The gastroenterologist's approach to dysphagia

In the gastroenterological diagnostic armamentarium, dysphagia is considered as an important symptom for diseases of the esophagus. Concerning the history of illness, symptoms such as retrosternal pain and heartburn are often associated with gastroesophageal reflux disease. Morphological changes of the mucosa can be diagnosed by flexible endoscopy and radiographic examinations. Investigation with 24-h pH monitoring, manometry, and pharmacological tests is necessary for the diagnosis of functional disorders. Additionally, dysphagia can be associated with multiple internal diseases, including muscular diseases such as dermatomyositis, progressive systemic sclerosis, as well as lupus erythematosus. Difficulties in swallowing associated with hypo- and hyperthyrodism can also be interpreted as muscular lesions. Metabolic disorders such as alcoholism, and diabetes mellitus can be the cause of dysphagia. Increasing importance in the differential diagnosis of dysphagia is attached to infections of the upper GI tract. Especially in immunocompromised patients, infections ofCandida albicans, mycobacterias, herpes, varicella zoster, and cytomegaloviruses can produce dysphagia and odynophagia. The differential diagnosis of the angina-like chest pain has to differentiate between cardiac disease and a noncardiac genesis. Therefore, besides the cardiac diagnostic investigation, endoscopy, radiography, and manometry are often indicated.     

Evaluating Swallowing Dysfunction Using a 100-ml Water Swallowing Test

This study used comparison with videofluoroscopic examination of swallowing (VFES) to examine the validity of a 100-ml water swallowing test (WST) in assessing swallowing dysfunction. Fifty-nine consecutive outpatients (15 females, 44 males) with clinically suspected dysphagia were enrolled in this study. Each subject underwent a 100-ml WST followed by VFES. Data was obtained on swallowing speed and signs of choking (coughing and a wet-hoarse voice). The analytical results revealed that 49 subjects had abnormal swallowing speeds (< 10 ml/s) in the 100-ml WST, and 47 of them were identified as having dysphagia by VFES. Among the ten participants with normal swallowing speed (> 10 ml/s), eight were diagnosed with dysphagia by VFES. Notably, 14 participants choked in the 100-ml WST, 11 of whom exhibited aspiration or penetration in VFES. Among the 45 participants without choking in WST, 12 displayed aspiration or penetration in VFES. The sensitivity of swallowing speed in detecting the swallowing dysfunction was 85.5%, and the specificity was 50%. Moreover, the sensitivity of using choking or wet-horse voice in the 100-ml WST as the sole factor for predicting the presence of aspiration was 47.8%, while the specificity was 91.7%. Therefore, this study concluded that swallowing speed is a sensitive indicator for identifying patients at risk for swallowing dysfunction. Moreover, choking in the 100-ml WST may be a potential specific indicator for followup aspiration.     

Dysphagia caused by diffuse idiopathic skeletal hyperostosis

Summary Diffuse idiopathic skeletal hyperostosis (DISH) of the spine is often a hazardous radiological finding. Dysphagia, caused by ossification of the anterior longitudinal ligament, may be one of the most important clinical symptoms disturbing the patient. Diagnosis is done by esophagogram, and cervical decompression restores esophageal function. The case of a successfully operated patient is reported and a short overview of the literature is given.     

脑卒中吞咽障碍患者预后和住院费用相关性的回顾性研究

目的探讨吞咽障碍与脑卒中患者预后和住院费用之间的相关性。方法选取于潍坊市3家公立医院康复科就诊的脑卒中住院患者1370例, 根据吞咽造影检查结果, 将患者分为吞咽障碍组(499例)和非吞咽障碍组(871例)。收集患者临床资料, 包括病案号、年龄、性别、医保类型、卒中类型、病灶部位、Charlson合并症指数(CCI)等。采用二元Logistic回归和多重线性回归模型分析吞咽障碍与肺炎发生情况、改良Rankin量表(mRS)评分、改良Barthel指数(MBI)、住院时长、住院总费用之间的相关性。结果本研究纳入脑卒中患者的吞咽障碍发生率为36.42%。校正混杂因素后, 吞咽障碍组肺炎的发生风险是非吞咽障碍组的2.417倍[OR=2.417, 95%CI(1.902, 3.072), P=0.000]。出院时, 吞咽障碍患者mRS评分≥3分和MBI<60分的风险分别为3.272倍[OR=3.272, 95%CI(2.508, 4.269), P<0.001]和1.670倍[OR=1.670, 95%CI(1.230, 2.268), P<0.001]。多重逐步线性回归结果...     

