RESUMEN

Esophageal pathologies can exhibit extremely low incidence and prevalence rates. Therefore, it is essential to have multidisciplinary teams including surgeons specialized in esophageal pathology, with a high caseload, to ensure proper diagnosis and management. This manuscript presents a series of esophageal pathology cases with favorable outcomes and atypical resolution for non-specialized groups. However, failure to refer to specialists in a timely manner can result in missed diagnoses or poor quality of life for patients. These findings underscore the importance of having surgeons specialized in esophageal pathology and multidisciplinary teams to provide the best possible care for patients. Lusoria dysphagia (LD) is a condition caused by vascular compression of the esophagus, resulting from the most common embryological vascular abnormality of the aortic arch: the aberrant right subclavian artery (ARSA) or lusoria artery (LA). This variant occurs in 0.5 to 2.5% of individuals. Necrosis of the gastric tube following an esophagectomy is a rare complication with a high mortality rate. Esophageal replacement with coloplasty is the preferred technique for a second attempt at reconstruction. However, this remains a complex surgery with a high rate of complications.

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Las enfermedades del esófago pueden presentar una incidencia y prevalencia extremadamente baja. Por lo tanto, es fundamental contar con equipos multidisciplinarios que incluyan cirujanos especializados en afecciones esofágicas, con un alto volumen de casos, para garantizar un diagnóstico y manejo adecuados. En este estudio, se analizan casos de enfermedad esofágica con resultados satisfactorios y una resolución atípica. La falta de derivación a especialistas a tiempo puede llevar a una ausencia de diagnóstico o una baja calidad de vida para los pacientes. Estos hallazgos subrayan la importancia de disponer de cirujanos especializados en esófago y equipos multidisciplinarios para asegurar la mejor atención posible para los pacientes.

Asunto(s)

Trastornos de Deglución , Humanos , Trastornos de Deglución/terapia , Trastornos de Deglución/etiología , Masculino , Arteria Subclavia/anomalías , Grupo de Atención al Paciente , Persona de Mediana Edad , Femenino , Esofagectomía/métodos , Anomalías Cardiovasculares/terapia , Esófago/anomalías , Enfermedades del Esófago/terapia , Enfermedades del Esófago/diagnóstico

RESUMEN

PURPOSE: To correlate the functional performance and impact of dysphagia on the quality of life of cancer patients in palliative care. METHODS: This cross-sectional, quantitative study was conducted at the outpatient clinic and oncology ward of a university hospital. Inclusion criteria required patients to respond positively to the question: "Do you have difficulty or problems swallowing?". Patients were excluded if they had been diagnosed with head and neck cancer, were unable to answer questionnaires due to actively dying status, were in a state of drowsiness, experienced extreme pain and systemic instability, or if data collection instruments were incomplete. Two instruments were used in their Brazilian Portuguese versions: the Palliative Performance Scale (PPS) and the M. D. Anderson Dysphagia Inventory (MDADI). The variables were analyzed using descriptive and inferential statistics, with Pearson's correlation used at a 5% significance level. RESULTS: The sample consisted of 39 participants, with an average age of 65.3 years, of whom 24 (61.5%) were women. The most frequent neoplasm sites were the pancreas and stomach. The results of the PPS indicated that the average patient had reduced ambulation and inability to work, but maintained independence in self-care, with a complete level of swallowing and consciousness. The MDADI showed an average degree of limitation. Outpatients exhibited a moderate correlation between the MDADI result and the level of functionality according to the PPS. CONCLUSION: Cancer patients at the palliative care outpatient clinic demonstrated a correlation between functional performance and the impact of dysphagia on quality of life.

