonfrail persons (group B), and young (25-65 y) adults (group C). Frail persons showed no postprandial ghrelin suppression, and old subjects, frail and nonfrail, showed no significant postprandial ghrelin recovery compared with young adults. Frailty was also associated with lower fasting ghrelin concentrations. No differences in fasting CCK were observed between young and old persons however, postprandial CCK concentrations were enhanced in young persons, whereas no frailty effect on the CCK curve was observed in the old subjects. No correlations between mean ghrelin and hunger values over time were found, but strong negative correlations were shown between CCK and hunger (group A: r(s) = -0.88, P = 0.009 group B: r(s) = -0.86, P = 0.014 group C: r(s) = -0.71, P = 0.071) and insulin and hunger (group A: r(s) = -0.901, P = 0.006 group B: r(s) = -0.964, P < 0.001 group C: r(s) = -0.929, P = 0.003). Advanced age determines a poorer ghrelin postprandial recuperation phase, a reduced CCK postprandial response, and an exaggerated postprandial insulin release. A loss of ghrelin prandial rhythm is present in old frail persons. The impaired response of these hunger regulatory hormones with age might contribute to the mechanisms of anorexia associated with aging.

Catheter‐based high‐frequency intraluminal ultrasound imaging is a powerful tool to study esophageal dysmotility patients

Publisher: Wiley

Date: 31-01-2017

DOI: 10.1111/NYAS.13313

Abstract: High-resolution manometry (HRM) is currently the most important diagnostic test for esophageal motility disorders, providing information on the contraction pattern of the circular muscle layer, which helps classify these esophageal motor diseases. However, with the increasing development of ultrasound, other techniques, such as high-frequency intraluminal ultrasound (HFIUS), have gained importance. This technique uses a flexible shaft with a central wire integrated into a standard endoscope, which facilitates real-time sonography. Its main utility is to provide anatomical information on the structure of the esophageal wall, including both the circular and longitudinal layers that constitute the esophageal muscularis propria. Increasing knowledge about these motility disorders has led to the hypothesis that, in addition to an abnormal contraction pattern of the circular muscle, an overall increased muscle thickness and an abnormal longitudinal muscle contraction could be added as pathophysiological factors. The increase in muscle thickness could be an important indicator of the severity of diseases, such as achalasia, distal esophageal spasm, or hypercontractile esophagus. More studies are required before definitive conclusions can be reached, but HFIUS employed simultaneously with HRM could provide a more complete and precise evaluation of these esophageal motor disorders.

Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia

Publisher: MDPI AG

Date: 24-03-2020

DOI: 10.3390/NU12030863

Abstract: The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p 0.007), had worse functionality (p 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

Automatic voice analysis for dysphagia detection

Publisher: Informa UK Limited

Date: 05-10-2017

DOI: 10.1080/2050571X.2017.1369017

Quality of Life Differences in Female and Male Patients with Fecal Incontinence

Publisher: The Korean Society of Neurogastroenterology and Motility

Date: 30-12-2015

DOI: 10.5056/JNM15088

Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital

Publisher: No publisher found

Date: 2015

DOI: 10.1016/J.CLNU.2014.04.014

Abstract: Oropharyngeal dysphagia and malnutrition are prevalent conditions in the older. The aim of this study was to explore the relationship between oropharyngeal dysphagia, nutritional status and clinical outcome in older patients admitted to an acute geriatric unit. We studied 1662 patients ≥70 years consecutively hospitalized with acute diseases, in whom dysphagia could be clinically assessed by the volume-viscosity swallow test and nutritional status with the Mini Nutritional Assessment(®). Anthropometric and laboratory measurements were taken and mortality recorded during hospital stay, at 6 months and one year after discharge was recorded. 47.4% (95% CI 45-49.8%) patients presented oropharyngeal dysphagia and 30.6% (95% CI 27.9%-33.3%), malnutrition. Both conditions were associated with multimorbidity, multiple geriatric syndromes and poor functional capacity (p < 0.001). However, patients with dysphagia presented increased prevalence of malnutrition (MNA(®) < 17 45.3% vs 18%, p < 0.001) regardless of their functional status and comorbidities (OR 2.31 (1.70-3.14)) and lower albumin and cholesterol levels. Patients with malnutrition presented an increased prevalence of dysphagia (68.4% (95% CI 63.3-73.4)). Patients with dysphagia and patients with malnutrition presented increased intrahospital, 6-month and 1-year mortality rates (p < 0.05). The poorest outcome was for patients with both conditions (1-year mortality was 65.8%). Prevalence of dysphagia was higher than malnutrition in our older patients. Dysphagia was an independent risk factor for malnutrition, and both conditions were related to poor outcome.

Defective Conduction of Anorectal Afferents Is a Very Prevalent Pathophysiological Factor Associated to Fecal Incontinence in Women

Publisher: The Korean Society of Neurogastroenterology and Motility

Date: 07-2019

DOI: 10.5056/JNM18196

Selective stimulation of intrinsic excitatory and inhibitory motor pathways in porcine lower oesophageal sphincter

Publisher: Wiley

Date: 10-11-2009

DOI: 10.1111/J.1365-2982.2009.01357.X

Abstract: The mechanisms of stimulation of inhibitory and excitatory motor neurons (MNs) in the lower oesophageal sphincter (LOS) are not fully understood. The aim of this study was to assess the effect of selective stimulation of inhibitory and excitatory MNs in porcine LOS through nicotinic acetylcholine receptors (nAChRs), 5-HT(3) and P2X receptors. Circular LOS strips from adult pigs were studied in organ baths. We compared the effects of stimulation of MNs by electrical field stimulation (26 V, 0.3-20 Hz) nicotine (1-300 micromol L(-1)) 5-HT and 2-Me-5-HT (1 nmol(-1)-30 micromol L(-1)) and alpha,beta-methylene ATP (alpha,beta-meATP 1-100 micromol L(-1)) in standard Krebs solution a non-adrenergic non-nitrergic non-purinergic (NANNNP) solution and a non-adrenergic non-cholinergic (NANC) solution. Electrical stimulation of inhibitory MNs caused an intense LOS relaxation (-78.94 +/- 4.50% of LOS tone) and of excitatory MNs, a strong contraction (17.89 +/- 1.96 g). Nicotine 100 micromol L(-1) relaxed LOS (-84.67 +/- 3.98%) in standard Krebs solution, an effect reduced by Tetrodotoxin (TTX) 1 micromol L(-1). Nicotine induced a weak TTX-sensitive contraction (1.64 +/- 0.4 g) in NANNNP solution. 5-HT 10 micromol L(-1) and 2-Me-5-HT 30 micromol L(-1) contracted LOS in standard, NANC and NANNNP conditions, maximal responses (7.30 +/- 1.52 g, 3.50 +/- 0.18 g respectively) being reduced by TTX. alpha,beta-meATP 100 micromol L(-1) caused a LOS relaxation (-17.45 +/- 6.62%) unaffected by TTX in NANC solution, and a contraction (6.7 +/- 0.85 g) antagonized by TTX in NANNNP solution. Our results suggest selective mechanisms for stimulation of intrinsic excitatory and inhibitory motor pathways in porcine LOS. Inhibitory MNs are strongly stimulated by nAChRs and do not respond to stimulation of 5-HT(3) and P2X receptors. By contrast, excitatory MNs are stimulated through 5-HT(3) and P2X receptors, stimulation through nACRs being difficult and causing a weak response.

P2Y₁ receptors mediate inhibitory purinergic neuromuscular transmission in the human colon

Publisher: American Physiological Society

Date: 10-2006

DOI: 10.1152/AJPGI.00474.2005

Abstract: Indirect evidence suggests that ATP is a neurotransmitter involved in inhibitory pathways in the neuromuscular junction in the gastrointestinal tract. The aim of this study was to characterize purinergic inhibitory neuromuscular transmission in the human colon. Tissue was obtained from colon resections for neoplasm. Muscle bath, microelectrode experiments, and immunohistochemical techniques were performed. 2′-deoxy- N 6 -methyl adenosine 3′,5′-diphosphate tetraammonium salt (MRS 2179) was used as a selective inhibitor of P2Y 1 receptors. We found that 1) ATP (1 mM) and adenosine 5′-β-2-thiodiphosphate (ADPβS) (10 μM), a preferential P2Y agonist, inhibited spontaneous motility and caused smooth muscle hyperpolarization (about −12 mV) 2) MRS 2179 (10 μM) and apamin (1 μM) significantly reduced these effects 3) both the fast component of the inhibitory junction potential (IJP) and the nonnitrergic relaxation induced by electrical field stimulation were dose dependently inhibited (IC 50 ∼1 μM) by MRS 2179 4) ADPβS reduced the IJP probably by a desensitization mechanism 5) apamin (1 μM) reduced the fast component of the IJP (by 30–40%) and the inhibitory effect induced by electrical field stimulation and 6) P2Y 1 receptors were localized in smooth muscle cells as well as in enteric neurons. These results show that ATP or a related purine is released by enteric inhibitory motoneurons, causing a fast hyperpolarization and smooth muscle relaxation. The high sensitivity of MRS 2179 has revealed, for the first time in the human gastrointestinal tract, that a P2Y 1 receptor present in smooth muscle probably mediates this mechanism through a pathway that partially involves apamin-sensitive calcium-activated potassium channels. P2Y 1 receptors can be an important pharmacological target to modulate smooth muscle excitability.

