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Introduction. Laryngeal cancer is the most common malignant neoplasm of the ENT organs. The preferred and primary therapy for this pathology is surgical intervention. The search for highly effective organ-saving methods of surgical treatment aimed at minimization of resection volume and preservation of functioning of the larynx continues. Current endolaryngeal surgery allows to improve functional results and is the most modern and advanced method.Aim. To compare functional and oncological results of surgical treatment of patients with laryngeal squamous cell carcinoma Т2N0M0 performed through transcervical and endolaryngeal accesses.Materials and methods. The results of surgical treatment of patients with squamous cell carcinoma of the vocal folds part of the larynx T2N0M0 performed between 2015 and 2020 at the Oncological Division of Head and Neck Tumors of the The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia were analyzed. The study included 49 men aged 52–72 years; the diagnosis was confirmed by histological examination. All patients underwent standard exams which led to diagnosis per the Tumor, Nodus and Metastasis international system.Results. Three-year recurrence-free survival after endolaryngeal resection of cancer of the vocal folds part of the larynx Т2N0M0 was 88.47 %, after transcervical resections it was 91.31 %. Analysis of functional and surgical results showed that compared to patients who underwent surgery through external access, in patients who underwent surgery with endolaryngeal access the rate of complications associated with the surgical wound in the early postoperative period was 13.04 % lower, frequency of cicatricial stenoses of the larynx was 20.06 % lower, and abnormalities of separating function of the larynx were 49.33 % rarer.Conclusion. In patients who underwent endolaryngeal resection of the larynx, better functional and surgical results were achieved compared to patients who underwent surgery through external access. Moreover, there was no statistically significant difference in oncological results between the study groups. This allows to conclude that minimally invasive endolaryngeal approaches are highly effective and functional in organ-saving surgeries for patients with squamous cell carcinoma of the vocal fold part of the larynx T2N0M0.

Eosinophilic esophagitis is an antigen-mediated chronic inflammatory disorder that has risen in incidence and prevalence over the past 2 decades. The clinical presentation is variable and consists of mainly esophageal symptoms such as dysphagia, heartburn, food impaction, and vomiting. Current management relies on dietary elimination, proton-pump inhibitors, and topical corticosteroids with different response rates and relapses after treatment discontinuation. With a better understanding of the underlying pathophysiology, many molecules emerged recently as targeted treatment including dupilumab (IL4/IL13 blocker), as the first FDA-approved biological treatment, which has changed the management paradigm.

Swallowing is a complex neuromuscular activity regulated by the autonomic central nervous system, and impairment can lead to dysphagia, which is difficulty in swallowing. This research presents a novel approach that utilizes wireless, wearable technology for the continuous mechano-acoustic tracking of respiratory activities and swallowing. To address the challenge of accurately tracking swallowing amidst potential confounding activities or significant body movements, we employ two accelerometers. These accelerometers help distinguish between genuine swallowing events and other activities. By monitoring movements and vibrations through the skin surface, the developed device enables non-intrusive monitoring of swallowing dynamics and respiratory patterns. Our focus is on the development of both the wireless skin-interfaced device and an advanced algorithm capable of detecting swallowing dynamics in conjunction with respiratory phases. The device and algorithm demonstrate robustness in detecting respiratory patterns and swallowing instances, even in scenarios where users exhibit periodic movements due to disease or daily activities. Furthermore, peak detection using an adaptive threshold automatically adjusts to an individual’s signal strength, facilitating the detection of swallowing signals without the need for individual adjustments. This innovation has significant potential for enhancing patient training and rehabilitation programs aimed at addressing dysphagia and related respiratory issues.