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OBJETIVO: Correlacionar a performance funcional e impacto da disfagia na qualidade de vida de pacientes oncológicos em cuidados paliativos. MÉTODO: Estudo transversal e quantitativo realizado no ambulatório e enfermaria de oncologia de um hospital universitário. Os critérios de inclusão exigiram que os pacientes respondessem positivamente à pergunta: "você tem dificuldade ou problema para engolir?". Foram excluídos os pacientes que tivessem diagnóstico de câncer de cabeça e pescoço, incapacidade de responder questionários devido a estarem em processo ativo de morte, estado de sonolência, dor extrema e instabilidade sistêmica, bem como os instrumentos de coleta que não foram concluídos. Foram aplicados dois instrumentos em suas versões para o português brasileiro: a Palliative Performance Scale (PPS) e M. D. Anderson Dysphagia Inventory (MDADI). A análise das variáveis foi realizada com base na estatística descritiva e inferencial, por meio da correlação de Pearson, em nível de significância de 5%. RESULTADOS: A amostra foi composta por 39 participantes, com média de 65,3 anos, dos quais 24 (61,5%) eram mulheres. As localizações mais frequentes de neoplasia foram: pâncreas e estômago. O resultado da PPS indicou que a média dos pacientes apresentou deambulação reduzida, incapacidade para trabalhar, porém com independência no autocuidado, nível de ingesta e consciência completos e o MDADI obteve grau médio de limitação. Pacientes ambulatoriais apresentaram correlação moderada entre o resultado do MDADI e nível de funcionalidade pela PPS. CONCLUSÃO: Pacientes oncológicos do ambulatório de cuidados paliativos apresentaram correlação entre performance funcional e o impacto da disfagia na qualidade de vida.

Asunto(s)

Trastornos de Deglución , Neoplasias , Cuidados Paliativos , Calidad de Vida , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Estudios Transversales , Masculino , Anciano , Neoplasias/complicaciones , Neoplasias/fisiopatología , Persona de Mediana Edad , Encuestas y Cuestionarios , Brasil , Anciano de 80 o más Años , Adulto , Rendimiento Físico Funcional

RESUMEN

OBJECTIVE: The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. METHODS: This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. RESULTS: Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. CONCLUSIONS: The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.

Asunto(s)

Remoción de Dispositivos , Traqueostomía , Humanos , Masculino , Estudios Retrospectivos , Niño , Preescolar , Femenino , Lactante , Adolescente , Remoción de Dispositivos/métodos , Traqueostomía/métodos , Traqueostomía/efectos adversos , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Protocolos Clínicos , Trastornos de Deglución/etiología

RESUMEN

Introduction: The gag reflex is a protection mechanism that prevents food and unwanted agents from entering the lower airways. It is usually part of the physical examination of swallowing to detect oropharyngeal dysphagia, but it is a potentially ambiguous sign. Objective: To evaluate the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia and adults without it. Materials and methods: We conducted an analytical observational study in patients with neurogenic oropharyngeal dysphagia (cases) and patients without dysphagia (controls). We evaluated the absence or presence of the reflex bilaterally, by direct visualization, and adjusted it according to sex, age, and other interaction variables. Results: We included 86 patients with neurogenic oropharyngeal dysphagia and 80 control subjects. The gag reflex on swallowing physical examination showed a positive relationship with the patients (right side: OR = 3.97; 95 % CI: 2.01-7.84; left side: OR = 4.84; 95 % CI: 2.41-9.72), but a negative association with the control group. In both groups, neither sex, nor age, nor other interaction variables modified the gag reflex. Conclusions: The gag reflex absence or presence does not confirm or exclude the existence of oropharyngeal dysphagia due to neurological and neuromuscular causes. Therefore, health professionals must not rely on this reflex. Clinicians must go beyond a simple reflex revision, even in neurological patients where it is supposed to be absent.

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Introducción. El reflejo nauseoso es un mecanismo de protección que impide que alimentos y agentes no deseados penetren en la vía aérea inferior. Usualmente, hace parte del examen físico de la deglución para detectar la disfagia orofaríngea, pero es un signo potencialmente ambiguo. Objetivo. Evaluar el valor diagnóstico del reflejo nauseoso en pacientes con disfagia orofaríngea neurogénica y en pacientes sin ella. Materiales y métodos. Se trata de un estudio observacional, analítico, en pacientes con disfagia orofaríngea neurogénica (casos) y en personas sin disfagia (controles), en el cual se evaluó por visualización directa la ausencia o la presencia del reflejo nauseoso de forma bilateral. Este resultado se ajustó por sexo, edad y otras variables de interacción. Resultados. Se evaluaron 86 pacientes con disfagia orofaríngea neurogénica y 80 personas sin ella. En el examen físico de la deglución, la presencia del reflejo mostró una relación positiva con los pacientes (lado derecho: OR = 3,97; IC95%: 2,01-7,84; lado izquierdo: OR = 4,84; IC95%: 2,41-9,72), pero una asociación negativa con los controles. En ambos grupos, ni el sexo ni la edad, ni otras variables de interacción modificaron el reflejo nauseoso. Conclusiones. La ausencia o la presencia del reflejo nauseoso no confirma ni excluye la existencia de una disfagia orofaríngea por causas neurológicas o neuromusculares; por lo tanto, no es recomendable que los profesionales de la salud se fíen del resultado de este reflejo. Los médicos tratantes deben ir más allá de una simple revisión del reflejo nauseoso, incluso en pacientes neurológicos en quienes se supone que debería estar ausente.