A Comparative Study Between Two Sensory Stimulation Strategies After Two Weeks Treatment on Older Patients with Oropharyngeal Dysphagia

Publisher: Springer Science and Business Media LLC

Date: 09-08-2016

DOI: 10.1007/S00455-016-9736-4

Abstract: Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome. Treatment is based on compensatory strategies to avoid complications. New treatments based on sensory stimulation to promote the recovery of the swallowing function have proved effective in acute studies but prolonged treatment needs further research. Our aim was to evaluate and compare the effect of two, longer-term sensory treatment strategies on older patients with OD. 38 older patients (≥70 years) were studied with videofluoroscopy (pre osttreatment) and randomized into two 10-day treatment groups: Group A-transient receptor potential vanilloid 1 (TRPV1) agonist (capsaicin 1 × 10(-5) M) and Group B-transcutaneous sensory electrical stimulation (TSES) (Intelect VitalStim, biphasic pulses, 300 μs, 80 Hz). Patients were analyzed for treatment response. Patients were old (80.47 ± 5.2 years), with comorbidities (3.11 ± 1.59 Charlson Index), polymedication (8.92 ± 3.31 drugs atient), and mild functional impairment (86.84 ± 17.84 Barthel Index), and 28.9 % were at risk of malnutrition (MNA-sf). Overall, all patients had videofluoroscopic signs of impaired safety of swallow (ISS) with delayed oropharyngeal swallow response (OSR). After sensory stimulation, prevalence of ISS decreased to 68.42 % in both groups (P = 0.019). There were 68.42 % responders in Group A (TRPV1) and 42.11 % in Group B (TSES). Group A responders showed an improvement in the penetration-aspiration scale (PAS, 5.23 ± 2.04 to 3 ± 1.47 P = 0.002), and the same was true for those of Group B (4.63 ± 1.41 to 2.13 ± 0.64 P = 0.007). 10-day sensory stimulation with either therapy improved safety of swallow and OSR in older patients with OD, reducing the severity of OD in a significant subgroup of these patients.

Pharmacological and molecular characterization of muscular cholecystokinin receptors in the human lower oesophageal sphincter

Publisher: Wiley

Date: 12-2000

DOI: 10.1046/J.1365-2982.2000.00229.X

Abstract: In vitro cholecystokinin (CCK) contracts the human lower oesophageal sphincter by stimulating muscular receptors. The aim of this study was to characterize the muscular CCK receptor subtypes in the human lower oesophageal sphincter. Twenty-five circular strips from six patients were studied. RNA was extracted, reverse transcribed, and cDNAs were lified with primers for human CCK-A and B receptors. The potency of the contraction induced by CCK-8, desulphated CCK-8, and gastrin-I, and the effect of the CCK-A (loxiglumide and SR 27897) and the CCK-B (YM022 and L-365 260) specific receptor antagonists were compared. Both CCK-A and CCK-B receptor mRNAs were found in functional lower oesophageal sphincter strips. The potency of the CCK-8 concentration-dependent contraction was two and three orders of magnitude higher than that of desulphated CCK-8 and gastrin-I, respectively. The CCK-8-induced contraction was blocked by the CCK-A receptor antagonists loxiglumide (IC50 11 micromol L-1) and SR 27897 (IC50 74 nmol L-1) but not by CCK-B receptor antagonists (1 micromol L-1). Our data suggest that, although the human lower oesophageal sphincter expresses both CCK-A and CCK-B receptors, the contractile effect of CCK-8 on the circular muscle is mainly due to the activation of CCK-A receptors.

Natural History of Swallow Function during the Three-Month Period after Stroke

Publisher: MDPI AG

Date: 09-07-2019

DOI: 10.3390/GERIATRICS4030042

Abstract: Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety 30.8%, efficacy) and 41.7% (19.4% impaired safety 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.

Adaptation to Spanish Language and Validation of the Fecal Incontinence Quality of Life Scale

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 04-2006

DOI: 10.1007/S10350-006-0514-5

Abstract: The aim of this study was to perform a psychometric evaluation of the Fecal Incontinence Quality of Life Scale in the Spanish language. Eleven hospitals in Spain participated in the study, which included 118 patients with active fecal incontinence. All the patients filled out a questionnaire on the severity of their incontinence, a general questionnaire of health (Medical Outcomes Survey Short Form), and a Spanish translation of the Fecal Incontinence Quality of Life Scale (Cuestionario de Calidad de Vida de Incontinencia Anal), which consists of 29 items in four domains: lifestyle, behavior, depression, and embarrassment. On a second visit, patients repeated the Fecal Incontinence Quality of Life Scale. For each domain, an evaluation was made of temporal reliability, internal reliability, the convergent validity with the generic questionnaire of health, and the discriminant validity correlating the domains of Cuestionario de Calidad de Vida de Incontinencia Anal with the severity of fecal incontinence. For cultural adaptation, the answer alternatives for 14 items were modified. A total of 111 patients (94 percent) completed the study adequately. Temporal reliability (test-retest) was good for all domains except for embarrassment, which showed significant differences (P 0.80, between 0.84 and 0.96). The four domains of Cuestionario de Calidad de Vida de Incontinencia Anal significantly correlated with the domains of the generic questionnaire on health (P < 0.01) and with the scale of severity of fecal incontinence (P < 0.001). All domains of Cuestionario de Calidad de Vida de Incontinencia Anal correlated negatively with the need to wear pads (P < 0.01) and with the presence of complete fecal incontinence. The Cuestionario de Calidad de Vida de Incontinencia Anal incorporates sufficient requirements of reliability and validity to be applied to patients with fecal incontinence.

Healthcare costs of post‐stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections

Publisher: Wiley

Date: 27-07-2021

DOI: 10.1111/ENE.14998

Abstract: The healthcare economic costs of post‐stroke oropharyngeal dysphagia (OD) are not fully understood. The purpose of this study was to assess the acute, subacute and long‐term costs related to post‐stroke OD and its main complications (malnutrition and respiratory infections). A cost of illness study of patients admitted to Mataró Hospital (Catalonia, Spain) from May 2010 to September 2014 with a stroke diagnosis was performed. OD, malnutrition and respiratory infections were assessed during hospitalization and follow‐up (3 and 12 months). Hospitalization and long‐term costs were measured from hospital and healthcare system perspectives. Multivariate linear regression analysis was performed to assess the independent effect of OD, malnutrition and respiratory infections on healthcare costs during hospitalization, and at 3 and 12 months’ follow‐up. In all, 395 patients were included of whom 178 had OD at admission. Patients with OD incurred major total in‐hospital costs (€5357.67 ± €3391.62 vs. €3976.30 ± €1992.58, p 0.0001), 3‐month costs (€8242.0 ± €5376.0 vs. €5320.0 ± €4053.0, p 0.0001) and 12‐month costs (€11,617.58 ± €12,033.58 vs. €7242.78 ± €7402.55, p 0.0001). OD was independently associated with a cost increase of €789.68 ( p = 0.011) during hospitalization and of €873.5 ( p = 0.084) at 3 months but not at 12 months. However, patients with OD who were at risk of malnutrition or malnourished and suffered respiratory infections incurred major mean costs compared with those patients without OD (€19,817.58 ± €13,724.83 vs. €7242.8 ± €7402.6, p 0.0004) at 12 months’ follow‐up. Oropharyngeal dysphagia causes significant high economic costs during hospitalization that strongly and significantly increase with the development of malnutrition and respiratory infections at long‐term follow‐up.

PREVALENCE OF OROPHARYNGEAL DYSPHAGIA AND IMPAIRED SAFETY AND EFFICACY OF SWALLOW IN INDEPENDENTLY LIVING OLDER PERSONS

Publisher: Wiley

Date: 2011

DOI: 10.1111/J.1532-5415.2010.03227.X

Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia

Publisher: BMJ

Date: 21-06-2012

DOI: 10.1136/GUTJNL-2011-300753

Abstract: There is no pharmacological treatment for oropharyngeal dysphagia (OD). The aim of this study was to compare the therapeutic effect of stimulation of oropharyngeal transient receptor potential vanilloid type 1 (TRPV1) with that of thickeners in older patients with OD. A clinical videofluoroscopic non-randomised study was performed to assess the signs of safety and efficacy of swallow and the swallow response in (1) 33 patients with OD (75.94 ± 1.88 years) while swallowing 5, 10 and 20 ml of liquid (20.4 mPa.s), nectar (274.4 mPa.s), and pudding (3930 mPa.s) boluses (2) 33 patients with OD (73.94 ± 2.23 years) while swallowing 5, 10 and 20 ml nectar boluses, and two series of nectar boluses with 150 μM capsaicinoids and (3) 8 older controls (76.88 ± 1.51 years) while swallowing 5, 10 and 20 ml nectar boluses. Increasing bolus viscosity reduced the prevalence of laryngeal penetrations by 72.03% (p < 0.05), increased pharyngeal residue by 41.37% (p < 0.05), delayed the upper esophageal sphincter opening time and the larynx movement and did not affect the laryngeal vestibule closure time and maximal hyoid displacement. Treatment with capsaicinoids reduced both, penetrations by 50.% (p < 0.05) and pharyngeal residue by 50.% (p < 0.05), and shortened the time of laryngeal vestibule closure (p < 0.001), upper esophageal sphincter opening (p < 0.05) and maximal hyoid and laryngeal displacement. Stimulation of TRPV1 by capsaicinoids strongly improved safety and efficacy of swallow and shortened the swallow response in older patients with OD. Stimulation of TRPV1 might become a pharmacologic strategy to treat OD.