Montgomery’s medialization thyroplasty is a laryngeal frame surgery to treat patients with unilateral vocal cord paralysis. This procedure uses a silicone implant in six sizes each for male and female patients. The results of this technique are generally good; however, the results can be suboptimal in some female patients because of differences in female and male laryngeal anatomy. The angle formed by the thyroid cartilage is greater in women than in men, meaning that the posterior portion of this cartilage is further away from the midline in women. We describe our results using male prostheses to improve suboptimal results in some of our female patients. This study is a retrospective case series study. We included female patients who underwent thyroplasty reintervention from 2014 to 2021 using male Montgomery thyroplasty prostheses. Functional results were studied using maximum phonation time (MPT), the GRBAS scales, and two questionnaires: Voice-Handicap Index 30 and Eating Assessment Tool 10. The functional results for all of these women improved after secondary thyroplasty. In one case, the MPT parameter did not change but patient satisfaction improved. The use of male Montgomery implants in women can be a useful tool to achieve improvement in female thyroplasty failure.

Abstract Background Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation. Methods We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the “meta prop” command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies. Results Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29–44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4–6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0–59.0%), 28% (95% CI 22.0–35.0%), 41% (95% CI 33.0–49.0%), and 49.0% (95% CI 34.0–63.0%), respectively. When sample size was 100

Abstract Dysphagia, a disorder affecting the ability to swallow, has a high prevalence among the older adults and can lead to serious health complications. Therefore, early detection of dysphagia is important. This study evaluated the effectiveness of a newly developed deep learning model that analyzes syllable-segmented data for diagnosing dysphagia, an aspect not addressed in prior studies. The audio data of daily conversations were collected from 16 patients with dysphagia and 24 controls. The presence of dysphagia was determined by videofluoroscopic swallowing study. The data were segmented into syllables using a speech-to-text model and analyzed with a convolutional neural network to perform binary classification between the dysphagia patients and control group. The proposed model in this study was assessed in two different aspects. Firstly, with syllable-segmented analysis, it demonstrated a diagnostic accuracy of 0.794 for dysphagia, a sensitivity of 0.901, a specificity of 0.687, a positive predictive value of 0.742, and a negative predictive value of 0.874. Secondly, at the individual level, it achieved an overall accuracy of 0.900 and area under the curve of 0.953. This research highlights the potential of deep learning modal as an early, non-invasive, and simple method for detecting dysphagia in everyday environments.

Objective: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition. Methods: This study presents a secondary analysis of the SABE-Colombia survey, a cross-sectional study of community-dwelling older adults. The dependent variable was self-reported swallowing difficulty, assessed through the question: “How often do you have difficulty or discomfort swallowing?” Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables. Results: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 – 1.26), age > 80 years (OR 1.26, 95%CI 1.08 – 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 – 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 – 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 – 1.65), sarcopenia (OR 1.32, 95%CI 1.02 – 1.69), malnutrition (OR 1.35, 95%CI 1.23 – 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 – 1.38). Conclusion: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia.

Introduction: The esophagus and duodenum are rare sites of manifestation for extrapulmonary tuberculosis (TB). Its rarity makes the diagnosis challenging, especially when no other organ is involved, and the endoscopic findings may resemble malignancy. Case Presentation: We report a unique case of a 37-year-old woman who presented with dysphagia secondary to esophageal TB with an endoscopic appearance of a submucosal mass resembling malignancy. Conclusion: Esophageal TB is a rare cause of dysphagia, especially in a western setting. It should always be considered as a potential etiology in patients with dysphagia.

Abstract Background Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post‐stroke dysphagia, little is known about the contribution of other acute stroke‐unrelated factors. We aimed to analyse the impact of swallowing and non‐swallowing muscles measurements on swallowing function after large vessel occlusion stroke. Methods This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5 days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross‐sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non‐swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate‐to‐severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters. Results The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74 years (interquartile range 62–83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7–16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho = −0.391, P