Asunto(s)

Trastornos de Deglución , Atragantamiento , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Anciano , Atragantamiento/fisiología , Adulto , Deglución/fisiología , Anciano de 80 o más Años , Reflejo/fisiología

RESUMEN

OBJECTIVE: To identify internal structure validity evidence of a dysphagia screening questionnaire for caregivers of older adults with Alzheimer's disease dementia and/or vascular dementia. METHODS: The 24-question Dysphagia Screening in Older Adults with Dementia - Caregiver Questionnaire (RaDID-QC) was administered by interviewing 170 caregivers of older people with dementia, selected by convenience at the Outpatient Reference Center for Older People. Exploratory Factor Analysis (EFA) was used to assess the internal structure validity of the questionnaire, and Cronbach's alpha was used to analyze reliability. Questions with factor loadings lower than 0.45 in magnitude were removed from the final questionnaire. Multivariate multiple linear regression was used to assess the percentage of variance explained by the remaining questions. RESULTS: Kayser-Meyer-Olkin (KMO) and Bartlett's tests suggested that the questionnaire was adequate for EFA. Principal Component Analysis (PCA) suggested that 12 components captured at least 75 % of the total variance. The corresponding 12-factor EFA model showed a statistically significant fit, and 15 out of the 24 questions had factor loadings greater than 0.45. Cronbach's alpha was 0.74 for the 15 questions, which explained 71 % of the total variance in the complete dataset. The questionnaire has adequate internal structure validity and good reliability. Based on EFA, RaDID-QC decreased from 24 to 15 questions. Other internal validity and reliability parameters will be obtained by administering the questionnaire to larger target populations. CONCLUSION: The RaDID-QC applied to caregivers of older adults with dementia due to Alzheimer's disease and/or vascular dementia produced valid and reliable responses to screen dysphagia signs and symptoms.

Asunto(s)

Cuidadores , Trastornos de Deglución , Demencia , Humanos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Encuestas y Cuestionarios/normas , Femenino , Masculino , Anciano , Reproducibilidad de los Resultados , Cuidadores/psicología , Persona de Mediana Edad , Demencia/complicaciones , Demencia/diagnóstico , Anciano de 80 o más Años , Análisis Factorial , Adulto , Tamizaje Masivo/métodos , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/diagnóstico , Demencia Vascular/diagnóstico

RESUMEN

PURPOSE: To compare oral status, swallowing function (through instrumental and SLH assessment), and nutritional risk between dysphagic individuals with and without Parkinson's disease. METHOD: This is a cross-sectional retrospective study based on data collected from medical records. It included 54 dysphagic older adults, divided into two groups according to the diagnosis of Parkinson's disease. The study collected data on the speech-language-hearing assessment of postural control, tongue mobility and strength, maximum phonation time (MPT), and cough efficiency. Oral status was assessed using the number of teeth and the Eichner Index. The level of oral intake and pharyngeal signs of dysphagia were analyzed with four food consistencies, according to the International Dysphagia Diet Standardization Initiative classification, using fiberoptic endoscopic evaluation of swallowing, for comparison between groups. The severity of pharyngeal residues was analyzed and classified with the Yale Pharyngeal Residue Severity Rating Scale, and the nutritional risk was screened with the Malnutrition Screening Tool. RESULTS: The group of older adults with Parkinson's disease was significantly different from the other group in that they had fewer teeth, unstable postural control, reduced tongue strength, reduced MPT, weak spontaneous coughing, pharyngeal signs, less oral intake, and nutritional risk. CONCLUSION: Dysphagic older people with Parkinson's disease had different oral status, swallowing function, and nutritional risk from those without the diagnosis.