Erratum for Ann. N.Y. Acad. Sci. 1300: 261–277

Publisher: Wiley

Date: 09-2014

DOI: 10.1111/NYAS.12556

Oesophageal tone and sensation in the transition zone between proximal striated and distal smooth muscle oesophagus

Publisher: Wiley

Date: 22-11-2007

DOI: 10.1111/J.1365-2982.2007.01028.X

Abstract: Previous studies have shown that the proximal striated muscle oesophagus is less compliant and more sensitive than the distal smooth muscle oesophagus. Conventional and high resolution manometry described a transition zone between striated and smooth muscle oesophagus. We aimed to evaluate oesophageal tone and sensitivity at the transition zone of oesophagus in healthy volunteers. In 18 subjects (seven men, mean age: 28 years) an oesophageal barostat study was performed. Tone and sensitivity were assessed using stepwise isobaric distensions with the balloon located at transition zone and at distal oesophagus in random order. To study the effect induced on transition zone by a previous distension at the distal oesophagus and vice versa, identical protocol was repeated after 7 days with inverted order. Initial distension of a region is referred to as 'naïf' distension and distension of a region following the distension of the other segment as 'primed' distension. Assessment of three oesophageal symptoms (chest pain, heartburn and 'other') was obtained at the end of every distension step. Compliance was significantly higher in the transition zone than in the distal oesophagus (1.47 +/- 0.14 vs 1.09 +/- 0.09 mL mmHg(-1), P = 0.03) after 'naif' distensions. This difference was not observed during 'primed' distensions. Higher sensitivity at transition zone level was found in 11/18 (61%) subjects compared to 6/18 (33%, P < 0.05) at smooth muscle oesophagus. Chest pain and 'other' symptom were more often induced by distention of the transition zone, whereas heartburn was equally triggered by distension of either region. The transition zone is more complaint and more sensitive than smooth muscle oesophagus.

Errata for Ann. N. Y. Acad. Sci. Volume 1300: 1–10

Publisher: Wiley

Date: 11-2013

DOI: 10.1111/NYAS.12312

The Effect of Surface Electrical Stimulation on Swallowing in Dysphagic Parkinson Patients

Publisher: Springer Science and Business Media LLC

Date: 12-01-2012

DOI: 10.1007/S00455-011-9387-4

Effects of excitatory and inhibitory neurotransmission on motor patterns of human sigmoid colon in vitro

Publisher: Wiley

Date: 12-2008

DOI: 10.1038/BJP.2008.332

Short‐term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia

Publisher: Wiley

Date: 24-05-2020

DOI: 10.1111/NMO.13887

Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia

Publisher: Springer Berlin Heidelberg

Date: 2011

DOI: 10.1007/174_2011_348

Healthcare-related cost of oropharyngeal dysphagia and its complications pneumonia and malnutrition after stroke: a systematic review

Publisher: BMJ

Date: 08-2020

DOI: 10.1136/BMJOPEN-2019-031629

Abstract: To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death). Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. MEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019. Patients with poststroke. The costs associated to poststroke OD and its complications. Data were synthetised narratively, quality evaluation was done using an adaptation of Drummond’s checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence. A total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requiring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition. This systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heterogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD. CRD42018099977.

Dehydration in Dysphagia

Publisher: Springer Berlin Heidelberg

Date: 2011

DOI: 10.1007/174_2011_349

A Systematic and Universal Artificial Intelligence Screening Method for Oropharyngeal Dysphagia: Improving Diagnosis Through Risk Management

Publisher: Springer Science and Business Media LLC

Date: 28-12-2022

DOI: 10.1007/S00455-022-10547-W

Origin and modulation of circular smooth muscle layer contractions in the porcine esophagus

Publisher: Wiley

Date: 28-05-2012

DOI: 10.1111/J.1365-2982.2012.01936.X

Abstract: The origin and modulation mechanisms controlling timing and litude of esophageal body peristalsis are not fully understood. We aimed to characterize the neurotransmitters involved in the origin and modulation of circular smooth muscle esophageal body (EB) contractions. Responses of porcine EB strips to electrical stimulation of motor neurons (MNs) were assessed in organ baths and with microelectrodes. The effect of antagonists of inhibitory (L-NAME 1 mmol L(-1) , MRS2179 10 μmol L(-1) ) and excitatory neurotransmitters (atropine 1 μmol L(-1) SR140333 1 μmol L(-1) -NK(1) ra-, GR94800 1 μmol L(-1) -NK(2) ra-) and of ganglionic neurotransmitters (hexamethonium 100 μmol L(-1) , ondansetron 1 μmol L(-1) , NF279 10 μmol L(-1) ) were characterized. Electrical field stimulation (EFS) induced a frequency-dependent off-contraction (16.8 ± 0.8 g) following a latency period. Latency was significantly reduced by L-NAME (-66.1 ± 4.1%) and MRS2179 (-25.9 ± 5.6%), and strongly increased by atropine (+36.8 ± 5.8%). Amplitude was reduced by L-NAME (-69.9 ± 10.4%), MRS2179 (-34.1 ± 6.0%), atropine (-42.3 ± 4.7%), hexamethonium (-18.9 ± 3.3%), NF279 (-20.7 ± 3.5%), ondansetron (-16.3 ± 3.2%), GR94800 (-28.0 ± 4.8%) SR140333 (-20.9 ± 7.1%), and α-chymotrypsin (-31.3 ± 7.0%). The EFS induced a monophasic nitrergic inhibitory junction potential. Our results suggest that timing (latency) and litude of esophageal contractions are determined by a balance of complex interactions between excitatory and inhibitory MNs. Latency depends on the activation of inhibitory MNs releasing NO and a minor purinergic contribution through P2Y(1) receptors, and excitatory MNs releasing ACh. Amplitude depends on a major contribution of excitatory MNs releasing ACh and tachykinins, and also on inhibitory MNs releasing NO, ATP or related purines, and peptidergic neurotransmitters acting as strong modulators of the excitatory neuroeffector transmission.

Otilonium bromide - challenges of putting trial data into practice: authors’ reply

Publisher: Wiley

Date: 20-09-2011

DOI: 10.1111/J.1365-2036.2011.04820.X

Erratum to: Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society

Publisher: Springer Science and Business Media LLC

Date: 21-07-2016

DOI: 10.1007/S00455-016-9729-3

Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowi

Publisher: Springer Science and Business Media LLC

Date: 25-03-2016

DOI: 10.1007/S00455-016-9696-8

Abstract: Fluid thickening is a well-established management strategy for oropharyngeal dysphagia (OD). However, the effects of thickening agents on the physiology of impaired swallow responses are not fully understood, and there is no agreement on the degree of bolus thickening. To review the literature and to produce a white paper of the European Society for Swallowing Disorders (ESSD) describing the evidence in the literature on the effect that bolus modification has upon the physiology, efficacy and safety of swallowing in adults with OD. A systematic search was performed using the electronic Pubmed and Embase databases. Articles in English available up to July 2015 were considered. The inclusion criteria swallowing studies on adults over 18 years of age healthy people or patients with oropharyngeal dysphagia bolus modification effects of bolus modification on swallow safety (penetration/aspiration) and efficacy and/or physiology and original articles written in English. The exclusion criteria consisted of oesophageal dysphagia and conference abstracts or presentations. The quality of the selected papers and the level of research evidence were assessed by standard quality assessments. At the end of the selection process, 33 articles were considered. The quality of all included studies was assessed using systematic, reproducible, and quantitative tools (Kmet and NHMRC) concluding that all the selected articles reached a valid level of evidence. The literature search gathered data from various sources, ranging from double-blind randomised control trials to systematic reviews focused on changes occurring in swallowing physiology caused by thickened fluids. Main results suggest that increasing bolus viscosity (a) results in increased safety of swallowing, (b) also results in increased amounts of oral and/or pharyngeal residue which may result in post-swallow airway invasion, (c) impacts the physiology with increased lingual pressure patterns, no major changes in impaired airway protection mechanisms, and controversial effects on oral and pharyngeal transit time, hyoid displacements, onset of UOS opening and bolus velocity—with several articles suggesting the therapeutic effect of thickeners is also due to intrinsic bolus properties, (d) reduces palatability of thickened fluids and (e) correlates with increased risk of dehydration and decreased quality of life although the severity of dysphagia may be an confounding factor. The ESSD concludes that there is evidence for increasing viscosity to reduce the risk of airway invasion and that it is a valid management strategy for OD. However, new thickening agents should be developed to avoid the negative effects of increasing viscosity on residue, palatability, and treatment compliance. New randomised controlled trials should establish the optimal viscosity level for each phenotype of dysphagic patients and descriptors, terminology and viscosity measurements must be standardised. This white paper is the first step towards the development of a clinical guideline on bolus modification for patients with oropharyngeal dysphagia.

