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OBJECTIVES@#At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke.@*METHODS@#From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function.@*RESULTS@#In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05).@*CONCLUSIONS@#BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.
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Humans , Deglutition Disorders/therapy , Esophageal Achalasia/drug therapy , Dilatation/adverse effects , Botulinum Toxins, Type A/therapeutic use , Brain Stem Infarctions/drug therapy , Treatment OutcomeABSTRACT
Objective@#To evaluate the motility of the esophagus while swallowing of brainstem stroke survivors.@*Methods@#Eighteen patients and 10 healthy subjects were included in the study. There was no significant difference in average age, gender, weight or body mass index between the two groups. All underwent high-resolution esophageal manometry to assess esophageal motility while swallowing, and they were rated using the version 3.0 of the Chicago classification.@*Results@#Fourteen of the 18 stroke survivors displayed abnormal esophageal dynamics (77.8%), compared with only 10.0% of the healthy control group, but that difference was not statistically significant. The typical abnormalities were a lack of contraction, high pressure contractile esophagus, gastroesophageal junction outflow obstruction and/or distal esophageal spasm. Compared with the control group, the average resting pressure of the patients′ upper esophageal sphincters (UESs) was significantly lower, while the UES residual pressure and integrated relaxation pressure of their lower esophageal sphincters (LESs) were higher and the average UES relaxation time was significantly shorter. No significant differences were found in the LES resting pressures, distal contractile integrals or the distal latency between the two groups.@*Conclusions@#Abnormal esophageal motility is highly prevalent in brainstem stroke survivors and due attention should be paid to it. High-resolution manometry can be used to assess this condition.
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Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke.Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter (UES) dysfunction were recruited and randomly divided into a dilatation group and a control group,each of 15.The control group was given the routine swallowing therapy twice daily,while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily.The treatment lasted 3 weeks,30min per day and 5 days per week.Both groups were evaluated using the bilateral submental motor evoked potentials (SMEPs),penetration-aspiration scale (PAS) and functional oral intake scale (FOIS) before and after treatment.Results Repeated analysis of variance showed that there was significant interaction effect of group,time on SMEPs.The MEPs of the affected submental muscle increased significantly in both groups after treatment (P＜0.01),but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment (P＜0.05).In the dilatation group,the average FOIS score increased significantly (P＜0.01),while the average PAS score decreased significantly after the treatment (P＜0.05).An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score (P＜0.01,r=0.815),but weakly correlated with the average FOIS score (P =0.02,r =0.43).Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke,which might be more correlated with improvement in swallowing safety.
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Objective To explore after brainstem stroke patients with dysphagia by modified balloon dilation of the clinical effect of treatment and before and after the treatment in patients with pharyngeal function change by swallowing angiog -raphy digital analysis method for analysis and evaluation .Methods 60 patients with dysphagia after collection of brainstem stroke in our hospital were randomly divided into two groups .Control group (30 cases) underwent routine dysphagia rehabili-tation training in the treatment , and the observation group of 30 cases in the control group on the basis of the treatment added with balloon dilatation for treatment .Comparative analysis of pharyngeal contraction rate ( PCR) and pharyngeal contraction time between two groups before and after treatment were assessed by swallowing and digital measurement .Results There was no significant differences in PCR between two groups of patients before treatment ( P>0.05 ) .Compared with before treat-ment, the two groups of patients after treatment with different food PCR were significantly improved , and the difference was statistically significant (P0.05).Com-pared with before treatment and after treatment in two groups of patients with different swallowing food pharyngeal contraction duration were significantly improved , and the difference is statistically significant ( P<0.05 ) and to improve the degree of the observation group compared with the control group is more significant ( P<0.05 ) .Conclusion The digital analysis technology of swallowing angiography can effectively evaluate the changes of pharyngeal function in patients with dysphagia af -ter stroke.It is worth to be further popularized .
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Objective To observe the therapeutic efficacy of electrical stimulation and balloon dilatation in treating cricopharyngeal achalasia after a brainstem stroke.Methods Thirty dysphagia patients with cricopharyngeal achalasia after a brainstem stroke were randomly divided into an experimental group and a control group, each of 15.The experimental group was given real-time electrical stimulation and balloon dilatation, while the control group was treated using common electrical stimulation and balloon dilatation.Results Twenty-six patients in the 2 groups returned to oral feeding after treatment.Videofluoroscopy revealed that the cricopharyngeal sphincter had relaxed and the food passed successfully when swallowing.No aspiration was observed.There was no significant difference in swallowing between the two groups, but the average treatment time, days of treatment and cost of therapy in the experimental group were significantly less than in the control group.Conclusions Either real-time electrical stimulation or common electrical stimulation combined with balloon dilatation can treat dysphagia effectively, but the former can shorten the course of treatment and lower its cost.
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Objective To explore the effects of modified balloon dilatation therapy for treating upper esophageal sphincter dysfunction after a brainstem stroke.Methods Ten healthy adult volunteers and 20 dysphagic patients with upper esophageal sphincter dysfunction after a brainstem stroke were recruited.The 20 patients were divided into a balloon dilatation therapy group of ten who were treated with catheter balloon dilatation therapy, and a control group of ten who received conventional therapy.All were given block-designed task fMRI scans guided by a matched visual presentation system before and after the treatment.Results Widespread activation was observed in both hemispheres, including the bilateral cerebral cortex, the brainstem and the cerebellum, but the activated areas were significantly smaller in the stroke patients before treatment.After the treatment, seven patients in the balloon dilatation group were totally orally fed, while only three patients in the control group recovered totally oral intake.After dilatation, significantly more regions were activated, including the anterior cingulate, insula, supplementary motor area, precuneus and the frontal lobe.They were activated with relatively low voxels in the treatment group, while in the control group significant activation was observed only in the precuneus after treatment.Conclusion Modified balloon dilatation therapy can increase activation of the cortex and subcortical structures related to swallowing, promoting better swallowing function.
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Objective To observe the therapeutic effects of balloon dilatation with ice water and room temperature water on cricopharyngeal achalasia after brainstem stroke.Methods Forty dysphagic patients with cricopharyngeal achalasia after brainstem stroke were recruited.Twenty patients assigned to experimental group were treated by balloon dilatation with ice water and low frequency elecrtrical stimulation.Twenty patients assigned to control group were treated by balloon dilatation with room temperature water and low frequency electrical stimulation.Results After treatment,36 out of the 40 patients of the two groups could eat pasty food independently without choking.Videofluoroscopic swallowing study (VFSS) showed that the cricopharyngeal sphincter relaxed and the foods passed successfully when swallowing bolus,and no aspiration happened.In comparison,the level of cricopharyngeal opening,the number of patients with nasogastric tube remained and eating normally,and the scores of functional oral intake scale (FOIS) between the two groups showed no significant difference (P ＞ 0.05).The average treatment sessions,average hospitalization days and average treatment cost in treatment group were significantly less than those in the control group(P ＜0.05).Conclusion Cricopharyngeal achalasia can be treated effectively by balloon dilatation with ice water or with room temperature water combined with low frequency electrical stimulation,but treatment course of balloon dilatation with ice water were significantly shorter than that of balloon dilatation with room temperature water.