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OBJETIVO: Comparar o estado oral, a função de deglutição por meio da avaliação instrumental, fonoaudiológica e do risco nutricional entre indivíduos disfágicos com e sem doença de Parkinson. MÉTODO: Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram incluídos 54 idosos disfágicos divididos em dois grupos, de acordo com a presença do diagnóstico de doença de Parkinson. Foram coletados dados com relação à avaliação fonoaudiológica de controle postural, mobilidade e força de língua, Tempo Máximo de Fonação (TMF) e eficiência da tosse. O estado oral foi avaliado por meio do número de dentes e o Índice de Eichner. Foram analisados o nível de ingestão oral e os sinais faríngeos de disfagia em quatro consistências alimentares, de acordo com a classificação International Dysphagia Diet Standardisation Initiative (IDDSI), por meio da videoendoscopia da deglutição, para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), enquanto que, para rastrear o risco nutricional foi utilizado o Malnutrition Screening Tool (MST). RESULTADOS: O grupo de idosos com doença de Parkinson apresentou diferença significativa em menor número de dentes, controle postural instável, força de língua reduzida, TMF reduzido, tosse espontânea fraca, sinais faríngeos, nível de ingestão oral menor e em risco nutricional, em comparação ao outro grupo. CONCLUSÃO: Os idosos disfágicos com doença de Parkinson apresentaram diferenças no estado oral, na função de deglutição e no risco nutricional em comparação àqueles sem o diagnóstico.

Asunto(s)

Trastornos de Deglución , Deglución , Estado Nutricional , Enfermedad de Parkinson , Humanos , Estudios Transversales , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/complicaciones , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico , Anciano , Masculino , Femenino , Estudios Retrospectivos , Deglución/fisiología , Anciano de 80 o más Años , Salud Bucal , Factores de Riesgo , Desnutrición/diagnóstico , Desnutrición/fisiopatología , Desnutrición/etiología , Persona de Mediana Edad , Estudios de Casos y Controles

RESUMEN

PURPOSE: To investigate the outcomes of fiberoptic endoscopic evaluation of pharyngeal swallowing phase and clinical evaluation of swallowing among dysphagic individuals with and without chronic stroke in different food consistencies. METHODS: This is a cross-sectional and retrospective study based on data collection from medical records. 134 swallowing video endoscopy exams of dysphagic patients were analyzed, in which they were divided into two groups according to the diagnosis of stroke, in which data were collected regarding mobility and strength of the tongue, phonation and cough efficiency, and the pharyngeal signs of dysphagia with four food consistencies from the International Dysphagia Diet Standardization Initiative (IDDSI), for comparison between groups. To analyze and classify the severity of pharyngeal residues, the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) was used by two independent professionals. RESULTS: There was a significant difference in the presence of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration in all consistencies evaluated (level 0, 2, 4 and 7) (p= <0.001), in addition to the association with multiple swallowing in thin liquid, slightly thickened liquid and solid (level 0, 2 and 7) (p= 0.026). CONCLUSION: Dysphagic individuals diagnosed with stroke showed differences in videoendoscope signs of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration, regardless of the food consistency assessed, compared to dysphagic individuals without the diagnosis. Just as there was a difference in the finding of multiple swallowing only in the consistencies of thin liquid, extremely thickened liquid and solid.

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OBJETIVO: Investigar os achados videoendoscópios da fase faríngea da deglutição e da avaliação clínica da deglutição, entre indivíduos disfágicos com e sem AVE crônico em diferentes consistências alimentares. MÉTODO: Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram analisados 134 exames da videoendoscopia da deglutição de pacientes disfágicos, em que foram divididos em dois grupos de acordo com o diagnóstico de AVE, na qual, foram coletados dados com relação à mobilidade e força de língua, fonação e eficiência da tosse, e os sinais faríngeos de disfagia com quatro consistências alimentares do International Dysphagia Diet Standartisation Initiative (IDDSI), para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) por dois profissionais independentes. RESULTADOS: Houve diferença significativa com a presença de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal em todas as consistências avaliadas (nível 0, 2, 4 e 7) (p= <0,001), além da associação com deglutições múltiplas em líquido ralo, líquido levemente espessado e sólido (nível 0, 2 e 7) (p= 0,026). CONCLUSÃO: Os indivíduos disfágicos com diagnóstico de acidente vascular encefálico apresentaram diferença nos sinais videoendoscópios de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal independentemente da consistência alimentar avaliada, em comparação aos indivíduos disfágicos sem o diagnóstico. Assim como houve diferença no achado da deglutição múltipla apenas nas consistências de líquido ralo, líquido extremamente espessado e sólido.