Cortical metaplasticity as a novel candidate mechanism for boosting brain swallow performance in neurogenic dysphagia

Publisher: Wiley

Date: 03-10-2020

DOI: 10.1113/JP280663

Randomised clinical trial: otilonium bromide improves frequency of abdominal pain, severity of distention and time to relapse in patients with irritable bowel syndrome

Publisher: Wiley

Date: 16-06-2011

DOI: 10.1111/J.1365-2036.2011.04730.X

Abstract: Otilonium bromide (OB) is a spasmolytic agent that blocks L-Type Calcium channels in human colonic smooth muscle. To study the efficacy of OB in symptom control in irritable bowel syndrome (IBS). A total of 356 patients (46.16±19years, 71% female) with IBS participated in a double-blind, randomised, parallel placebo-controlled phase IV study. OB (40mg t.d.s.) or placebo was administered for 15weeks, and follow-up was extended 10 additional weeks. Otilonium bromide (n=179) and placebo (n=177) groups had comparable demographics, symptom severity and IBS subtype. Both OB and placebo reduced abdominal pain and IBS symptoms. The effect of OB was significantly greater than placebo in the reduction of weekly frequency of episodes of abdominal pain at the end of treatment period (primary endpoint, -0.90±0.88 vs. -0.65±0.91, P=0.03), reduction of abdominal bloating (-1.2±1.2 vs. -0.9±1.1, P=0.02) and global efficacy by patient assessment (1.3±1.1 vs. 1.0±1.1, P=0.047). Intensity of abdominal pain, proportion of patient responders, safety and quality of life scores were similarly affected by OB and placebo. During follow-up, the therapeutic effect of OB remained greater than placebo in terms of withdrawal rate due to symptom relapse (10% vs. 27%, P=0.009), global efficacy of treatment and relapse-free probability (P=0.038). This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide.

A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19

Publisher: MDPI AG

Date: 16-09-2022

DOI: 10.3390/NU14183826

Abstract: Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years ) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN MN, with age, OD, diarrhea and ICU admission mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.

Oropharyngeal dysphagia: when swallowing disorders meet respiratory diseases

Publisher: European Respiratory Society (ERS)

Date: 04-2017

DOI: 10.1183/13993003.02530-2016

Disfagia orofaríngea en el anciano

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.REGG.2012.04.009

Prevalence and Pathophysiology of Functional Constipation Among Women in Catalonia, Spain

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-2011

DOI: 10.1097/DCR.0B013E31822CB5C2

Interstitial cells of Cajal and neuromuscular transmission in the rat lower oesophageal sphincter

Publisher: Wiley

Date: 30-03-2007

DOI: 10.1111/J.1365-2982.2007.00901.X

Abstract: The distribution of interstitial cells of Cajal (ICC) and neurotransmission were investigated in lower oesophageal sphincter (LES) circular muscle strips from Sprague-Dawley (SD) rats, Ws/Ws mutant rats and their wild-type (+/+) siblings. Intramuscular c-Kit-positive cells, confirmed to be ICC-IM by electron microscopy, were observed throughout both muscle layers from SD and +/+ rats. In contrast, c-Kit-positive, ultrastructurally typical ICC-IM were absent in Ws/Ws. LES strips from Ws/Ws rats showed increased spontaneous contractile activity. Strips from SD and +/+ rats, responded to electrical neuronal stimulation with a relaxation that was in part L-NNA and in part apamin sensitive, followed by a contraction which was decreased by atropine. In Ws/Ws rats, similar to +/+ rats, neurally mediated relaxation was L-NNA and apamin sensitive and the contraction was decreased by atropine. We conclude that in the rat LES, relaxation is mediated by NO and an apamin-sensitive mediator, and contraction primarily by acetylcholine. Despite the absence of c-Kit-positive ICC, nerve-muscle interaction can be accomplished likely by diffusion of neurotransmitters to the smooth muscle cells. The lack of c-Kit-positive ICC is related to an increase in the basal tone and spontaneous contractile activity. The presence of fibroblast-like ICC in Ws/Ws rats might represent immature ICC whose possible functions need further investigation.

Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2016

DOI: 10.1161/STROKEAHA.115.012455

Abstract: Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given on 3 consecutive days. The primary outcome was swallowing safety, assessed using the PAS, at 2 weeks. Secondary outcomes included dysphagia severity, function, quality of life, and serious adverse events at 6 and 12 weeks. In randomized patients, the mean age was 74 years, male 58%, ischemic stroke 89%, and PAS 4.8. The mean treatment current was 14.8 (7.9) mA and duration 9.9 (1.2) minutes per session. On the basis of previous data, 45 patients (58.4%) randomized to PES seemed to receive suboptimal stimulation. The PAS at 2 weeks, adjusted for baseline, did not differ between the randomized groups: PES 3.7 (2.0) versus sham 3.6 (1.9), P =0.60. Similarly, the secondary outcomes did not differ, including clinical swallowing and functional outcome. No serious adverse device-related events occurred. In patients with subacute stroke and dysphagia, PES was safe but did not improve dysphagia. Undertreatment of patients receiving PES may have contributed to the neutral result. URL: www.controlled-trials.com . Unique identifier: ISRCTN25681641.

Different responsiveness of excitatory and inhibitory enteric motor neurons in the human esophagus to electrical field stimulation and to nicotine

Publisher: American Physiological Society

Date: 07-2004

DOI: 10.1152/AJPGI.00534.2003

Abstract: To compare electrical field stimulation (EFS) with nicotine in the stimulation of excitatory and inhibitory enteric motoneurons (EMN) in the human esophagus, circular lower esophageal sphincter (LES), and circular and longitudinal esophageal body (EB) strips from 20 humans were studied in organ baths. Responses to EFS or nicotine (100 μM) were compared in basal conditions, after N G -nitro-l-arginine (l-NNA 100 μM), and after l-NNA and apamin (1 μM). LES strips developed myogenic tone enhanced by TTX (5 μM) or l-NNA. EFS-LES relaxation was abolished by TTX, unaffected by hexamethonium (100 μM), and enhanced by atropine (3 μM). Nicotine-LES relaxation was higher than EFS relaxation, reduced by TTX or atropine, and blocked by hexamethonium. After l-NNA, EFS elicited a strong cholinergic contraction in circular LES and EB, and nicotine elicited a small relaxation in LES and no contractile effect in EB. After l-NNA and apamin, EFS elicited a strong cholinergic contraction in LES and EB, and nicotine elicited a weak contraction amounting to 6.64 ± 3.19 and 9.20 ± 5.51% of that induced by EFS. EFS elicited a contraction in longitudinal strips after l-NNA and apamin, nicotine did not induce any response. Inhibitory EMN tonically inhibit myogenic LES tone and are efficiently stimulated both by EFS and nicotinic acetylcholine receptors (nAChRs) located in somatodendritic regions and nerve terminals, releasing nitric oxide and an apamin-sensitive neurotransmitter. In contrast, although esophageal excitatory EMN are efficiently stimulated by EFS, their stimulation through nAChRs is difficult and causes weak responses, suggesting the participation of nonnicotinic mechanisms in neurotransmission to excitatory EMN in human esophagus.

Triple Adaptation of the Mediterranean Diet: Design of A Meal Plan for Older People with Oropharyngeal Dysphagia Based on Home Cooking

Publisher: MDPI AG

Date: 18-02-2019

DOI: 10.3390/NU11020425

Abstract: Background: Oropharyngeal dysphagia (OD) and malnutrition are highly prevalent in older patients that are discharged from general hospitals (47% and 30%, respectively). Aims: To develop a nutritional plan for these patients involving a triple adaptation of their traditional diet: (a) rheological adaptation (texture and viscosity) for safe deglutition, (b) nutritional adaptation (water, calories, and proteins), and (c) organoleptic adaptation to improve compliance. Methods: Two fluid viscosities (250 and 800 mPa·s) were selected according to previous studies on optimal viscosities in older patients. The British Dietetic Association food texture classification based on common clinical practice selected two food textures (thick purée and fork-mashable. Two levels of calorie protein enrichment were selected according to previous studies using the Mini Nutritional Assessment (MNA®). Results: The daily caloric-protein and hydric needs were established at 1750 kcal, 70 g protein, and 1750 mL water in patients with MNA® ≥ 17 and, 2037 kcal, 90 g protein, and 2000 mL water/day in malnourished patients. Sixteen weekly menus (296 recipes) were developed while using two textures, two levels of viscosity, two nutritional phenotypes (normal/at-risk vs. malnourished), and two seasons of the year (spring/summer-autumn/winter) based on Mediterranean cuisine. Conclusion: This concept paper demonstrates that traditional Mediterranean cooking can be adapted to meet the rheological, nutritional, and hydration needs of older patients with OD. The recipes that we have developed meet the needs of patients with varying degrees of OD and malnutrition are reproducible in patient’s homes and they could have a major impact on the clinical outcomes of these patients.