While oropharyngeal cancer treatment regimens, including surgical resection, irradiation, and chemotherapy, are effective at removing tumors, they lead to muscle atrophy, denervation, and fibrosis, contributing to the pathogenesis of oropharyngeal dysphagia – difficulty swallowing. Current standard of care of rehabilitative tongue strengthening and swallowing exercises is ineffective. Here, we evaluate an alternative approach utilizing an acellular and injectable biomaterial to preserve muscle content and reduce fibrosis of the tongue after injury. Skeletal muscle extracellular matrix (SKM) hydrogel is fabricated from decellularized porcine skeletal muscle tissue. A partial glossectomy injury in the rat is used to induce tongue fibrosis, and SKM hydrogels along with saline controls are injected into the site of scarring two weeks after injury. Tissues are harvested at 3 and 7 days post-injection for gene expression and immunohistochemical analyses, and at 4 weeks post-injection to evaluate histomorphological properties. SKM hydrogel reduces scar formation and improves muscle regeneration at the site of injury compared to saline. SKM additionally modulates the immune response towards an anti-inflammatory phenotype. This study demonstrates the immunomodulatory and tissue-regenerative capacity of an acellular and minimally invasive ECM hydrogel in a rodent model of tongue injury.

Hemiplegia, aphasia and cognitive impairment are common consequences of stroke and have direct implications for post-stroke functioning and quality of life. Therefore, it is imperative to reduce the disability rate following stroke by early rehabilitation intervention. This paper reviewed studies on stroke rehabilitation nursing in perspectives of rehabilitation opportunity, psychological care, body position management, motor function rehabilitation exercise, dysphagia nursing and activity of daily living, and provided reference for improving prognosis and quality of life after stroke. (脑卒中后可能遗留偏瘫、失语、认知障碍等后遗症, 严重影响患者日常生活。早期进行康复干预对降低脑卒中致残率有着重要的临床意义。本研究就脑卒中患者的早期康复时机、心理康复护理、体位摆放、运动功能康复训练、吞咽障碍的护理、日常生活训练等应用现状进行综述, 旨在为改善脑卒中患者预后提供参考。)

Abstract Objective Dysphagia is common in individuals who have undergone posterior fossa tumor (PFT) resection and negatively impacts on the individual’s quality of life, nutritional status, and overall health. We aimed to quantitatively synthesize data from studies of the prevalence of dysphagia following PFT resection. Methods PubMed, Web of Science, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case-control and cross-sectional studies that evaluated the prevalence of dysphagia after PFT surgery. Meta-analyses were performed to determine the prevalence of dysphagia. Subgroup and meta-regression analyses were performed to determine the sources of heterogeneity among the studies. Results A total of 22 studies were included, involving 20,921 cases. A meta-analysis of the random-effects model showed that the pooled global prevalence of dysphagia following PFT resection was 21.7% (95% confidence interval: 16.9–26.6). The subgroup and meta-regression analyses demonstrated that participant age (P < 0.001), assessment methods (P = 0.004), and geographical region of the study participants (P = 0.001) were sources of heterogeneity among the studies. Conclusions Dysphagia has a high prevalence following PFT resection. Individuals with PFTs who are at a high risk for dysphagia should be identified early through screening. Multidisciplinary diagnosis and treatment of dysphagia are required to improve the outcomes in the early stages after PFT resection.

Abstract Background High-resolution manometry (HRM) can quantify swallowing pathophysiology to evaluate the status of the pharynx. Sequential 4-channel neuromuscular electrical stimulation (NMES) was recently developed based on the normal contractile sequences of swallowing-related muscles. This study aimed to examine the effects of sequential 4-channel NMES for compensatory application during swallowing and to observe the residual effects after the application of NMES using HRM. Results Sequential 4-channel NMES significantly improved the HRM parameters, with respect to the maximal pressure and area of the velopharynx (VP), maximal pressure and area of the mesopharynx (MP), and upper esophageal sphincter (UES) activation and nadir duration. Furthermore, the improvement in the pressure and area variables of the VP and MP showed a tendency to maintain even when measured after NMES, but there are no significant differences. Conclusions The present study suggests that the sequential 4-channel NMES application of the suprahyoid and infrahyoid muscles during swallowing improves the pressure, area, and time variables of the oropharynx, as measured by HRM, and it is likely that the effects may persist even after stimulation. Trial Registration Clinicaltrials.gov, registration number: NCT02718963 (initial release: 03/20/2016, actual study completion date: 06/24/2016, last release: 10/20/2020).