间歇经口管饲法在痴呆所致吞咽障碍患者中的应用

目的 观察痴呆合并吞咽障碍患者采用间歇经口管饲法（IOE）的临床疗效。 方法 选取痴呆所致吞咽障碍患者60例,按照随机数字表法将其分为IOE组和鼻饲（NGT）组,每组30例。2组患者均给予常规治疗,其中IOE组采用IOE进食,NGT组采用经鼻管饲进食。入院24 h和治疗30 d后,评估患者的吞咽功能和营养状况;管饲24 h内及第10天,比较2组患者的管饲舒适度;对2组患者30 d内的并发症发生率、平均住院天数、平均住院费用进行比较。 结果 治疗前,2组患者营养不足发生情况、营养风险及相关指标、功能性经口摄食量表（FOIS）分级比较,差异无统计学意义（P＞0.05）。与组内治疗前比较,2组患者治疗后的营养不足人数减少、营养风险降低,体重指数（BMI）、血清白蛋白（ALB）、血红蛋白（Hb）、血清前白蛋白（PAB）均改善（P＜0.05）。与NGT组治疗后比较,IOE组治疗后营养不足发生情况、营养风险及相关指标明显改善,差异有统计学意义（P＜0.05）。治疗后,2组患者FOIS分级均较组内治疗前改善（P＜0.05）,且IOE组改善较为显著（P＜0.05）。管饲第30天,IOE组吞咽障碍改善总有效率（90.0%）高于NGT组（70.0%）,差异有统计学意义（P＜0.05）。IOE组管饲舒适度较高、并发症发生率较低,平均住院日及住院费用较少（P＜0.05）。 结论 IOE可以改善痴呆所致吞咽障碍患者的营养状况和吞咽功能,提高生活质量,并能降低并发症的发生率、缩短住院日、减少住院费用。     

心脏术后获得性吞咽障碍患者吞咽功能恢复时间及影响因素研究

目的 探讨心脏术后获得性吞咽障碍患者吞咽功能恢复时间及影响因素,为优化其康复方案提供参考。方法 选取2018年10月—2019年10月就诊于南京市某三级甲等医院的85例心脏术后获得性吞咽障碍患者为研究对象,收集患者一般资料和临床相关资料,以吞咽功能恢复结局及恢复时间为因变量,采用Kaplan'Meier法和Cox比例风险回归分析吞咽功能恢复时间及其影响因素。结果 心脏术后获得性吞咽障碍患者吞咽功能恢复时间为1~12（2.72±1.85） d。多因素Cox比例风险回归分析结果显示,气管插管时间（RR=0.987,P=0.004）和拔管后首次标准吞咽功能评估量表评分（RR=0.828,P＜0.001）影响心脏术后获得性吞咽障碍患者的吞咽功能恢复时间。结论 气管插管时间和拔管后首次标准吞咽功能评估量表评分是心脏术后获得性吞咽障碍患者吞咽功能恢复的影响因素,尚需进一步明确吞咽障碍恢复进程及相关预后指标,从而优化临床实践,改善患者预后结局。     

早期应用吞咽治疗仪治疗脑卒中吞咽障碍的疗效观察与护理

目的分析应用吞咽治疗仪治疗脑卒中吞咽障碍的临床疗效并总结护理要点。方法选取2017年9月-2019年9月我院收治的30例脑卒中吞咽功能障碍患者。按时间先后分为对照组15例及观察组15例。对照组采取综合护理干预,观察组在对照组基础上采取早期应用吞咽治疗仪治疗,比较2组治疗效果。结果治疗护理2周后观察组患者吞咽功能获得明显改善,优于对照组(P<0.05);观察组治疗总有率为93.3%,对照组为66.7%(P<0.05)。结论脑卒中吞咽障碍患者早期给予吞咽治疗仪治疗配合综合护理干预可改善吞咽效果,改善生活质量。