[Multidisciplinary management of esophageal affections: Two challenging cases]. / Manejo multidisciplinario de la enfermedad esofágica: dos casos complejos.

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.

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.

Profile of oropharyngeal swallowing in healthy Brazilian adults and older adults.

OBJECTIVES: To describe the findings of Fiberoptic Endoscopic Examination of Swallowing (FEES) in asymptomatic young and older adults, comparing results across different age groups. Additionally, this study aims to test the Eating Assessment Tool (EAT-10) as an instrument to identify dysphagia risk. METHODS: A prospective cross-sectional observational analysis was conducted on a sample of individuals aged 20 and above, asymptomatic for dysphagia, stratified by age groups. The EAT-10 questionnaire was completed, and the FEES was employed to assess oropharyngeal swallowing function. Various parameters, including salivary stasis, swallowing reflex trigger, swallowing sequence, residue, penetration, and aspiration were blindly analyzed by two otolaryngologists. RESULTS: A total of 184 participants were included, with a mean age of 44.7 ±â€¯18.5 years. There was good to excellent agreement between examiners for FEES parameters. The EAT-10 score ≥3 suggested dysphagia risk in 7.6% (n = 14) of the sample, with no association with age or any FEES parameter. Individuals aged ≥80 years presented more residue (50%; n = 5/10) compared to younger individuals (11.5%; n = 20/174; p =  0.039). Salivary stasis was found exclusively in individuals aged ≥60 years (n = 5/39; 12.8%; p = 0.027). Age did not influence on the swallowing reflex trigger, swallowing sequence, penetration, and aspiration. Penetration was observed in 4.9% (n = 9) of subjects and aspiration occurred in 0.5% (n = 1) of subjects, with no statistical significance in age groups. CONCLUSION: Age does not have a linear influence on swallowing in healthy adults and elderly people. However, individuals aged ≥80 years showed a higher prevalence of residue, and individuals aged ≥60 years showed a higher prevalence of salivary stasis, suggesting an increased risk or presence of dysphagia. Other FEES parameters were not influenced by age. These findings provide valuable insights into the nuanced dynamics of swallowing across different age groups, emphasizing the importance of age-specific considerations in dysphagia assessment.

Swallowing during provision of helmet ventilation: Review and provisional multidisciplinary guidance.

Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.

Dysphagia Prevalence in Brazil, UK, China, and Indonesia and Dysphagic Patient Preferences.

BACKGROUND: Dysphagia is common, but there is limited information about its prevalence and patient preferences regarding dosage forms (oral solids, liquids, topical, etc.) in Brazil, China, the United Kingdom (UK), and Indonesia. METHODS: We conducted an online survey of 1000 adults from each country, without any required disease, to estimate the prevalence of dysphagia in these four nations and the dosage form preferences among UK patients. RESULTS: A total of 36.9%, 40.5%, 54.9%, and 64.5% from the UK, Indonesia, Brazil, and China, respectively, had an Eating Assessment Tool (EAT-10) score of ≥3 (indicative of dysphagia). Only 2% of UK respondents and 5% of Brazilian respondents reported a formal diagnosis of dysphagia. Indonesian (74%) and Chinese respondents (77%) were more likely than Brazilian (52%) and UK respondents (45%) to report that their swallowing problems affected their ability to adhere to medication instructions. Liquids were the oral medication formulation most preferred by those who reported difficulty swallowing. CONCLUSIONS: To conclude, substantial populations have difficulty swallowing, which can translate into an access issue for medical treatment. The availability of people's preferred dosage forms may help alleviate the adherence issues associated with difficulty swallowing and the concomitant effects on health outcomes.

Chemotherapy/Radiotherapy-Induced Dysphagia in Head and Neck Tumors: A Challenge for Otolaryngologists in Low- to Middle-Income Countries.

Head and neck cancer accounts for 2.8% of all cancers and a large proportion of these patients have a locally advanced stage of the disease, for which chemotherapy and radiation therapy are potentially curative treatments. Dysphagia is one of the most common chemoradiotherapy-related side effects in head and neck cancer since it can lead to life-threatening complications. Reports from the current literature suggest better swallowing outcomes with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3DCT). However, in low-/middle-income countries, multiple healthcare access barriers to 3DCT that may lead to higher rates of chemo/radiotherapy related adverse events. This narrative review provides a comprehensive appraisal of published peer-reviewed data, as well as a description of the clinical practice in an otolaryngology referral center in Colombia, a low-income country.