Abstract Background Ganglioneuromatosis is a rare type of benign neurogenic tumor that usually affects the sites of the major sympathetic ganglia in the retroperitoneum and the posterior mediastinum. Affection of the gastrointestinal tract is rare, and involvement of the esophagus is exceptional. To the best of our knowledge, only 4 cases of esophageal ganglioneuromatosis in adults were reported in the literature. No cases have been reported in the pediatric age group. Case presentation An 11-year-old boy presented with dysphagia due to severe esophageal stenosis caused by esophageal ganglioneuromatosis. Conclusions Despite its rarity, the present case implies that ganglioneuromatosis should be considered in children with idiopathic esophageal stenosis.

Abstract Gastroesophageal reflux disease (GERD) presents a general health problem with a variety of symptoms and an impairment of life quality. Conservative therapies do not offer sufficient symptom relief in up to 30% of patients. Patients who suffer from ineffective esophageal motility (IEM) and also GERD may exhibit symptoms ranging from mild to severe. In cases where surgical intervention becomes necessary for this diverse group of patients, it is important to consider the potential occurrence of postoperative dysphagia. RefluxStop is a new alternative anti-reflux surgery potentially reducing postoperative dysphagia rates. In this bicentric tertiary hospital observational study consecutive patients diagnosed with PPI refractory GERD and IEM that received RefluxStop implantation were included. A first safety and efficacy evaluation including clinical examination and GERD-HRQL questionnaire was conducted. 40 patients (25 male and 15 female) were included. 31 patients (77.5%) were on PPI at time of surgery, with mean acid exposure time of 8.14% ± 2.53. The median hospital stay was 3 days. Postoperative QoL improved significantly measured by GERD HRQL total score from 32.83 ± 5.08 to 6.6 ± 3.71 (p

Abstract Post-stroke dysphagia (PSD) is an increasingly common complication of stroke. Despite its intuitively unfavorable impact on secondary prevention medication use, limited awareness is available regarding this issue. Herein, a cross-sectional survey was conducted to determine the current use, patient-perceived needs and preferences for secondary prevention medications among PSD patients. To emphasize the unique context related to dysphagia, we recruited Chinese stroke patients with a duration of less than 5 years. These patients were initially categorized into PSD respondents with and without dysphagia. Among the 3490 eligible respondents, 42.7% reported experiencing dysphagia after stroke. Those PSD respondents were more likely to consume multiple medications and suffer from anticoagulants-associated gastrointestinal bleeding as compared to non-PSD ones (p

Xiaona He,1 Dan Yang,2 Jing Shao,1,3 Huafen Wang,4 Huafang Zhang1 1Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, People’s Republic of China; 2Zhejiang Nursing Association, Hangzhou, 310000, People’s Republic of China; 3Institute of Nursing Research, School of Medicine Zhejiang University, Hangzhou, 310058, People’s Republic of China; 4The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of ChinaCorrespondence: Huafen Wang, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China, Tel +86 13516805833, Email 2185015@zju.edu.cn Huafang Zhang, Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, People’s Republic of China, Tel +89 15924187619, Email wuyizhangyichi@zju.edu.cnBackground: In recent years, research on dysphagia has gained significant traction as one of the key topics of oral health research pertaining to the aged. Numerous academics have studied dysphagia in great detail and have produced numerous excellent scientific research findings.Objective: To review the literature regarding dysphagia in community-dwelling older adults and identify the knowledge and trends using bibliometric methods.Methods: The literature on dysphagia in older adults in the community was gathered from the Web of Science Core Collection (WoSCC), with inclusion criteria specifying English-language publications. The retrieval deadline was November 28, 2022. We extracted the following data: title, year, abstract, author, keywords, institution, and cited literature, and used CiteSpace (version 6.1.R3) to visualize the data through the knowledge map, burst keyword analysis, cluster analysis, and collaborative network analysis.Results: A total of 979 articles and reviews were retrieved. Regarding productivity, the top 2 countries were the United States (n =239) and Japan (n =236). Hidetaka Wakabayashi (n =26) was one of the most prolific writers. The first paper in the frequency ranking of references cited was a white paper: European Society for Swallowing Disorders and European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome (n =53). “Prevalence” (n =173), “risk factor” (n =119), and “aspiration pneumonia” (n =108) were the most frequently occurring keywords (excluding defining nouns). The study identified reliability, tongue pressure, home discharge, and swallowing function as research hotspots from 2020 to 2022.Conclusion: Prevalence, risk factors, and pneumonia are significant areas of study. Tongue pressure and sarcopenia are research hotspots and potential targets. In the future, research on dysphagia needs to refine strategies for prevention and control, as well as provide tertiary preventative services.Keywords: dysphagia, community, older adults, bibliometric analysis, citespace