Asunto(s)

Trastornos de Deglución , Accidente Cerebrovascular , Grabación en Video , Humanos , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Estudios Transversales , Estudios Retrospectivos , Masculino , Femenino , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Persona de Mediana Edad , Anciano , Deglución/fisiología , Faringe/fisiopatología , Anciano de 80 o más Años , Índice de Severidad de la Enfermedad , Patología del Habla y Lenguaje/métodos , Adulto

RESUMEN

PURPOSE: Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. METHODS: Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. RESULTS: General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. CONCLUSION: In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.

Asunto(s)

COVID-19 , Enfermedades Cardiovasculares , Trastornos de Deglución , Humanos , COVID-19/complicaciones , Trastornos de Deglución/etiología , Estudios Transversales , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/complicaciones , SARS-CoV-2 , Unidades de Cuidados Intensivos , Adulto , Intubación Intratraqueal , Anciano de 80 o más Años , Hospitalización

Asunto(s)

Trastornos de Deglución , Dermatomiositis , Mordeduras y Picaduras de Insectos , Humanos , Dermatomiositis/complicaciones , Trastornos de Deglución/etiología , Mordeduras y Picaduras de Insectos/complicaciones , Femenino , Masculino , Persona de Mediana Edad

RESUMEN

BACKGROUND: Swallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF). METHODS: Patients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax). RESULTS: The sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea. CONCLUSION: Patients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.

Asunto(s)

Trastornos de Deglución , Deglución , Fibrosis Pulmonar Idiopática , Lengua , Humanos , Masculino , Femenino , Anciano , Fibrosis Pulmonar Idiopática/fisiopatología , Fibrosis Pulmonar Idiopática/complicaciones , Deglución/fisiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/etiología , Persona de Mediana Edad , Lengua/fisiopatología , Pruebas de Función Respiratoria , Presión , Estado Nutricional , Pulmón/fisiopatología , Disnea/fisiopatología , Disnea/etiología , Evaluación Nutricional , Anciano de 80 o más Años

RESUMEN

BACKGROUND: Chagas disease causes digestive anatomic and functional changes, including the loss of the myenteric plexus and abnormal esophageal radiologic and manometric findings. OBJECTIVE: To evaluate the association of abnormal esophageal radiologic findings, cardiac changes, distal esophageal contractions, and complaints of dysphagia and constipation in upper (UES) and lower (LES) esophageal sphincter basal pressure in Chagas disease patients. METHODS: The study evaluated 99 patients with Chagas disease and 40 asymptomatic normal volunteers. The patients had normal esophageal radiologic examination (n=61) or esophageal retention without an increase in esophageal diameter (n=38). UES and LES pressure was measured with the rapid pull-through method in a 4-channel water-perfused round catheter. Before manometry, the patients were asked about dysphagia and constipation and submitted to electrocardiography and chest radiography. RESULTS: The amplitude of esophageal distal contraction decreased from controls to chagasic patients with esophageal retention. The proportion of failed and simultaneous contractions increased in patients with abnormal radiologic examination (P<0.01). There were no significant differences in UES and LES pressure between the groups. UES pressure was similar between Chagas disease patients with cardiomegaly (n=27, 126.5±62.7 mmHg) and those without it (n=72, 144.2±51.6 mmHg, P=0.26). Patients with constipation had lower LES pressure (n=23, 34.7±20.3 mmHg) than those without it (n=76, 42.9±20.5 mmHg, P<0.03). CONCLUSION: Chagas disease patients with absent or mild esophageal radiologic involvement had no significant changes in UES and LES basal pressure. Constipation complaints are associated with decreased LES basal pressure.

Asunto(s)

Enfermedad de Chagas , Trastornos de la Motilidad Esofágica , Esfínter Esofágico Inferior , Manometría , Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad de Chagas/fisiopatología , Enfermedad de Chagas/complicaciones , Esfínter Esofágico Inferior/fisiopatología , Esfínter Esofágico Inferior/diagnóstico por imagen , Estudios de Casos y Controles , Trastornos de la Motilidad Esofágica/fisiopatología , Trastornos de la Motilidad Esofágica/complicaciones , Adulto , Esfínter Esofágico Superior/fisiopatología , Esfínter Esofágico Superior/diagnóstico por imagen , Estreñimiento/fisiopatología , Estreñimiento/etiología , Estreñimiento/diagnóstico por imagen , Anciano , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico por imagen , Presión