Physiology and Execution of Swallowing Maneuvers in 3D Videos: Integrating the Technology into Patient Care.

Educational technologies have proven to be an effective way to guide and educate patients, allowing them to increase awareness of their dysphagia condition and how treatment will help them. In this sense, this study aimed to develop and validate the content and appearance of 3D iconographic videos, which addressed the physiological demonstration and execution of protective and facilitating swallowing maneuvers, as well as verifying the feasibility of its use in teleconsultation, having adults and elderly people with oropharyngeal dysphagia as the main target audience. The development of the 3D videos was elaborated based on a guiding scientific script, constructed from an integrative literature review. After the development of the 3D videos by the digital designer, a committee of 12 expert judges evaluated the material produced to validate the content and appearance where a minimum agreement index of 0.8 among the judges was considered satisfactory. Subsequently with the validated material, the proof of concept was conducted together with the target population of 10 dysphagic patients through individual teleconsultation via Google Meet platform. After the teleconsultation, patients responded to a Google Forms questionnaire, analyzing the videos presented. From the integrative literature review, 29 studies that contained relevant information about the physiological effects caused by swallowing maneuvers were selected. Based on this information, the scientific script was created, allowing a detailed description of the physiological events that occurred during swallowing while executing the maneuvers. With the finished script, 3D videos of swallowing maneuvers were produced. After developing the material, the committee of expert judges validated the content and appearance. The twelve items that had an agreement index below 0.8 were adjusted. Once the adjustments were completed, the videos were analyzed again, obtaining approval from the judges, and ensuring the validation of content and appearance of the material developed. A proof of concept was conducted on ten dysphagic patients. The maneuver applied was chosen according to the patient's physiological changes, causing only 4 of the 9 maneuvers to be tested, as the patients did not demonstrate changes in swallowing that would justify the use of the other maneuvers. After this, patients answered a form in which all items covered received positive evaluations, related to both ease of understanding and learning. This study allowed the development of the 3D videos with a didactic demonstration of the physiology and execution of protective and facilitating swallowing maneuvers, in addition to having its content and appearance validity assured through analysis by the committee of expert judges.

Esophageal achalasia: A case report in an adolescent. / Acalasia esofágica: a propósito de un caso en una adolescente.

Esophageal achalasia is an uncommon disease in pediatrics. With an insidious clinical presentation, diagnosis is delayed. Here we describe a case of esophageal achalasia in a 16-year-old girl, with the typical delay in consultation and diagnosis. Although pneumatic balloon dilatation has been described as the best therapeutic option for type II achalasia, it was ineffective in our patient and she required Heller extramucosal myotomy with gastroesophageal fundoplication for reflux.

La acalasia esofágica es una patología infrecuente en la edad pediátrica. Su presentación clínica es insidiosa, lo que causa un retraso en el diagnóstico. Se presenta un caso de acalasia esofágica en una niña de 16 años, que tuvo la demora característica en la consulta y el diagnóstico. A pesar de que se describe la dilatación neumática con balón como la mejor opción terapéutica para la acalasia tipo II, en nuestra paciente fue inefectiva y requirió miotomía extramucosa de Heller con funduplicatura gastroesofágica antirreflujo.

Exploring the Impact of Amyotrophic Lateral Sclerosis on Otolaryngological Functions.