Background. An introduction of minimally invasive technologies contributes to annual increase in the number of surgical interventions for hiatal hernia. However, the rate of major complications (pain syndrome, dysphagia and recurrence of gastroesophageal reflux) inevitably reaches 32%. 19% of the patients need re-surgery, 60‒70% of them fail to recover, and 45% undergo surgical interventions for the third time.Aim. To specify the major complications of surgical treatment for hiatal hernia and to substantiate the optimal techniques of reconstructive interventions for its elimination.Methods. An observational non-randomized study involved 78 patients diagnosed with hiatal hernia without obstruction or gangrene. Patients were categorized into three groups depending on the performed surgical intervention — primary or reconstructive. Group 1 included 31 patients who underwent surgical treatment by means of traditional tactics and techniques (Nissen, Dor procedures); Group 2 enrolled 35 patients after incomplete selective proximal vagotomy with fundoplication according to Chernousov; Group 3 consisted of 12 patients who underwent reconstructive re-surgey for complications of surgical treatment of hiatal hernia. Surgical interventions were performed in five city and district general surgical hospitals of Belgorod Oblast, Russia. The hospitals were considered equally equipped and had surgeons of similar qualification. Patients were included in the study from 2015 to 2023, the follow-up of each patient lasted from 3 months to 8 years. The results of surgical treatment were evaluated by a questionnaire survey. Presence and severity of the major complications of surgical treatment for hiatal hernia were assessed according to the Dakkak scale and Gastro Esophageal Reflux Disease (GERD) questionnaire, evaluating patient outcomes as excellent, good, satisfactory, and unsatisfactory. Statistical data processing was carried out by means of Microsoft Excel 2019 (Microsoft, USA). A statistical level with p ≤ 0.05 was considered statistically significant.Results. The major complications of surgical interventions for hiatal hernia include recurrence of gastroesophageal reflux, pain syndrome and dysphagia, which made up 54.8, 48.4 and 61.3% in Group 1, respectively. In total, the shares of all types of complications exceed 100%, as three patients were recorded with all three complications, 12 patients — with two types of complications, and 15 patients had one complication. The results evaluating the patient’s condition were expressed as good in 19.4% of patients, satisfactory — in 22.6%, and unsatisfactory — in 58.0%. In Group 2, the results evaluating the patient’s condition appeared only good (22.9%) and excellent (77.1%). The reconstructive interventions in Group 3 included: elimination of cruroraphia; incomplete selective proximal vagotomy with modified gastroesophageal refundoplication and fundoplication according to Chernousov; formation of the esophageal hiatus in the diaphragm adequate to the parameters of the fundoplication cuff. The results evaluating the patient’s condition appeared only good (22.2%) and excellent (77.8%).Conclusion. The major complications of surgical treatment for hiatal hernia include pain syndrome, dysphagia and recurrence of gastroesophageal reflux and can be eliminated by the reconstructive interventions composed of the following techniques: elimination of cruroraphia, removal of the cuff, incomplete selective proximal vagotomy, refundoplication by the modified method according to Chernousov, formation of the esophageal hiatus in the diaphragm with adequate parameters of the fundoplication cuff.

