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1.
Management of oral antiretroviral administration in patients with swallowing disorders or with an enteral feeding tube.
San, C, Lê, MP, Matheron, S, Mourvillier, B, Caseris, M, Timsit, JF, Wolff, M, Yazdanpanah, Y, Descamps, D, Peytavin, G
Medecine et maladies infectieuses. 2020;(7):537-544
Abstract
HIV infection has evolved into a chronic disease with comorbidities since the combination antiretroviral therapy era. Complications still occur and patients may need to be admitted to an intensive care unit. Acute respiratory failure is the first cause of these admissions, questioning the administration of solid oral dosage formulations. This issue is also observed in geriatric units where the prevalence of dysphagia is high and underestimated. The problem of antiretroviral administration is critical: altered solid oral dosage formulations and/or administration via enteral feeding tubes are sometimes the only option. The aim is to help manage antiretroviral treatment in unconscious or intubated patients and those with swallowing disorders who are hospitalized in intensive care units or geriatric units. This review provides information on the main antiretroviral regimens and on practical and legal aspects of manipulating solid oral dosage formulations and administration via enteral feeding tubes. Alternatives to the solid formulation are available for most of the 27 oral antiretrovirals available, or manufacturers provide recommendations for patients who are unable to swallow. Manipulation of solid oral dosage formulations such as crushing tablets or opening capsules and administration via feeding tubes are frequently reported but should be the last option for safety and liability issues. Before any off-label administration of a drug, physicians should consider alternatives to the solid oral dosage formulation and check whether the drug can be altered. Therapeutic monitoring is important in this particular setting as the pharmacokinetic profile of drugs is difficult to predict.
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2.
Swallowing evaluation with videofluoroscopy in the paediatric population.
Re, GL, Vernuccio, F, Di Vittorio, ML, Scopelliti, L, Di Piazza, A, Terranova, MC, Picone, D, Tudisca, C, Salerno, S
Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2019;(5):279-288
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3.
Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review.
Ghammam, M, Houas, J, Bellakhdher, M, Abdelkefi, M
The Pan African medical journal. 2019;:189
Abstract
Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.
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4.
Overview of eosinophilic oesophagitis.
Attwood, SE
British journal of hospital medicine (London, England : 2005). 2019;(3):132-138
Abstract
Eosinophilic oesophagitis is a disease that has been recognized in the past 30 years. It causes dysphagia and other symptoms of oesophageal dysfunction. Eosinophilic oesophagitis presents either with a chronic feeling of difficulty swallowing, with food moving slowly through the oesophagus, or as an acute food bolus obstruction requiring emergency attention. Patients may also experience chest pain at this time. It is an inflammatory disorder, thought to be driven by food or environmental antigens, where the most distinctive cell type is eosinophils. Eosinophilic oesophagitis is mediated through a local IgG4 mechanism and does not manifest as a systemic disease. It is diagnosed only on endoscopy and biopsy - there are characteristic endoscopic appearances with oedema, rings, furrows and strictures but the golden rule in its diagnosis is to perform multiple biopsies from multiple sites in the oesophagus in all patients with dysphagia or other oesophageal dysfunction. Finding a peak concentration of >15 eosinophils per high power field in this situation is diagnostic of eosinophilic oesophagitis. Eosinophilic oesophagitis is not usually related to gastro-oesophageal reflux disease, but the two conditions may co-exist. Current therapies include topical steroids (oro-dispersible formulation of budesonide), proton pump inhibitors and dietary exclusions. Therapeutic oesophageal dilatation is reserved for refractory symptoms or tight strictures.
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5.
Oesophageal Stents for Potentially Curable Oesophageal Cancer - A Bridge to Surgery?
Tham, JE, Tharian, B, Allen, PB, Spence, G, Tham, TC
The Ulster medical journal. 2019;(1):10-14
Abstract
For oesophageal cancer patients with potentially curative disease, treatment usually comprises neoadjuvant chemoradiotherapy followed by surgery. Several methods are currently used for nutritional support while patients are undergoing neoadjuvant treatment but these do not relieve dysphagia. Stenting as a bridge to curative surgery has been explored in several case series and a case control study. This is a review of the current literature on the topic. Some small series have shown it to be safe and effective in relieving dysphagia and malnutrition without adverse effect on surgical outcomes, perioperative complications or delay in surgical resection post neoadjuvant therapy. However, there are sufficient concerns about its adverse impact on oncological outcomes such as a reduction in the R0 resection rates, median time to recurrence and 2 - 3 year overall survival, to not currently recommend its routine use in resectable cancers.