The effect of levosulpiride on in vitro motor patterns in the human gastric fundus, antrum, and jejunum

Publisher: Wiley

Date: 03-02-2016

DOI: 10.1111/NMO.12788

Abstract: Levosulpiride is a 5HT4 agonist/D2 antagonist prokinetic agent used to improve gastric emptying in patients with functional dyspepsia or gastroparesis. The aim of this study was to characterize its effect on the main in vitro motility patterns in the human fundus, antrum, and jejunum. Circular muscle strips from human stomach (antrum and fundus) and jejunum, obtained from 46 patients undergoing bariatric surgery, were studied using organ baths. Enteric motor neurons (EMNs) were stimulated by electrical field stimulation (EFS). Levosulpiride, caused an increase in the EFS-induced cholinergic contractions in the gastric antrum (+37 ± 15.18% at 100 μM, pEC50 = 4.46 ± 0.14 p < 0.05, n = 8) and jejunum (+45.4 ± 22.03% at 100 μM, pEC50 = 3.78 ± 6.81 p < 0.05, n = 5), but not in the gastric fundus. It also caused a slight decrease in tone and frequency of spontaneous contractions in the jejunum, but did not have any major effect on tone or spontaneous contractions in the stomach. It did not have any effect on EFS-induced relaxations mediated by nitric oxide (NO) in the stomach (antrum and fundus) and by NO and ATP in the jejunum. Our results suggest that the prokinetic effects of levosulpiride in humans are mainly due to the facilitation of the release of acetylcholine by enteric motor neurons in the gastric antrum and the jejunum.

Localization and expression of TRPV1 and TRPA1 in the human oropharynx and larynx

Publisher: Wiley

Date: 04-11-2015

DOI: 10.1111/NMO.12701

Abstract: Previous studies have found that TRPV1 and TRPA1 receptor agonists improve swallow response in patients with oropharyngeal dysphagia (OD), but little is known about the expression of these receptors in the human oropharynx. The aim of this study was to assess the expression and localization of TRPV1 and TRPA1 in human s les from the oropharynx of healthy patients, to provide the basis for new pharmacological treatments for OD. S les from oropharyngeal regions innervated by cranial nerves V, IX, and X (tongue, pharynx, and epiglottis) were obtained during ENT surgery and processed either for mRNA (21 patients) or for immunohistochemical assays (seven patients). The expression analysis was performed with RT-qPCR using ACTBh as reference gene. Hemotoxylin and eosin staining was used to study the histology the immunohistochemical assay used (i) neuron-specific enolase to detect nerve fibers or (ii) fluorescent probes to locate TRPV1 and TRPA1. TRPV1 was expressed in the three studied regions, with higher levels in CN V region (tongue) than in CN X region (epiglottis p < 0.05), and was localized at epithelial cells and nociceptive fibers in all studied regions. TRPA1 was also expressed in all studied regions, but was always localized below the basal lamina. No immunoreactivity for TRPA1 was found on epithelial cells. TRPV1 and TRPA1 are widely expressed in the human oropharynx with two distinct patterns. Our study further confirms that TRPV1/A1 receptors are promising therapeutic targets to develop active treatments for OD patients.

Pathophysiology of Swallowing Dysfunction in Parkinson Disease and Lack of Dopaminergic Impact on the Swallow Function and on the Effect of Thickening Agents

Publisher: MDPI AG

Date: 23-03-2023

DOI: 10.3390/BRAINSCI10090609

Abstract: (1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson’s disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities ( , 120, and 4000 mPa·s) (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.

Neumonía aspirativa

Publisher: Elsevier BV

Date: 09-2007

DOI: 10.1157/13110467

Abstract: The incidence and the prevalence of aspiration pneumonia (AP) in the community is poorly defined. It increases in direct relation with age and underlying diseases. The pathogenesis of AP presumes the contribution of risk factors that alter swallowing funtion and predispose the orofaringe and gastric region to bacterial colonization. The microbial etiology of AP involves Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumoniae for community-acquired aspiration pneumonia and Gram-negative aerobic bacilli in nosocomial pneumonia. It is worth bearing in mind the relative unimportance of anaerobic bacterias in AP. When we choose the empirical antibiotic treatmentant we have to consider some pathogens identified in orofaríngea flora. Empirical treatment with antianaerobics should only be used in certain patients. Videofluoroscopic swallowing studies should be used to determine the nature and extent of any swallow disorder and to rule out silent aspiration. Assessment of swallowing disorders is cost-effective and results in a significant reduction in overall morbidity and mortality.

The Impact of Periventricular Leukoaraiosis in Post-stroke Oropharyngeal Dysphagia: A Swallowing Biomechanics and MRI-Based Study

Publisher: Springer Science and Business Media LLC

Date: 23-08-2022

DOI: 10.1007/S00455-022-10509-2

Abstract: Oropharyngeal dysphagia is a highly prevalent post-stroke complication commonly associated with topographically specific gray-matter damage. In contrast, the role of damage to the extensive white matter brain network (leukoaraiosis) in post-stroke oropharyngeal dysphagia has not yet been clarified. We aim to assess the role of leukoaraiosis in post-stroke oropharyngeal dysphagia. We designed a cross-sectional study and retrospectively collected from our database patients with dysphagia affected by a recent stroke and on whom both a brain 1.5 T-MRI and a videofluoroscopy had been performed. Leukoaraiosis was assessed in brainstem and in cerebral regions (periventricular or deep) with Fazekas scale. Penetration-Aspiration-Scale and time to laryngeal vestibule closure and to upper esophageal sphincter opening were analyzed. Study population (n = 121 57% men, 75.5 ± 9.4y) presented mostly supratentorial ischemic PACI-type strokes. Of the patients, 86% had unsafe swallows (PAS = 3.97 ± 2.04) 94.2% had cerebral leukoaraiosis (Fazekas = 3.36 ± 1.7) and 42.1% had brainstem-leukoaraiosis, hypertension being the main risk factor. We found both significant positive associations between degree of periventricular-leukoaraiosis and total-leukoaraiosis and presence of risk of aspirations (p = 0.016 and p = 0.023, respectively) and a correlation between periventricular-leukoaraiosis and PAS scale severity (r = 0.179, p = 0.049). No correlations/associations were found between stroke volume and dysphagia in this study. Our study supports a role for leukoaraiosis in the pathophysiology of dysphagia. Stroke is associated with chronic short-connection/circuit injury and damage to periventricular white matter long connections is a relevant neuro-pathophysiological mechanism contributing to impaired safety of swallow in post-stroke oropharyngeal dysphagia patients.

Irritable bowel syndrome: focus on otilonium bromide

Publisher: Informa UK Limited

Date: 13-01-2014

DOI: 10.1586/17474124.2014.869477

Abstract: Irritable bowel syndrome is a prevalent and chronic disorder, characterized by recurrent abdominal pain/discomfort, bloating and altered bowel habits. This condition affects an estimated 10-15% of the population worldwide and impacts heavily on a patient's daily life and ability to work, as well as healthcare resource utilization. Drug therapy aimed at correcting the primary symptoms of diarrhea/constipation/bloating may have little effect on abdominal pain, which results from visceral hypersensitivity. Smooth muscle relaxants or antispasmodics decrease the tone and contractility of intestinal smooth muscle, effectively managing abdominal pain. Otilonium bromide has been widely used worldwide and has been found to be safe and well tolerated, and superior to placebo for the reduction of symptoms and the prevention of symptom relapse in patients with irritable bowel syndrome.

Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art

Publisher: Elsevier BV

Date: 07-2017

DOI: 10.1016/J.JAMDA.2017.02.015

Abstract: Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization and defined as the difficulty or inability to move a bolus safely and effectively from the oral cavity to the esophagus, and can include aspirations, choking, and residue. OD is pandemic among different phenotypes of older people, affecting between 27% and 91% of the population 70 years or older. Although OD can be diagnosed by well-defined clinical methods and complementary explorations, in the clinical setting OD is seldom systematically screened and treated, and awareness among the medical/geriatric community is scarce. The etiology of OD in this population includes many concomitant risk factors with neurogenic and neurodegenerative processes, muscular weakness, and sarcopenia. The pathophysiology includes mechanical deficits in the swallow response (mainly delayed laryngeal vestibule closure time and weak tongue thrust), reduced pharyngeal sensitivity, and sensory/motor central nervous system impairments. Recently, OD has been recognized as a geriatric syndrome due to its high prevalence and its relationship with many comorbidities and their poor outcomes, including malnutrition, respiratory infections and aspiration pneumonia, functional disability and frailty, institutionalization and increased readmissions, and mortality. There is an evidence-based and effective treatment for OD in the elderly mainly oriented to compensating swallow impairments through adaptation of fluid viscosity and solid food textures to avoid aspiration and choking, and improving nutritional status and oral health to avoid respiratory infections. This has been defined as the minimal effective treatment to be provided to this population. New treatments aiming at recovering the swallowing function are under research with promising results, and the near future will provide us with methods to stimulate the swallow response with pharmacological or physical stimuli.