Abstract As a remarkably common clinical symptom of many diseases, dysphagia has become a major public health issue. Texture-modified foods is a widespread therapeutic strategy for dysphagia, but the design of texture-modified foods is a challenging task. Considering that the implementation of standardized terms and definitions are helpful for the texture modification of food, literature reviews has been conducted in this paper and relevant classification standards in different countries were summarized. And the techniques and means for food texture modification, such as traditional dietary softening approaches, use of biopolymers, as well as emerging structural technologies were also discussed. In addition, potential research directions have been suggested for the design of texture-modified foods.

Abstract Pneumonia after cervical spinal cord injury (CSCI) is a common and serious complication; however, its nutrition-related etiology has not yet been elucidated. This study aimed to elucidate the effects of nutritional factors on pneumonia after CSCI. Patients with acute traumatic CSCI who were admitted within 3 days after injury and followed up for at least 3 months were retrospectively examined. Occurrence of pneumonia, nutritional status, severity of dysphagia, vital capacity, use of respirators, and motor scores for paralysis were evaluated. Of 182 patients included in this study, 33 (18%) developed pneumonia. Multiple logistic regression analysis revealed that low nutritional status, severe paralysis, and low vital capacity were significant risk factors for pneumonia. The severity of paralysis, respiratory dysfunction, and poor nutritional status can affect the occurrence of pneumonia after CSCI. In addition to respiratory management, nutritional assessment and intervention may play key roles in preventing pneumonia associated with spinal cord injury-induced immune depression. Nutritional care should be provided as soon as possible when the nutritional status of a patient worsens after an injury.

Objectives: Since December 2019, COVID-19 spread worldwide. Patients with COVID-19 are at high hazard for dysphagia. This study investigates the incidence of dysphagia in COVID-19 patients admitted to the intensive care unit (ICU) and identifies predictors of dysphagia in COVID-19 patients. Methods: This prospective study analyzed 100 COVID-19 patients admitted to the ICU of Firoozgar Hospital in Tehran City, Iran. The demographic and clinical features of the eligible patients were collected. Dysphagia and cognition were evaluated according to the Persian version of functional oral intake (FOIS-P) status and the Rancho Los Amigos scale (RLAS). The qualitative variables are described in frequency and percentages and the quantitative variables are illustrated by Mean±SD. Also, univariate and multivariate cox regression was performed to predict possible relations between demographic and clinical variables with dysphagia. Results: A total of 100 COVID-19 patients (43.3±13.3 years, 55% were men) who were admitted to the ICUs were appraised by speech and language pathologists. Meanwhile, 70% of the subjects had at least one comorbidity, with the most common ones being diabetes, hypertension, and obesity. Also, 74% of patients were on invasive mechanical ventilation (60% through endotracheal tube and 40% through tracheostomy). In addition, 57% of patients presented dysphagia. Age (odd ratio (OR)=1.127; 95% confidence interval (CI), 1.019%, 1.247%; P=0.02) and level of consciousness (OR=0.393; 95% CI, 0.178%, 0.868%; P=0.021) were predictors of dysphagia. Discussion: Dysphagia was prevalent among COVID-19 patients predicted by age and level of consciousness. Early evaluation of suspected patients is required for timely and efficient interventions to avoid further problematic issues and progress their quality of life.