RESUMEN

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

Asunto(s)

Gastrectomía , Laparoscopía , Humanos , Femenino , Anciano , Laparoscopía/efectos adversos , Gastrectomía/efectos adversos , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Índice de Severidad de la Enfermedad

RESUMEN

Oncological patients show intense catabolic activity, as well as a susceptibility to higher nutritional risk and clinical complications. Thus, tools are used for monitoring prognosis. Our objective was to analyze the nutrition prognosis of patients who underwent radiotherapy, correlating it with outcomes and complications. We performed a retrospective transversal study based on secondary data from hospital records of patients who started radiotherapy between July 2022 and July 2023. We established Prognostic Scores through a combination of Prognostic Nutritional Index (PNI) and a Subjective Global Assessment (SGA), assessed at the beginning and end of treatment. Score 3 patients, with PNI ≤ 45.56 and an SGA outcome of malnutrition, initially presented a higher occurrence of odynophagia, later also being indicative of reduced diet volume, treatment interruption, and dysphagia. SGA alone showed sensitivity to altered diet volume, dysphagia, and xerostomia in the second assessment. Besides this, PNI ≤ 45.56 also indicated the use of alternative feeding routes, treatment interruption, and hospital discharge with more complications. We conclude that the scores could be used to indicate complications; however, further studies on combined biomarkers are necessary.

Asunto(s)

Desnutrición , Evaluación Nutricional , Estado Nutricional , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Pronóstico , Anciano , Desnutrición/etiología , Desnutrición/diagnóstico , Trastornos de Deglución/etiología , Neoplasias/radioterapia , Radioterapia/efectos adversos , Estudios Transversales , Adulto

RESUMEN

PURPOSE: The aim of this systematic review was to assess the role of hyperbaric oxygen therapy  (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD: A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS: We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION: Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.

Asunto(s)

Trastornos de Deglución , Neoplasias de Cabeza y Cuello , Oxigenoterapia Hiperbárica , Traumatismos por Radiación , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Neoplasias de Cabeza y Cuello/radioterapia , Oxigenoterapia Hiperbárica/métodos , Traumatismos por Radiación/terapia , Traumatismos por Radiación/etiología

RESUMEN

BACKGROUND: The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE: Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING: A retrospective study. METHODS: The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS: In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (ß: 1.62, 95% CI, 0.70-3.17, P < 0.001; ß: -1.24, 95% CI: -1.55--0.92; P < 0.001). CONCLUSION: Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

Asunto(s)

COVID-19 , Trastornos de Deglución , Intubación Intratraqueal , Respiración Artificial , SARS-CoV-2 , Humanos , COVID-19/complicaciones , Trastornos de Deglución/etiología , Trastornos de Deglución/rehabilitación , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Extubación Traqueal/efectos adversos , Adulto , Pandemias , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/rehabilitación , Neumonía Viral/complicaciones , Neumonía Viral/rehabilitación , Betacoronavirus , Factores de Riesgo , Anciano de 80 o más Años

RESUMEN

OBJECTIVE: To understand caregivers' strategies for offering food to older adults with oropharyngeal dysphagia after dehospitalization. METHOD: Qualitative research carried out with caregivers of older adults with oropharyngeal dysphagia, who were discharged after hospitalization at a university hospital in Bahia. Data collection was carried out between January and February 2023 through a semi-structured interview, whose data were organized based on content analysis and analyzed with the help of IRaMuTeQ software. RESULTS: Three categories emerged: Caregivers' strategies for safely offering food to older adults with dysphagia; Caregiver strategies for oral hygiene for older adults; Recognition of continuity of speech therapy after dehospitalization. CONCLUSION: Caregivers' strategies for offering food to older adults with oropharyngeal dysphagia were supported by tacit knowledge and effective care in the hospital-home transition.