IMPORTANCE: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive degeneration of upper and lower motor neurons at the spinal or bulbar level. OBJECTIVE: We aim to describe the most frequent otolaryngology (ORL) complaints and voice disturbances in patients with bulbar onset ALS. DESIGN: Retrospective cohort study. SETTING: Single-center study with combined ORL and ALS clinic evaluation. PARTICIPANTS: Patients with a confirmed diagnosis of ALS following an ORL visit and who underwent comprehensive voice assessments between January 2021 and January 2023. EXPOSURE: Objective voice assessments. MAIN OUTCOMES AND MEASURES: Glottal functional index (GFI), voice handicap index (VHI), reflux system index (RSI), and voice quality characteristics such as shimmer, jitter, maximum phonation time (MPT), and other essential parameters were assessed. RESULTS: One hundred and thirty-three patients (age 62.17 ± 10.79, 54.48% female) were included. Three patients were referred from the ORL department to the ALS clinic. The most frequent symptoms were; dysphagia, dysarthria, facial weakness, pseudobulbar affect, and sialorrhea. The mean of forced vital capacity was 59.85%, EAT-10 15.91 ± 11.66, RSI 25.84 ± 9.03, GFI 14.12 ± 5.58, VHI-10 42.81 ± 34.94, MPT 15.22 s ± 8.06. Many patients reported voice impairments mainly related to spastic dysarthria and the combination of lower and upper motor neuron dysarthria, hypernasality, reduced verbal expression, and articulatory accuracy. Shimmer was increased to 8.46% ± 7.20, and jitter to 2.26% ± 1.39. CONCLUSIONS AND RELEVANCE: Based on our cohort, this population with bulbar onset ALS has a higher frequency of voice disturbance characterized by hypernasality, spastic dysarthria, and reduced verbal expression. LEVEL OF EVIDENCE: Level 3.

Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia.

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

Surgical approach with minimally invasive intervention in lusoria dysphagia.

The lusoria artery has a prevalence of 0.5-2% in the general population. The abnormal development of the aortic arch forms vascular rings around the trachea and esophagus, causing pressure on them and leading to characteristic symptoms such as chest pain, difficulty breathing, and/or swallowing. Conventionally, only the subclavian artery was severed to release the esophagus, as done in neonates. However, this can lead to long-term hypotrophy of the thoracic limb. The surgical intervention remains controversial, with limitations, and it is only to be performed when the patient presents with symptoms. In the following two cases, a two-stage minimally invasive approach is described: first, a left lateral minithoracotomy for lusoria artery sectioning, and second, a supraclavicular approach for reimplantation into the right carotid artery.

La arteria lusoria tiene una prevalencia del 0.5% al 2% en la población general. Se trata de un arco aórtico izquierdo con arteria subclavia derecha aberrante, resulta de la regresión del cuarto arco derecho y la aorta dorsal derecha proximal. La anormalidad del desarrollo del arco aórtico forma anillos vasculares alrededor de la tráquea y el esófago ocasionando una presión hacia ellos y dar clínica característica de dolor torácico, dificultad para la respiración y/o deglución. Tradicionalmente solo seccionábamos la subclavia para liberar el esófago como se realiza en la edad neonatal, sin embargo, esto puede condicionar hipotrofia del miembro torácico a largo plazo. La intervención quirúrgica sigue siendo controvertida, con limitaciones y se decide realizarse cuando el paciente presenta sintomatología. En este reporte de dos casos se describe un abordaje por incisiones mínimamente invasiva en dos tiempos: primero por mini toracotomía lateral izquierda para sección de la arteria lusoria; segundo abordaje supraclavicular para reimplantación en la carótida derecha.

Feeding practices and weight status of children with congenital Zika syndrome: A longitudinal study in Brazil.

OBJECTIVE: The objective of this study was to describe feeding practices and weight status in a cohort of children with congenital Zika syndrome (CZS) in northeastern Brazil. METHODS: This longitudinal study of children with CZS (N = 156) included data collection on child feeding practices and weight status at five timepoints between 2018 and 2022. The average age of the children was 32.1 months at enrollment and 76.6 months at the fifth assessment. Multilevel models, with repeated observations nested within children, were used to estimate time-related differences in each outcome. RESULTS: Use of enteral feeding, such as gastrostomy, increased from 19.2% to 33.3% over 4 years (p < .001). Among children who did not exclusively use an enteral feeding method, the percentage experiencing at least one dysphagia-associated behavior, such as coughing or gagging, increased from 73.9% to 85.3% (p = .030) while consuming liquids and from 36.2% to 73.5% (p = .001) while consuming solids. Based on weight-for-age z-scores, the percentage of children who were moderately or severely underweight increased from 42.5% to 46.1% over the 4 years but was not statistically significant. Children exclusively using an enteral feeding method had significantly decreased odds of being underweight at assessments 3, 4, and 5. CONCLUSIONS: These data highlight the ongoing and increasing challenges of feeding young children with CZS. Our findings elucidate the physiological reasons children with CZS may be underweight and point to intervention targets, such as enteral feeding, to improve their feeding practices.