Neurophysiological and Biomechanical Evaluation of the Mechanisms Which Impair Safety of Swallow in Chronic Post-stroke Patients

Publisher: Springer Science and Business Media LLC

Date: 02-04-2019

DOI: 10.1007/S12975-019-00701-2

Abstract: Oropharyngeal dysphagia (OD) is a common post-stroke complication and is associated with respiratory infections. The aim was to assess the biomechanical impairments in swallow function and the afferent and efferent swallowing pathways impairing swallow safety in chronic post-stroke patients. We studied 30 patients with unilateral stroke and chronic OD (> 3 months from stroke onset) with impaired safety of swallow (Penetration-Aspiration Scale [PAS] ≥ 2). We evaluated the efficacy, safety, and kinematics of the swallow response (residue, PAS, laryngeal vestibule closure time [LVCT]) with videofluoroscopy, sensory evoked potentials to pharyngeal electrical stimulation (pSEP), and pharyngeal motor evoked potentials (pMEP) to transcranial magnetic stimulation of both hemispheres. Mean age of patients was 70.1 ± 10.9 years (7 women). Stroke severity at onset was moderate (NIHSS median 10 [IQ range 3-11.5]), and modified Rankin Scale 2.8 ± 1.3. Mean PAS was 5.1 ± 1.9 prevalence of delayed LVCT was 86.7% and 30% presented aspirations. Pharyngeal hypoesthesia was present in 46.7% of patients and 92.3% showed abnormally asymmetrical pSEPs when comparing the ipsilesional with the contralesional hemisphere. Increased duration of swallow was associated with lower pSEP litude (P1-N2) in the contralesional hemisphere (p = 0.033). Patients with right hemispheric strokes showed greater reduction of pSEPs litude (N1-P1, p = 0.049). In contrast, pharyngeal resting motor threshold and pMEPs were symmetric in 73.3% patients without the physiologic hemispheric dominance. Mild-to-moderate disabled chronic post-stroke patients with OD presented severe impaired biomechanics of swallow response and high prevalence of aspirations. Initial results from the neurophysiological evaluation demonstrated prevalent impairments with disrupted integration of pharyngeal sensory inputs and reduced cortical excitability of efferent pathways. Patients with right hemispheric strokes showed poorer neurophysiological responses.

Sensitivity and specificity of the Eating Assessment Tool and the Volume‐Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia

Publisher: Wiley

Date: 09-06-2014

DOI: 10.1111/NMO.12382

Purinergic neuromuscular transmission in the gastrointestinal tract; functional basis for future clinical and pharmacological studies

Publisher: Wiley

Date: 05-09-2014

DOI: 10.1111/BPH.12802

Changes in the response to excitatory antagonists, agonists, and spasmolytic agents in circular colonic smooth muscle strips from patients with diverticulosis

Publisher: Wiley

Date: 24-08-2015

DOI: 10.1111/NMO.12659

Abstract: Colonic s les from asymptomatic erticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS. Circular muscle strips from sigmoid colon of DS patients (n = 30 69.5 ± 14.8 years) and controls (n = 32 64.7 ± 16.2 years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels. Contractions to carbachol (Emax : 663.7 ± 305.6% control vs 2698.0 ± 439.5% DS p < 0.0005) and NKA (Emax : 387.8 ± 35.6% vs 1102.0 ± 190.1% p < 0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50 = 8.56 ± 0.15 control vs pIC50 = 9.95 ± 0.18 DS group p < 0.005) and slightly higher for GR94800 (pIC50 = 7.21 ± 0.18 control vs pIC50 = 7.97 ± 0.32 group p < 0.0001). Lower efficacy (Emax ) and potency (pIC50 ) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups. The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in erticular disease.

Spontaneous Swallowing Frequency in Post-Stroke Patients with and Without Oropharyngeal Dysphagia: An Observational Study

Publisher: Springer Science and Business Media LLC

Date: 23-04-2022

DOI: 10.1007/S00455-022-10451-3

Abstract: Oropharyngeal dysphagia (OD) is a frequent complication after stroke (PSOD) that increases morbidity and mortality. Early detection of PSOD is essential to reduce morbidity and mortality in patients with acute stroke. In recent years, an association between reduced spontaneous swallowing frequency (SSF) and OD has been described. Likewise, the reduction of saliva substance P (SP) concentration has been associated with an increased risk of aspiration and a decrease in SSF. In this study we aimed to compare SSF, salivary SP concentration, hydration and nutritional status in post-stroke (PS) patients with and without OD. We included 45 acute PS patients (4.98 ± 2.80 days from stroke onset, 62.22% men, 71.78 ± 13.46 year). The Volume-Viscosity Swallowing Test (V-VST) was performed for clinical diagnosis of OD. SSF/minute was assessed through 10-min neurophysiological surface recordings including suprahyoid-electromyography and cricothyroid-accelerometry. Saliva s les were collected with a Salivette® to determine SP by ELISA. Hydration status was assessed by bioimpedance. Nutritional status was evaluated by Mini Nutritional Assessment Short Form (MNA-sf) and blood analysis. Twenty-seven PS patients (60%) had OD 19 (40%), impaired safety of swallow. SSF was significantly reduced in PSOD, 0.23 ± 0.18 and PSOD with impaired safety, 0.22 ± 0.18 vs 0.48 ± 0.29 swallows/minute in PS without OD (PSnOD) (both p 0.005). Nutritional risk was observed in 62.92% PSOD vs 11.11% PSnOD ( p = 0.007) and visceral protein markers were also significantly reduced in PSOD ( p 0.05). Bioimpedance showed intracellular dehydration in 37.50% PSOD vs none in PSnOD. There were no differences for saliva SP concentrations. SSF is significantly reduced in PSOD in comparison with PSnOD. Acute PSOD patients present poor nutritional status, hydropenia, and high risk for respiratory complications.

Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia

Publisher: Springer Science and Business Media LLC

Date: 11-12-2013

DOI: 10.1007/S00535-013-0920-0

Abstract: Oropharyngeal dysphagia (OD) is a major gastrointestinal motility disorder that causes severe nutritional and respiratory complications in elderly and neurological patients. In an earlier study, we found that stimulation of pharyngeal sensory neurons by capsaicinoids acting on transient receptor potential vanilloid 1 (TRPV1) improved the swallow response of dysphagic patients. The aim of this study was to explore the effect of piperine, a dual TRPV1/TRPA1 agonist, on the swallow response of dysphagic patients. A videofluoroscopic study was performed to assess the signs of impaired safety and efficacy of swallow and the swallow response of 40 dysphagic patients while swallowing one series of nectar control boluses and two series of nectar boluses supplemented with piperine. Patients were randomized into two groups: one group received 150 μM piperine and the other group received 1 mM. Piperine improved the safety of swallow by: (a) reducing the prevalence of unsafe swallows by -34.48% (P = 0.004) at 150 μM and -57.19% (P < 0.001) at 1 mM, and the severity score of the penetration-aspiration scale from 3.25 ± 0.51 to 1.85 ± 0.27 (P = 0.003, 1 mM) and (b) shortening the time to laryngeal vestibule closure from 0.366 ± 0.024 to 0.270 ± 0.022 s with 150 μM piperine (P < 0.001) and from 0.380 ± 0.032 to 0.306 ± 0.028 s with 1 mM piperine (P < 0.05). Supplementing the alimentary bolus with piperine speeds swallow response and strongly improves safety of swallow in patients with OD, with a maximal therapeutic effect at 1 mM. Our results suggest that activation of TRPV1/A1 in oropharyngeal sensory neurons is a very promising neurostimulation strategy for dysphagic patients.

Endogenous cholecystokinin delays gastric emptying and decreases postprandial release of insulin in man

Publisher: Elsevier BV

Date: 07-1992

DOI: 10.1016/0167-0115(92)90253-Q

A comparative study on the therapeutic effect of TRPV1, TRPA1, and TRPM8 agonists on swallowing dysfunction associated with aging and neurological diseases

Publisher: Wiley

Date: 11-08-2017

DOI: 10.1111/NMO.13185

Abstract: Oropharyngeal sensory impairment is a potential target to treat swallowing dysfunction in patients with oropharyngeal dysphagia (OD). To assess the therapeutic effect of stimulating oropharyngeal sensory afferents with TRPV1, TRPA1, or TRPM8 agonists vs increasing bolus viscosity in older and neurologic patients with OD by comparing four studies of similar experimental design. Swallow function of 142 older patients with impaired safety of swallow at nectar ([50-350] mPa·s) viscosity was evaluated with videofluoroscopy (VFS) while treated with TRPV1 (150 μmol/L), TRPV1/A1 (150 μmol/L and 1 mmol/L), or TRPM8 (1 mmol/L or 10 mmol/L) agonists or modified starch (MS) at spoon thick viscosity (>1750 mPa·s). TRPV1 stimulation with capsaicinoids reduced penetrations by 50%, pharyngeal residue by 80%, and LVC time by 24.38% and increased bolus velocity by 36.51%. TRPV1/A1 stimulation with piperine reduced penetrations by 56.32%, LVC time by 25.55% and increased bolus velocity by 23.63%. TRPM8 stimulation with menthol 1 mmol/L reduced penetrations by 37.5% while 10 mmol/L reduced LVC time by 18.44%. Thickeners reduced penetrations by 77.11%, but increased pharyngeal residue by 19.89%, delayed LVC by 41.73%, and reduced bolus velocity by 13.44%. Natural capsaicinoids have a stronger therapeutic effect on VFS signs and swallow response by stimulating TRPV1 than TRPV1/A1 or TRPM8 agonists. While TRP stimulants increased bolus velocity and reduced swallow response times, thickeners reduced bolus velocity and further delayed the swallow response. This study sets the bases to develop new pharmacologic strategies for older patients with OD, moving away from compensation toward the recovery of swallow function.