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6.
The prevalence of oral stage dysphagia in adults presenting with temporomandibular disorders: a systematic review and meta-analysis.
Gilheaney, Ó, Béchet, S, Kerr, P, Kenny, C, Smith, S, Kouider, R, Kidd, R, Walshe, M
Acta odontologica Scandinavica. 2018;(6):448-458
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) are the most commonly experienced non-dental orofacial pain disorders, with pain and dysfunction potentially resulting in oral stage dysphagia (OD). However, limited research has been conducted on this condition, with potential negative effects on clinical practice. Therefore, the aim of this study was to determine the prevalence of OD in adults presenting with TMDs, diagnosed as per the Research Diagnostic Criteria for Temporomandibular Disorders or the Diagnostic Criteria for Temporomandibular Disorders protocols. MATERIAL AND METHODS A systematic review of the literature was completed. Nine electronic databases were searched from inception to January 2017, with no date/language restriction applied. Grey literature, conference proceedings, and reference lists were also searched. Studies presenting original data regarding OD prevalence in adults presenting with TMDs were included if they investigated impaired swallowing, mastication, masticatory pain or fatigue, or weight loss. Study eligibility and quality were assessed by two independent reviewers. Methodological quality was assessed using the Down's and Black tool. RESULTS AND CONCLUSIONS This search yielded 20 eligible studies. Swallowing itself was impaired in only 9.3% of patients with TMDs. A range of additional OD signs and symptoms were also commonly reported (e.g. masticatory pain (87.4%) and fatigue (62%)). Study limitations included the small number of studies which were eligible for inclusion. As signs and symptoms of OD are frequently reported by patients with TMDs, psychometrically robust prospective research is warranted to determine current and optimal management of this condition.
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7.
People with intellectual disabilities and dysphagia.
Robertson, J, Chadwick, D, Baines, S, Emerson, E, Hatton, C
Disability and rehabilitation. 2018;(11):1345-1360
Abstract
PURPOSE Dysphagia (difficulties in eating, drinking or swallowing) is associated with serious health complications and psychosocial sequelae. This review aims to summarise the state of the evidence regarding dysphagia in people with intellectual disabilities (excluding prevalence), identify gaps in the evidence base and highlight future research priorities. METHOD Studies published from 1 January 1990 to 19 July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross citations. Studies were reviewed narratively in relation to identified themes. RESULTS A total of 35 studies were included in the review. Themes identified were as follows: health conditions associated with dysphagia; mortality; health service use; practice and knowledge in supporting people with intellectual disabilities and dysphagia; intervention effectiveness and quality of life. Dysphagia is associated with respiratory infections and choking and may be under-recognised. Silent aspiration is common and may go unnoticed. Management practices exist, but there are few intervention studies and no randomised controlled trials (RCTs), and hence, the effectiveness of these is currently unclear. CONCLUSION Dysphagia is a key concern in relation to people with intellectual disabilities. There is urgent need for research on the management of dysphagia in people with intellectual disabilities, including mealtime support offered, positioning, dietary modification and impact on wellbeing. Implications for Rehabilitation Dysphagia is common in people with intellectual disabilities, associated with serious health risks and may be under-recognised. Caregivers of people with intellectual disabilities should be educated about dysphagia. There is an urgent need for research on improving the management of dysphagia in people with intellectual disabilities. Improved recognition and management of dysphagia may reduce the occurrence of associated health conditions and reduce hospital admissions and premature death in people with intellectual disabilities.
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8.
Interventions for maintaining nasogastric feeding after stroke: An integrative review of effectiveness and acceptability.