Disfagia no Transtorno do Espectro Autista (TEA): uma revisão integrativa / Dysphagia in Autism Spectrum Disorder (ASD): An integrative review / Disfagia en el trastorno del espectro autista (TEA): una revisión integradora

Introdução: O Transtorno do Espectro Autista (TEA) é um distúrbio do neurodesenvolvimento caracterizado por déficits na comunicação social, alterações de sensibilidade e dificuldades alimentares.Objetivo: Realizar uma revisão integrativa das alterações de deglutição em indivíduos com TEA.Métodos: A pesquisa foi realizada por meio de uma busca por artigos nacionais e internacionais, utilizando descritores para a pesquisa, bem como critérios de inclusão e exclusão para a seleção da amostra final. A estratégia PPOT foi utilizada para definir critérios de elegibilidade, incluindo população (crianças e adultos), preditor (diagnóstico de TEA), desfecho (relato ou diagnóstico de disfagia oral, faríngea ou esofágica) e tipo de estudo (estudos observatórios). A busca foi realizada no período de junho a agosto de 2023, nas bases de dados: Pubmed, Scopus, Embase e Google Scholar. Resultados: Foram selecionados dez estudos com pacientes diagnosticados com TEA que relataram sintomas de disfagia orofaríngea e esofágica, além de queixas sobre ingestão alimentar. Os estudos sugerem que crianças com TEA podem apresentar algum problema de disfunções motoras orais, frequência alimentar inadequada, padrões alimentares obsessivos, apresentação específica de determinados alimentos, seletividade alimentar e dificuldades de processamento sensorial. Conclusão: Conclui-se que não há evidências científicas robustas sobre a presença de disfagia em pacientes com TEA. (AU)

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, changes in sensitivity and eating difficulties. Objective: To carry out an integrative review of swallowing changes in individuals with ASD. Methods: The research was carried out through a search for national and international articles, using descriptors for the research, as well as inclusion and exclusion criteria for selecting the final sample. The PPOT strategy was used to define eligibility criteria, including population (children and adults), predictor (ASD diagnosis), outcome (report or diagnosis of dysphagia oral, pharyngeal or esophageal), and study type (observatory studies). The search was carried out from June to August 2023, in the databases: Pubmed, Scopus, Embase and Google Scholar. Results: Ten studies were selected with patients diagnosed with ASD who reported symptoms of oropharyngeal and esophageal dysphagia, in addition to complaints about food intake. Studies suggest that children with ASD may present problems with oral motor dysfunction, inadequate eating frequency, obsessive eating patterns, specific presentation of certain foods, food selectivity and sensory processing difficulties. Conclusion: It is concluded that there is no robust scientific evidence about the presence of dysphagia in patients with ASD. (AU)

Introducción: El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo caracterizado por déficits en la comunicación social, cambios en la sensibilidad y dificultades alimentarias. Objetivo: Realizar una revisión integradora de los cambios en la deglución en individuos con TEA. Métodos: La investigación se realizó mediante una búsqueda de artículos nacionales e internacionales, utilizando descriptores para la investigación, así como criterios de inclusión y exclusión para la selección de la muestra final. La estrategia PPOT se utilizó para definir los criterios de elegibilidad, incluida la población (niños y adultos), el predictor (diagnóstico de TEA), el resultado (informe o diagnóstico de enfermedad oral, faríngea o esofágica) y el tipo de estudio (estudios observatorios). La búsqueda se realizó de junio a agosto de 2023, en las bases de datos: Pubmed, Scopus, Embase y Google Scholar. Resultados: Se seleccionaron diez estudios con pacientes diagnosticados de TEA que refirieron síntomas de disfagia orofaríngea y esofágica, además de quejas sobre la ingesta de alimentos. Los estudios sugieren que los niños con TEA pueden presentar problemas de disfunción motora oral, frecuencia inadecuada de alimentación, patrones alimentarios obsesivos, presentación específica de ciertos alimentos, selectividad alimentaria y dificultades en el procesamiento sensorial. Conclusión: Se concluye que no existe evidencia científica robusta sobre la presencia de disfagia en pacientes con TEA. (AU)