Oropharyngeal dysphagia in older persons &ndash; from pathophysiology to adequate intervention: a review and summary of an international expert meeting

Publisher: Informa UK Limited

Date: 02-2016

DOI: 10.2147/CIA.S97481

Nutritional Aspects of Dysphagia Management

Publisher: Elsevier

Date: 2017

DOI: 10.1016/BS.AFNR.2016.11.008

Abstract: This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva.

Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly

Publisher: Hindawi Limited

Date: 2011

DOI: 10.1155/2011/818979

Abstract: Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration—half of them without cough, and 45%, oropharyngeal residue and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach.

Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

Publisher: Springer Science and Business Media LLC

Date: 14-05-2022

DOI: 10.1186/S13643-022-01969-6

Abstract: Oropharyngeal dysphagia (OD) affects 40–81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. PROSPERO CRD42020136245

Proposal for a Standard Protocol to Assess the Rheological Behavior of Thickening Products for Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 25-11-2022

DOI: 10.3390/NU14235028

Abstract: Increasing shear viscosity (ShV) in thickening products (TP) is a valid therapeutic strategy for oropharyngeal dysphagia (OD). However, salivary amylase in the oral phase and shear rate in the pharyngeal phase of swallowing can change the viscosity of TPs when swallowed. This study aims to design and validate a rheological protocol to reproduce the oral and pharyngeal factors that affect the therapeutic effect of TPs and report the viscosity measurements in a standardized scientific and precise manner. We measured (a) the variability of the ShV measurements across several laboratories (b) the in vitro and ex vivo properties of TPs and (c) the impact of the X-ray contrast Omnipaque, temperature and resting time on the rheological properties of TPs. A common protocol was applied in four international laboratories to assess five ShV values (100, 200, 400, 800 and 1600 mPa·s) for the xanthan-gum TP Tsururinko Quickly (TQ). The protocol included the dose (g/100 mL water), stirring procedure and standing time before measurement. Each value was characterized at the shear rate of 50 and 300 s−1 pre- and post-oral incubation in eight volunteers. The effect of temperature, standing time and Omnipaque was assessed. The main results of the study were: (a) The mean intra-laboratory variability on the ShV at all levels was very low: 0.85%. The mean inter-laboratory variability was higher: 9.3% (b) The shear thinning of TQ at 300 s−1 was 75–80%. Increasing the temperature or standing time did not affect the ShV, and oral amylase caused a small decrease (c) Omnipaque slightly decreased the dose of TP and hardly affected the amylase resistance or shear thinning. This study showed that different laboratories can obtain very accurate and similar ShV measurements using this protocol which uses scientific, universal SI units (mPa·s). Our protocol accurately reproduces oral and pharyngeal factors affecting the therapeutic effect of TPs. The addition of X-ray contrast did not produce significant changes.

Nitrergic neuro‐muscular transmission is up‐regulated in patients with diverticulosis

Publisher: Wiley

Date: 11-08-2014

DOI: 10.1111/NMO.12407

Abstract: Neuro-transmission impairment could be associated to motility changes observed in patients with erticular disease. Therefore, the objective was to characterize the inhibitory neuro-muscular transmission and gene expression changes of the enteric inhibitory pathways in patients with erticulosis (DS). Circular muscle strips from sigmoid colon of patients with DS and controls were studied using the organ bath technique to evaluate spontaneous contractility and enteric motor neurons stimulated by electrical field and qRT-PCR to assess the expression of nNOS, iNOS, P2Y1 R and PGP9.5. Patients with DS presented decreased spontaneous rhythmic contractions (SRC) that were significantly enhanced after incubation with L-NNA (1 mM) and TTX (1 μM), and unaffected by the P2Y1 antagonist MRS2500 (1 μM). Stimulation on enteric motor neurons caused an increased duration of the latency of OFF-contractions in DS group (p < 0.001), antagonized by L-NNA and slightly affected by MRS2500 (1 μM). No differences in the IC50 between controls and DS patients were observed on inhibition of SRC for the NO-donor sodium nitroprusside (SNP) and the preferential P2Y agonist ADPβS. Moreover, nNOS relative expression was also up-regulated 2.3-fold in the DS group (p < 0.05) whereas there was no significant difference in relative expression of iNOS, P2Y1 R and the neuronal marker PGP9.5 between groups. Patients with DS presented an over-expression of nNOS with increased endogenously NO-mediated responses suggesting enhanced NO-release. Up-regulation in the nitrergic pathway in early stages of the disease might play a role in colonic motor disorders associated to erticular disease.

Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.3945/AJCN.114.104307

Abstract: The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 16-08-2021

DOI: 10.3390/FOODS10081900

Abstract: (1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study

Publisher: Wiley

Date: 23-03-2018

DOI: 10.1111/NMO.13338

Abstract: Oropharyngeal dysphagia (OD) is a prevalent poststroke condition with severe complications and increased mortality. Poststroke OD prevalence varies among studies and there is little evidence of its related risk factors and associated complications. to evaluate the prevalence of OD after stroke and the risk factors and associated complications. We performed a prospective longitudinal study of stroke patients consecutively admitted to a general hospital. OD was diagnosed with the volume-viscosity swallow test (V-VST). Demographic, functional status and topographical and clinical variables of stroke were collected to assess risk factors for OD. We evaluated functional status, mortality, respiratory infections, and readmissions 3 and 12 months after stroke. A multivariate regression analysis determined associated risk factors for OD and for each outcome variable. We included 395 stroke patients with a 45.06% prevalence of OD on admission. OD was independently associated with age (OR = 1.05 CI = 1.02-1.08), previous stroke (OR = 2.40 CI = 1.00-5.79), severity using the National Institute of Health Stroke Scale (OR = 3.52 CI = 1.57-7.87) and volume of the lesion (OR = 1.02 CI = 1.01-1.03). OD after stroke was an independent risk factor for prolonged hospital stay (P = .049 β = 0.938) and institutionalization after discharge (OR = 0.47 CI = 0.24-0.92) OD was an independent risk factor for poorer functional capacity (OR = 3.00 CI = 1.58-5.68) and increased mortality (HR = 6.90 CI = 1.57-30.34) 3 months after stroke. Poststroke OD is prevalent and associated with poor short and long term prognosis. Stroke severity and patient status before stroke were more relevant to OD than lesion location. Systematic screening programs and early OD management could significantly improve poststroke patient outcome.

Peritoneal mast cell degranulation and gastrointestinal recovery in patients undergoing colorectal surgery

Publisher: Wiley

Date: 09-02-2015

DOI: 10.1111/NMO.12525

Abstract: Degranulation of peritoneal mast cells (MCs) induced by intestinal manipulation has been proposed as a pathophysiological factor in postoperative ileus (POI). We aimed to explore the relationship between peritoneal and colonic MC degranulation and gastrointestinal (GI) recovery following colectomy. Patients undergoing elective laparoscopic cholecystectomy (using a laparoscope and small abdominal incisions, n = 14), and elective laparoscopic (n = 32) or open partial colectomy (through a large abdominal incision, n = 10) were studied. MC protease tryptase and chymase were studied in peritoneal fluid at the beginning, middle, and end of each surgical intervention. Density of MCs in colectomy s les were examined and oro-caecal transit time by breath test, GI function recovery by clinical composite endpoint GI-2 and association between MC proteases and clinical recovery. Open and laparoscopic colectomy caused greater peritoneal release of tryptase and chymase (323.0 ng/mL [IQR: 53.05-381.4] and 118.6 ng/mL [IQR: 53.60-240.3]), than cholecystectomy (41.64 ng/mL [IQR: 11.17-90.93]) at the end of the surgical intervention. However, there were no differences between laparoscopic and open colectomy. Increased peritoneal protease release during surgery was observed in patients who developed POI after colectomy. Colorectal surgery causes protease release from peritoneal MCs. Protease release does not differ between both types of colectomy (laparoscopy vs laparotomy). However, MC activation is increased in colectomy patients developing POI. Therefore, degranulation of peritoneal MCs as a factor contributing to human POI after colectomy might be considered in future studies as a target to avoid POI.

Therapeutic Effect on Swallowing Function and on Hydration Status of a New Liquid Gum-Based Thickener in Independently-Living Older Patients with Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 31-10-2023

DOI: 10.3390/NU15214621

Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Publisher: Wiley

Date: 11-08-2019

DOI: 10.1111/NMO.13695

Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy

Publisher: MDPI AG

Date: 14-07-2021

DOI: 10.3390/NU13072413

Abstract: Background: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. Methods: A cross-sectional observational study was conducted at SNS L’Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). Results: A total of 33 students (mean age 13.3 years 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II–III of EDACS, and 31.3% required PEG furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. Conclusion: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia

Publisher: Oxford University Press (OUP)

Date: 26-06-2009

DOI: 10.1093/AGEING/AFP100

Abstract: oropharyngeal dysphagia is a common condition among the elderly but not systematically explored. to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia. a prospective cohort study. an acute geriatric unit in a general hospital. a total of 134 elderly patients (>70 years) consecutively admitted with pneumonia. clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered. of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001). oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.