Mahoney, C, Veitch, L
Journal of clinical nursing. 2018;(3-4):e427-e436
Abstract
AIMS AND OBJECTIVES To investigate the effectiveness and acceptability of interventions for maintaining nasogastric tubes in adult stroke patients. BACKGROUND Internationally, incidence of cerebral vascular disease continues to increase and stroke is the largest cause of complex disability in adults. Dysphagia is common following a stroke which necessitates feeding via a nasogastric tube. Nasogastric tubes are not well tolerated by stroke patients and may be frequently dislodged. Hence, interventions such as tape, the nasal bridle/loop or hand mittens may be used to maintain nasogastric tube position. However, evidence around the effectiveness and acceptability of these interventions has not been reviewed and synthesised. DESIGN Integrative literature review. METHOD Database searches in MEDLINE, PubMed, CINAHL, Scopus, Cochrane and EMBASE; manual reference list searches. RESULTS Seven studies met the eligibility criteria and were included in the review. Evidence for the effectiveness of nasal bridle/loop and hand mittens to maintain nasogastric tube position in patients after a stroke is spare and methodologically poor, and especially limited around hand mittens use. There is insufficient evidence about the acceptability of both nasal bridle/loop and hand mittens among stroke patients. CONCLUSION Current clinical practice is underpinned by assumptions around the acceptability of nasal bridle/loop and hand mittens to secure nasogastric tubes. This results in reliance on consensual judgement between professional, patients and their families to guide their use among individuals with dysphagia after stroke. Further research is required to assess the effectiveness of hand mittens and acceptability of both nasal bridle/loop and hand mittens among stroke patients to inform guideline development. RELEVANCE TO CLINICAL PRACTICE Given the lack of evidence on the acceptability of hand mittens and nasal bridle/loop among stroke patients to inform evidence-based guidelines and protocols, healthcare professionals should reach consensus on their use by exercising clinical judgement and through consultation with patients (if possible) and their families.
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9.
Systematic Review and Meta-Analysis of the Association between Sarcopenia and Dysphagia.
Zhao, WT, Yang, M, Wu, HM, Yang, L, Zhang, XM, Huang, Y
The journal of nutrition, health & aging. 2018;(8):1003-1009
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Abstract
OBJECTIVES Sarcopenia, an age-related decrease in muscle mass and function, is associated with several potential adverse health outcomes. Its association with another age-related syndrome, dysphagia remains unclear. This systematic review and meta-analysis aims to explore the association between sarcopenia and dysphagia. METHODS PubMed, Embase, Scopus and CINAHL were searched for cross-sectional, case-control and cohort studies that investigated the association between sarcopenia and dysphagia. First author, publication year, study type, sample size, inclusion and exclusion criteria, participant demographics, definition and measurement for evaluation of sarcopenia and dysphagia, main outcomes were retrieved. The association between sarcopenia and dysphagia were expressed by odds ratio (OR) and 95% confidence interval (CI). RESULTS 9 studies are eligible in the systematic review, and 5 cross-sectional studies comprising 913 participants which showed dichotomous classification of sarcopenia and dysphagia were included in the meta-analysis. The crude odds ratios (ORs) were extracted from 5 studies, and 4 of them also provide adjusted ORs. The crude ORs between sarcopenia and dysphagia is 6.17 (95% CI, 3.81- 10.00), after adjusting for some confounders, such as age, sex, Barthel Index score, nutritional status, sarcopenia is also have an association with dysphagia (adjusted ORs, 4.06; 95% CI, 2.27-7.29). The subgroup analysis showed that there was no significant difference between different sarcopenia diagnostic criteria, assessment tools of skeletal muscle mass and dysphagia. CONCLUSION Sarcopenia was positively associated with dysphagia. Prevention and screening of dysphagia is essential among sarcopenic old patients. The causal relationship requires more prospective cohort study for confirmation.
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Laryngotracheal reconstruction and swallowing: A review.
Ha, JF, Driver, L, Zopf, DA
International journal of pediatric otorhinolaryngology. 2017;:138-141
Abstract
OBJECTIVES Significant advances in laryngotracheal reconstruction over the last few decades have revolutionised the management of paediatric patients with complex congenital or acquired airway stenosis. The primary aim of laryngotracheal reconstruction has focused primarily on airway and surgery specific outcomes, often at the expense of voice, as well as swallowing function, which are all intricately related. There is currently a paucity of data on swallowing outcome. The goal of this paper is to review and discuss the existing research on the impact of laryngotracheal on swallowing. METHODS Narrative review. RESULTS Successful and safe oral feeding in children requires a highly complex and integrated sensorimotor system for proper timing and coordination, beginning with a well-coordinated suck-swallow-breathe sequence in infancy. Factors to consider include the normal laryngeal anatomy, nutrition as a stimulus and the development of feeding skills on swallowing, the underlying aetiology and other risk factors, LTR procedures and their adjuncts. All these impact on the children's growth. Swallow assessments and rehabilitation is therefore an important part of the post-operative care. CONCLUSIONS As airway reconstructive surgeries have improved in airway and surgery specific outcomes, swallowing function is an important secondary outcome that impacts on the children's and their families' life. Management in a multi-disciplinary manner will optimise the outcome and improve their quality of life.