Formulaciones de almuerzos con textura modificada para personas disfágicas, a partir de materias primas dominicanas / Modified texture lunch formulations for dysphagic people, from Dominican raw materials

Introducción: La disfagia es una condición que afecta la eficiencia de la deglución de los alimentos. Mundialmente, una tercera parte de los ancianos padece de algún grado de disfagia, representando un alto riesgo de malnutrición debido a que las carentes opciones alimenticias destinadas a este público no satisfacensus requerimientos nutricionales. Objetivo: Esta investigación tuvo como objetivo desarrollar formulaciones de almuerzos con textura modificada para pacientes con disfagia, a partir de materias primas típicas dominicanas. Materiales y métodos: Se realizaron dos almuerzos de diferentes composiciones [sancocho (S) y arroz con habichuelas y carnes (AHC)] y viscosidades (néctar: 51-350 mPa.s; miel: 351-1,750 mPa.s y pudín: 1,751- 2,500 mPa.s), a los cuales se les evaluó el análisis químico aproximado y la aceptación sensorial. Se utilizó un diseño completamente al azar, bajo arreglo factorial (2 x 3). Resultados: Se evidenciaron diferencias entre las medias de los tratamientos (p<0.05) para el contenido de humedad y de carbohidratos en relación con las composiciones; el análisis por viscosidades presentó diferencias en el contenido de humedad, grasa, proteínas y carbohidratos, en cuanto a la interacción entre las composiciones y las viscosidades hubo similitudes estadísticas en el porcentaje de cenizas y grasas. Se encontró que los tratamientos más viscosos y la composición S fueron mejor valorados y que el desempeño sensorial global de los almuerzos fue satisfactorio. Conclusiones: El alimento (tipo crema) con materias primas dominicanas, sensorialmente aceptado, podría ser utilizado y también aceptado, en pacientes con disfagia(AU)

Introduction: Dysphagia is a condition that affects the efficiency of food swallowing. Globally, one-third of the elderly population suffers from some degree of dysphagia, representing a high risk of malnutrition due to the lack of dietary options tailored to their nutritional requirements. Objective: This research aimed to develop modified texture lunch formulations for dysphagia patients using typical Dominican raw materials. Materials and methods: Two lunches of different compositions [sancocho (S) and rice with beans and meat (AHC)] and viscosities (nectar: 51-350 mPa.s; honey: 351-1,750 mPa.s and pudding: 1,751-2,500 mPa.s) were made and evaluated for proximate chemical analysis and sensory acceptance. A completely randomized design was used, under factorial arrangement (2 x 3). Results: Differences were observed between treatment means (p<0.05) for moisture and carbohydrate content concerning compositions; viscosity analysis showed differences in moisture, fat, protein, and carbohydrate content, while compositional and viscosity interactions exhibited statistical similarities in ash and fat percentage. It was found that the more viscous treatments and composition S were better rated, and overall sensory performance of the lunches was satisfactory. Conclusions: The food (cream type) with Dominican raw materials, sensorially accepted, could be used and also accepted in patients with dysphagia(AU)

Diagnostic differences in high-resolution esophageal motility in a large Mexican cohort based on geographic distribution.

High-resolution esophageal manometry [HRM] has become the gold standard for the evaluation of esophageal motility disorders. It is unclear whether there are HRM differences in diagnostic outcome based on regional or geographic distribution. The diagnostic outcome of HRM in a diverse geographical population of Mexico was compared and determined if there is variability in diagnostic results among referral centers. Consecutive patients referred for HRM during 2016-2020 were included. Four major referral centers in Mexico participated in the study: northeastern, southeastern, and central (Mexico City, two centers). All studies were interpreted by experienced investigators using Chicago Classification 3 and the same technology. A total of 2293 consecutive patients were included. More abnormal studies were found in the center (61.3%) versus south (45.8%) or north (45.2%) P < 0.001. Higher prevalence of achalasia was noted in the south (21.5%) versus center (12.4%) versus north (9.5%) P < 0.001. Hypercontractile disorders were more common in the north (11.0%) versus the south (5.2%) or the center (3.6%) P.001. A higher frequency of weak peristalsis occurred in the center (76.8%) versus the north (74.2%) or the south (69.2%) P < 0.033. Gastroesophageal junction obstruction was diagnosed in (7.2%) in the center versus the (5.3%) in the north and (4.2%) in the south p.141 (ns). This is the first study to address the diagnostic outcome of HRM in diverse geographical regions of Mexico. We identified several significant diagnostic differences across geographical centers. Our study provides the basis for further analysis of the causes contributing to these differences.