Asunto(s)

Cuidadores , Trastornos de Deglución , Investigación Cualitativa , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Femenino , Masculino , Anciano , Persona de Mediana Edad , Higiene Bucal/métodos , Alta del Paciente , Entrevistas como Asunto , Logopedia/métodos , Anciano de 80 o más Años , Hospitales Universitarios , Brasil , Hospitalización

Asunto(s)

Trastornos de Deglución , Grupo de Atención al Paciente , Humanos , Niño , Trastornos de Deglución/prevención & control , Trastornos de Deglución/etiología , Deglución/fisiología , Enfermedades Pulmonares/prevención & control

RESUMEN

Gastrointestinal symptoms and problems (GI- SP) frequently cause discomfort and suffering in pediatric patients with life-threatening and/or life-limiting illnesses (LTI/LLI). Pediatric palliative care (PPC) professionals should be aware of them and perform a comprehensive approach. OBJECTIVE: To determine the prevalence of GI- SP in patients treated in PPC units and to describe the pharmacological and non-pharmacological measures prescribed. PATIENTS AND METHOD: Observational, prospective, multicenter, prospective study in patients with LTI/LLI, seen by PPC teams in Uruguay. The variables analyzed included age, sex, origin, type of LTI/LLI, presence of mucositis, vomiting, swallowing disorders, abdominal pain, constipation, diarrhea, digestive bleeding, problems with digestive prosthesis, and prescribed pharmacological and non-pharmacological treatment. RESULTS: 10 out of 16 PPC teams participated. 96 out of 436 patients seen presented GI- SP (22%). Median age was 4.2 years (1 month-18 years). LTI/LLI: 65% neurological and 7% oncological. The 96 patients had 114 consultations; 50% had 2 or more GI- SP per consultation. GI- SP observed: swallowing disorders (57%), constipation (53%), nausea and/or vomiting (24%), gastrostomy problems (17%), abdominal pain (10%), digestive bleeding (3%), and diarrhea (2%). There were variable prescriptions of pharmacological and non-pharmacological measures; only 50% of those with swallowing disorder received speech and hearing therapy. CONCLUSIONS: GI- SP motivated consultations in all PPC settings, frequently due to 2 or more GI- SP. Swallowing disorders and gastrostomy complications are frequent but not very visible problems in PPC. According to the comprehensive approach, pharmacological and non-pharmacological measures were implemented.

Asunto(s)

Trastornos de Deglución , Enfermedades Gastrointestinales , Niño , Preescolar , Humanos , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Estreñimiento , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Diarrea/epidemiología , Diarrea/terapia , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/terapia , Cuidados Paliativos , Estudios Prospectivos , Vómitos/epidemiología , Vómitos/etiología , Vómitos/terapia , Masculino , Femenino , Lactante , Adolescente

RESUMEN

BACKGROUND: Magnetic ring (MSA) implantation in the esophagus is an alternative surgical procedure to fundoplication for the treatment of gastroesophageal reflux disease. AIMS: The aim of this study was to analyse the effectiveness and safety of magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD). METHODS: A systematic literature review of articles on MSA was performed using the Medical Literature Analysis and Retrieval System Online (Medline) database between 2008 and 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies. RESULTS: A total of 22 studies comprising 4,663 patients with MSA were analysed. Mean follow-up was 27.3 (7-108) months. The weighted pooled proportion of symptom improvement and patient satisfaction were 93% (95%CI 83-98%) and 85% (95%CI 78-90%), respectively. The mean DeMeester score (pre-MSA: 34.6 vs. post-MSA: 8.9, p=0.03) and GERD-HRQL score (pre-MSA: 25.8 vs. post-MSA: 4.4, p<0.0001) improved significantly after MSA. The proportion of patients taking proton pump inhibitor (PPIs) decreased from 92.8 to 12.4% (p<0.0001). The weighted pooled proportions of dysphagia, endoscopic dilatation and gas-related symptoms were 18, 13, and 3%, respectively. Esophageal erosion occurred in 1% of patients, but its risk significantly increased for every year of MSA use (odds ratio - OR 1.40, 95%CI 1.11-1.77, p=0.004). Device removal was needed in 4% of patients. CONCLUSIONS: Although MSA is a very effective treatment modality for GERD, postoperative dysphagia is common and the risk of esophageal erosion increases over time. Further studies are needed to determine the long-term safety of MSA placement in patients with GERD.

Asunto(s)

Trastornos de Deglución , Reflujo Gastroesofágico , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/cirugía , Fundoplicación , Fenómenos Magnéticos

RESUMEN

BACKGROUND: Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE: The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS: This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.

Asunto(s)

Trastornos de Deglución , Deglución , Humanos , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Estudios Retrospectivos , Reproducibilidad de los Resultados , Endoscopía