Diffuse idiopathic skeletal hyperostosis: Forestier's disease

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is characterized by calcification and ossification of soft tissue entheses of ligaments and tendons. DISH is believed to be a variant of osteoarthritis (OA) without the degenerative intervertebral disc and joint degenerative qualities seen in classic OA. The likely pathoetiologic causes of DISH are presented.     

帕金森病对吞咽活动的影响

帕金森病是老年人常见的以震颤、肌强直、运动减少和姿势障碍为主要临床症状的神经系统疾病。随着认识的深入,困扰帕金森患者的消化道症状日益得到人们的重视,其中吞咽困难在帕金森患者中尤为常见,但其发病机制仍不十分清楚。深入了解帕金森病吞咽活动的病理生理不仅有助于改善治疗,提高帕金森患者的生活质量,而且对于进一步探索帕金森病的发病机制具有重要的意义。     

Dysphagia in Huntington's disease

Although not the most obvious symptom of Huntington's disease (HD), difficulty swallowing, or dysphagia, is a common symptom and may be associated with fatal complications. Management of dysphagia requires an understanding of the process of normal food ingestion and how this process is impaired in HD. This article describes HD and how it interferes with food intake. An effective nursing approach to the management of dysphagia is presented.     

Dysphagia in stroke and neurologic disease

Dysphagia is a common problem in neurologic disease. The authors describe rates of dysphagia in selected neurologic diseases, and the evaluation and treatment of dysphagia in this population. Applicable physiology and aspects of neural control are reviewed. The decision-making process to determine oral feeding versus alternative means of alimentation is examined.     

Acupuncture for back pain in a patient with Forestier's disease (diffuse idiopathic skeletal hyperostosis/DISH)

Acupuncture was used to treat a 54-year-old man with low back pain and Forestier's disease. His symptoms were markedly improved with acupuncture where other treatments in the form of analgesics, non-steroidal anti-inflammatories, physiotherapy and hydrotherapy had proved ineffective. There would appear to be no cases reported in the literature where medical acupuncture has been used to treat back pain in a patient with this condition.     

Dysphagia

Difficulty in swallowing may result from a motor disorder of the esophagus or an obstructing lesion. Dysphagia for liquids is characteristic of motor disorders, while symptoms on swallowing solid food point to mechanical obstruction. Difficulty initiating a swallow indicates oropharyngeal dysphagia, an abnormality of striated muscle. The major mechanical causes of dysphagia are peptic stricture, esophageal carcinoma and a mucosal ring.     

Dysphagia

Dysphagia indicates an abnormality of pharyngeal or esophageal function due either to a motor abnormality or to organic narrowing of the lumen. As therapy differs for these two types of disorders, the physician's first responsibility is to establish the nature of the abnormality producing dysphagia. If the prognosis of cancer of the esophagus is to be improved, careful attention must be given to early symptoms of dysphagia.     

Dysphagia rehabilitation in Japan

This article describes the features of Japanese dysphagia rehabilitation, particularly where it differs from that in the United States. Many kinds of professionals participate in dysphagia rehabilitation; nurses and dental associates take important roles, and the Japanese insurance system covers that. Videofluorography and videoendoscopy are common and are sometimes done by dentists. Intermittent catheterization is applied to nutrition control in some cases. The balloon expansion method is applied to reduce pharyngeal residue after swallowing. If long-term rehabilitation does not work effectively in dysphagia due to brainstem disorder, the authors consider reconstructive surgery to improve function.     

Dysphagia in the elderly

The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.     

Dysphagia in Older Adults

Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient’s history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.     

Dysphagia in stroke patients

Practice profiles are reflective pieces written by nurses in practice and based on continuing professional development articles. This week Maria Rees discusses stroke and dysphagia. Article no. 489. Davies S (1999) Dysphagia in acute strokes.     

Presbyphagia: Dysphagia in the elderly

Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.