A Comparative Study on the Effect of Acute Pharyngeal Stimulation with TRP Agonists on the Biomechanics and Neurophysiology of Swallow Response in Patients with Oropharyngeal Dysphagia

Publisher: MDPI AG

Date: 15-09-2022

DOI: 10.3390/IJMS231810773

Abstract: Fluid thickening is the main compensatory strategy for patients with oropharyngeal dysphagia (OD) associated with aging or neurological diseases, and there is still no pharmacological treatment. We aimed to compare the effects of increasing bolus viscosity with that of acute stimulation with TRPV1, TRPA1 or TRPM8 agonists on the biomechanics and neurophysiology of swallow response in patients with OD. We retrospectively analyzed seven studies from our laboratory on 329 patients with OD. The effect of increasing shear viscosity up to 3682 mPa·s was compared by videofluoroscopy and pharyngeal sensory evoked potentials (pSEP) with that of adding to the bolus: capsaicin (TRPV1, 150 μM/10 μM), piperine (TRPA1/V1, 1 mM/150 μM), menthol (TRPM8, 1 mM/10 mM), cinnamaldehyde-zinc (TRPA1, 100 ppm–70 mM), citral (TRPA1, 250 ppm) or citral-isopulegol (TRPA1-TRPM8, 250 ppm–200 ppm). Fluid thickening improved the safety of swallow by 80% (p 0.0001) by delaying bolus velocity by 20.7 ± 7.0% and time to laryngeal vestibule closure (LVC) by 23.1 ± 3.7%. Capsaicin 150μM or piperine 1 mM significantly improved safety of swallow by 50% (p 0.01) and 57.1% (p 0.01) by speeding time to LVC by 27.6% (p 0.001) and 19.5% (p 0.01) and bolus velocity by 24.8% (p 0.01) and 16.9% (p 0.05), respectively. Cinnamaldehyde-zinc shortened the P2 latency of pSEPs by 11.0% (p 0.01) and reduced N2-P2 litude by 35% (p 0.01). In conclusion, TRPV1 and TRPV1/A1 agonists are optimal candidates to develop new pharmacological strategies to promote the recovery of brain and swallow function in patients with chronic OD.

Caspase-10 Triggers Bid Cleavage and Caspase Cascade Activation in FasL-induced Apoptosis

Publisher: Elsevier BV

Date: 05-2005

DOI: 10.1074/JBC.M414358200

Effect of otilonium bromide on contractile patterns in the human sigmoid colon

Publisher: Wiley

Date: 21-01-2010

DOI: 10.1111/J.1365-2982.2010.01495.X

Abstract: The mechanism of action of the spasmolytic compound otilonium bromide (OB) on human colonic motility is not understood. The aim of our study was to characterize the pharmacological effects of OB on contractile patterns in the human sigmoid colon. Circular sigmoid strips were studied in organ baths. Isolated smooth muscle cells from human sigmoid colon were examined using the calcium imaging technique. Otilonium bromide inhibited by 85% spontaneous non-neural rhythmic phasic contractions (RPCs), (IC(50) = 49.9 nmol L(-1)) and stretch-induced tone (IC(50) = 10.7 nmol L(-1)) with maximum effects at micromolar range. OB also inhibited by 50% both on- (IC(50) = 38.0 nmol L(-1)) and off-contractions induced by electrical stimulation of excitatory motor neurons. In contrast, the inhibitory latency period prior to off-contractions was unaffected by OB. OB inhibited acetylcholine-, substance P-, and neurokinin A-induced contractions. The L-type Ca(2+) channel agonist BayK8644 reversed the effects of OB on RPCs, on- and off-contractions. Hexamethonium, atropine, the NK(2) antagonist, or depletion of intracellular Ca(2+) stores by thapsigargin did not prevent the inhibitory effect of OB on RPCs and electrical contractions. KCl-induced calcium transients in isolated smooth muscle cells were also inhibited by OB (IC(50) = 0.2 micromol L(-1)). Otilonium bromide strongly inhibited the main patterns of human sigmoid motility in vitro by blocking calcium influx through L-type calcium channels on smooth muscle cells. This pharmacological profile may mediate the clinically observed effects of the drug in patients with irritable bowel syndrome.

Using Rasch Analysis to Evaluate the Reliability and Validity of the Swallowing Quality of Life Questionnaire: An Item Response Theory Approach

Publisher: Springer Science and Business Media LLC

Date: 02-2018

DOI: 10.1007/S00455-017-9873-4

Abstract: The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an in idual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The item-person dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were 'category', 'threshold' or 'step' disordered however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT.

Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial

Publisher: Springer Science and Business Media LLC

Date: 14-02-2021

DOI: 10.1007/S13760-021-01624-2

Abstract: The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an in idual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in in iduals with chronic oropharyngeal dysphagia after stroke.

Pathophysiology of oropharyngeal dysphagia in the frail elderly

Publisher: Wiley

Date: 07-07-2010

DOI: 10.1111/J.1365-2982.2010.01521.X

Abstract: Oropharyngeal dysphagia is a major complaint among the elderly. Our aim was to assess the pathophysiology of oropharyngeal dysphagia in frail elderly patients (FEP). A total of 45 FEP (81.5 +/- 1.1 years) with oropharyngeal dysphagia and 12 healthy volunteers (HV, 40 +/- 2.4 years) were studied using videofluoroscopy. Each subject's clinical records, signs of safety and efficacy of swallow, timing of swallow response, hyoid motion and tongue bolus propulsion forces were assessed. Healthy volunteers presented a safe and efficacious swallow, faster laryngeal closure (0.157 +/- 0.013 s) upper esophageal sphincter opening (0.200 +/- 0.011 s), and maximal vertical hyoid motion (0.310 +/- 0.048 s), and stronger tongue propulsion forces (22.16 +/- 2.54 mN) than FEP. By contrast, 63.63% of FEP presented oropharyngeal residue, 57.10%, laryngeal penetration and 17.14%, tracheobronchial aspiration. Frail elderly patients with impaired swallow safety showed delayed laryngeal vestibule (LV) closure (0.476 +/- 0.047 s), similar bolus propulsion forces, poor functional capacity and higher 1-year mortality rates (51.7%vs 13.3%, P = 0.021) than FEP with safe swallow. Frail elderly patients with oropharyngeal residue showed impaired tongue propulsion (9.00 +/- 0.10 mN), delayed maximal vertical hyoid motion (0.612 +/- 0.071 s) and higher (56.0%vs 15.8%, P = 0.012) 1-year mortality rates than those with efficient swallow. Frail elderly patients with oropharyngeal dysphagia presented poor outcome and high mortality rates. Impaired safety of deglutition and aspirations are mainly caused by delayed LV closure. Impaired efficacy and residue are mainly related to weak tongue bolus propulsion forces and slow hyoid motion. Treatment of dysphagia in FEP should be targeted to improve these critical events.

Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19

Publisher: MDPI AG

Date: 21-09-2021

DOI: 10.3390/NU13093293

Abstract: Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal in idualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.

Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study

Publisher: Springer Science and Business Media LLC

Date: 17-05-2018

DOI: 10.1007/S12603-018-1043-3

Abstract: Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population. Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. An open label trial was performed on 186 hospitalized older patients (>70y) with OD 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls. The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI. Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up. Both groups had similar advanced age (84.87±6.02MMI and 84.42±5.31 years), poor functionality (Barthel 59.51±26.76 MMI and 58.84±26.87), and high comorbidities (Charlson 3.00±1.60 MMI and 3.06±1.45). Main results showed that MMI improved nutritional status (MNA 9.84±2.05 pre-MMI vs. 11.31±2.21 post-MMI p=0.0038) and functionality (Barthel 62.34±25.43 pre-MMI vs. 73.44±25.19 post-MMI p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1-109.38) MMI vs. 190.8 (156.0-225.7) p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0-29.82) MMI vs. 74.68 (52.86-96.50) p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96% p=0.044). Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.

Swallowing in Parkinson Patients versus Healthy Controls: Reliability of Measurements in Videofluoroscopy

Publisher: Hindawi Limited

Date: 2011

DOI: 10.1155/2011/380682

Abstract: Objective . To determine and describe the pathophysiological aspects of oropharyngeal swallowing in patients with Parkinson's disease more accurately, a pilot study of qualitative as well as quantitative parameters of swallowing was performed using videofluoroscopy (VFS). Methods . Ten patients with a diagnosis of idiopathic Parkinson's disease having dysphagic complaints and ten healthy age- and gender-matched control subjects underwent a standardized videofluoroscopic swallowing protocol. Information on the swallowing function was derived from temporal, spatial, and descriptive visuoperceptual parameters. Intra- and interrater reliability was calculated. Results . No significant differences were found between Parkinson patients and healthy control subjects for the majority of the reliable variables. Conclusions . It was concluded that swallowing function seemed to be preserved in the early stages of Parkinson's disease. Furthermore, the reliability of many quantitative as well as qualitative swallowing parameters proved insufficient, raising questions about the interpretation of study outcomes in videofluoroscopy.

Universitat Autònoma De Barcelona

Location: Spain

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James Cook University

Location: Australia

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Instituto De Salud Carlos III

Location: Spain

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Consorci Sanitari Del Maresme

Location: Spain

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