Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication

The aim of this study was to determine whether preoperative physiologic factors can account for and be used to predict the development of postoperative dysphagia after laparoscopic Nissen fundoplication. One hundred sixty-three patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication with a median follow-up of 14 months (range 6 to 81 months). Preoperative dysphagia was present in 37% (60 of 163) and was relieved in all but five patients (92%). Female sex (P = 0.01) and the presence of a stricture (P = 0.02) were the only preoperative variables associated with the presence of preoperative dysphagia. Eight percent (8 of 103) of patients without preoperative dysphagia developed new-onset dysphagia, and of these 63% (5 of 8) had a normal lower esophageal sphincter (LES) (pressure >6 mm Hg; length >2 cm; abdominal length >1 cm). New-onset dysphagia was significantly more common in patients with a normal LES (22% [5 of 23] vs. 4% [3 of 80], P = 001). Patients with a normal LES had almost a sixfold increase in the risk of developing dysphagia as those with an abnormal LES (relative risk = 5.8). Only a preoperative normal LES (P = 0.02) or mean LES pressures (P = 0.04) were positively associated with the development of postoperative dysphagia. The severity of this dysphagia also showed a strong positive trend of increasing with mean preoperative LES pressures (P = 0.07). Finally, preoperative LES pressure significantly correlated with postoperative LES pressure (r = 0.48, P = 0.01) and with mean residual LES (nadir) pressure (r = 0.33, P = 0.05) offering insight into the mechanism of this dysphagia. In conclusion, preoperative LES parameters play a role in the development of dysphagia after laparoscopic Nissen fundoplication. Patients with a normal LES or high mean LES pressures are at increased risk for developing this complication and should be informed of this before laparoscopic Nissen fundoplication. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Ga., May 20–23, 2001.     

Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis

Background contextLarge, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up.PurposeTo study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH).Study designRetrospective review of a case series.Patient sampleFive cases from a University Hospital.Outcome measuresClinical and imagenological follow-up.MethodsThe records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs.ResultsPreoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3–C4 level was involved in three cases, C4–C5 in three cases, and C5–C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes.ConclusionsAlthough rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered.     

Oral sensorimotor therapy: Assessment,efficacy and future directions

This review addresses the current state of knowledge in oral sensorimotor therapy for children with neurological impairments and ingestive problems. Comprehensive assessment of the child with dysphagia looks at the interaction of oral performance and growth. These domains include eating efficiency, oral-motor skills, oral sensory evaluation, classification of the severity of an eating problem, interaction of respiration and ingestion, aspiration, positioning for feeding, social skills assessment, careload and assessment technologies. Oral sensorimotor therapy improves eating but not drinking skills in children 3–12 years of age. Weight gain is sufficient so that children maintain their growth channel but they do not show catchup growth. Many factors thought to contribute to better ingestive performance need further study, such as jaw and lip control in association with drinking. The earliest possible identification of infants at risk for eating impairments needs to be rigorously pursued. Such an approach offers hope that the later growth deterioration now seen in children with eating impairments may be prevented. Finally, the effect of positioning and the use of eating equipment to promote self-feeding need further study.     

Lähmung des N. hypoglossus nach operativem Eingriff – Behandlung mit Akupunktur

Acupuncture is able to accelerate the process of healing significantly when employed in cases of nerve paresis as shown in the following analysis. The patient's constant condition of speech and swallowing impediment before treatment changed relatively fast after starting acupuncture treatment. It is self evident that we took into account the primary disease (AIDS) and its problems. The simplicity of a complementary treatment with acupuncture according to the possible results should make us consider the use of acupuncture as an important way to treat paresis in the early subacute phase and if possible during clinical stay.     

The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9–8.2) and frailty status (OR: 2.3; 95% CI: 1.0–5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.     

吞咽障碍治疗仪穴位刺激治疗假性球麻痹58例

[目的]探讨利用吞咽障碍治疗仪对脑梗塞后假性球麻痹(PBP)患者进行穴位电刺激的治疗作用。[方法]58例脑梗塞后假性球麻痹患者随机分为常规组和观察组,两组均进行早期吞咽康复治疗,同时观察组使用Vitastim吞咽治疗仪对天突、人迎、廉泉、风池、翳风进行穴位电刺激治疗。常规组则用Vitastim吞咽治疗仪进行常规电刺激治疗。治疗28天后评价两组的治疗效果。[结果]观察组总有效率达87.50%,常规组总有效率达73.00%。两组有效率比较有显著性差异(P<0.05)。[结论]脑梗塞后假性球麻痹患者在康复治疗中运用吞咽障碍治疗仪电刺激相关穴位与常规电刺激治疗相比疗效提高更显著。     

针刺康复并用对脑卒中后吞咽障碍的干预研究

[目的]了解针刺配合功能恢复训练治疗对脑卒中并发吞咽障碍的效果。[方法]对住院30例脑卒中合并吞咽障碍的患者,按患者意愿分为治疗组、对照组各15例,治疗组针刺配合功能恢复训练,对照组只配合针刺治疗,评定治疗前后及组间的疗效并进行统计学分析。[结果]平均治疗2个疗程,15例治疗组,显效4例,有效10例,无效1例,总有效率93．33％,治疗前后比较差异有显著性（P〈0．05）;15例对照组,显效2例,有效8例,无效5例,总有效率66．67％,组间比较差异有显著性（P〈0．01）。[结论]针刺配合功能恢复训练治疗脑卒中并发吞咽障碍有较好的疗效。     

试论中风后吞咽障碍与中气的关系

现代医学认为吞咽的过程需要吞咽肌强有力的收缩才能完成。中医虽无吞咽障碍病名,但从脾主肌肉及患者临床表现来看,表明它与中气关系密切。这一认识可为中医药治疗中风后吞咽障碍提供理论依据。     

间歇经口管饲法对脑卒中后吞咽障碍患者营养状况及情绪状态的影响

目的:探讨应用间歇经口置管至食道管饲法干预脑卒中后吞咽障碍患者的营养状况及情绪状态的影响.方法:将符合要求的42例脑卒中后吞咽障碍患者随机分成对照组和观察组,其中对照组22例,观察组20例,对照组给予长期留置鼻饲,观察组予间歇经口置管至食道管饲.治疗前及治疗4周后分别观察2组患者的营养状况及情绪状态,营养状况采用血清总...