Tongue pressure is a strong predictor of recommendation for gastrostomy in amyotrophic lateral sclerosis.

INTRODUCTION/AIMS: Objective and practical biomarkers to determine the need for gastrostomy in patients with amyotrophic lateral sclerosis (ALS) are lacking. Tongue pressure (TP) is a promising biomarker because it is associated with bulbar dysfunction. The aims of this study were to evaluate the association of TP with the need for gastrostomy, and to determine its optimal cut-off value. METHODS: This prospective observational study included participants with ALS taking nutrition orally. TP was evaluated using the Iowa Oral Performance Instrument. Need for gastrostomy as determined by a multidisciplinary team during a 12-month follow up period was recorded. Associations between TP and need for gastrostomy placement were performed. ROC curve analysis determined the optimal cut-off value of TP to predict gastrostomy. RESULTS: Of 208 screened participants, 119 were included. Gastrostomy was indicated in 45% (53), in a 12-month follow up period. TP of ≤20 kPA was a strong predictor of gastrostomy indication (OR 11.8, CI 95% [4.61, 34.7], p < .001). The association persisted even after adjustment for weight loss, pneumonia, prolonged feeding duration, Revised ALS Functional Rating Scale score, and American Speech-Language-Hearing Association scale score (OR 4.51, CI 95% [1.50, 14.9], p = .009). By receiver operating characteristic curve analysis, 20 kPA represented the optimal cut-off value (sensitivity 0.75, specificity 0.89). DISCUSSION: TP is a strong independent predictor of gastrostomy indication in the subsequent 12 months in patients with ALS, with good sensitivity and specificity at a cutoff value of ≤20 kPA, suggesting that it may be a promising biomarker in clinical practice.

The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review.

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.

Brief Resolved Unexplained Events Symptoms Frequently Result in Inappropriate Gastrointestinal Diagnoses and Treatment.

OBJECTIVE: To determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE). STUDY DESIGN: We performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication. RESULTS: Presenting symptoms were varied in 157 subjects enrolled at 51.0 ± 5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD, and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, P = .04). CONCLUSIONS: Presenting symptoms may play a role in clinicians' decisions on which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of GERD explanatory diagnoses that is associated with increased acid suppression medication use.

Cross-Cultural Adaptation and Validation of the Persian Version of the M. D. Anderson Dysphagia Inventory.

Introduction Dysphagia is a common issue in patients with head and neck cancer (HNC) and is known to negatively impact their quality of life. To evaluate the impact of dysphagia on the quality of life of HNC patients, the M. D. Anderson Dysphagia Inventory (MDADI) questionnaire was developed. Objective The present study aimed to culturally adapt and validate the MDADI for Persian-speaking individuals. The MDADI is a self-administered questionnaire designed to assess the impact of dysphagia on the quality of life of HNC patients. Methods The original MDADI questionnaire was translated into Persian using the forward-backward method, following the guidelines of the World Health Organization (WHO) for cultural adaptation. The content validity of the Persian version, MDADI-P, was assessed by 10 speech-language pathologists using the content validity index (CVI). Seventy-five HNC patients completed the MDADI-P to evaluate its convergent validity, which was determined by comparing the results with the Short-Form 36 (SF-36) questionnaire. Internal consistency and test-retest reliability were assessed using Cronbach α coefficient and intraclass correlation (ICC), respectively. Results The scale content validity index (S-CVI) for the MDADI-P was 0.90, indicating good content validity. The MDADI-P demonstrated satisfactory internal consistency (Cronbach α coefficient = 0.728) and test-retest reliability (ICC = 0.91). The total MDADI-P score exhibited a significant correlation with the physical and mental components of the SF-36 (0.456 and 0.349, respectively, p < 0.05). Conclusion The findings of the present study confirm the suitability of the MDADI-P in terms of content validity, construct validity, internal consistency, and test-retest reliability.

Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis.

Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.

Risk of dysphagia in a population of infants born preterm: characteristic risk factors in a tertiary NICU

Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.