Abstract Early infant feeding and swallowing are complex motor processes involving numerous muscles in coordination, e.g. the orofacial muscles as well as the muscles of the pharynx, larynx and esophagus. The newborn’s reflexive drinking develops into the ability to ingest pureed complementary food as infancy progresses. Finally, in the last part of the first year of life, a differentiated eating, chewing and swallowing process develops allowing the voluntary intake of different foods of the family diet. The dietary schedule for the first year of life, which describes the recommended nutrition of infants in Germany, corresponds to these milestones in eating development. Disturbances in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere with the development of eating skills. Swallowing disorders (dysphagia) in children can have a detrimental effect on food intake and pose a serious risk to growth and development. Their prevention treatment requires a multidisciplinary approach with the aim of enabling the child to eat independently in the long term.

Summary: Background & Aims: Intermittent nasogastric (ING)/intermittent orogastric (IOG) tube feeding is an intermittent tube feeding (ITF) method in which a catheter is sporadically placed through the mouth or nose into the stomach to administer nutrients with syringes. This method proves advantageous in rehabilitation wards, as it allows for bed release and training. However, detailed reports on this method are limited, and its safety remains controversial. This study aimed to investigate the incidence of complications and risk factors associated with ING/IOG tube feeding. Methods: This longitudinal cohort study included 135 patients who received ING/IOG tube feeding for all meals and were discharged from our hospital between October 2018 and September 2022. The incidence and prevalence of complications (diarrhea, vomiting, and pneumonia) during the first 28 days after admission were retrospectively investigated. Multiple logistic regression analysis was performed to analyze factors associated with complications. The explanatory variables selected were age, functional independence measure (FIM) motor scores, low body mass index (BMI) (

Background Dysphagia, a prevalent geriatric syndrome, has been witnessing an upward trend in incidence rates, potentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance, research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce. Objective This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets. Methods Employing a cross-sectional survey approach, the study was conducted from July 2022 to May 2023. Using convenience sampling, the study involved 358 individuals aged 60 and above, selected from the outpatient and home care services of five community health service centers in Huangpu, Baoshan and Fengxian Districts of Shanghai. Demographic data were collected, and measurements of the Appendicular Skeletal Muscle Index (ASMI), grip strength, and walking speed were taken. The Eating Assessment Tool-10 (EAT-10) was utilized to assess the risk of dysphagia among the elderly. Results Out of the 358 community-dwelling elderly individuals surveyed, 80 (22.3%) exhibited symptoms of dysphagia (EAT-10≥3) (dysphagia group). Multivariate Logistic regression analysis identified advanced age (≥80 years) (OR=18.484, 95%CI=3.571-95.679), depressive state (OR=4.135, 95%CI=1.280-13.364), and a history of choking (OR=13.650, 95%CI=4.345-42.877) as significant risk factors for dysphagia (P

Background: Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation. Methods: We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the "meta prop" command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies. Results: Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29–44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4–6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0–59.0%), 28% (95% CI 22.0–35.0%), 41% (95% CI 33.0–49.0%), and 49.0% (95% CI 34.0–63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies. Conclusion: The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED. [ABSTRACT FROM AUTHOR]

Infectious esophagitis (IE) is the leading cause of esophagitis, second only to gastroesophageal reflux disease. Infectious esophagitis is typically observed in immunocompromised individuals due to neutropenia, HIV/AIDS, solid organ malignancies, cancer-directed therapy, or chronic steroid use. The most common causes of IE are herpes simplex virus (HSV), cytomegalovirus (CMV), and Candida albicans. Acute bacterial esophagitis is exceedingly rare, particularly in immunocompetent patients. Herein, we describe a unique case of acute streptococcal esophagitis in a male patient with no pertinent medical history. The patient's substernal chest pain and odynophagia resolved after antibiotic treatment. [ABSTRACT FROM AUTHOR]

Introduction: The increasing incidence of stroke globally has led to dysphagia becoming one of the most common complications in stroke patients, with significant impacts on patient outcomes. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life. Methods: Included studies involved stroke-diagnosed patients assessed for dysphagia using bedside screening tools. Data was sourced from Embase, PubMed, Web of Science, Scopus, and CINAHL, including publications up to 10 December 2023. The study employed both fixed-effect and randomeffects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. The random-effects model was particularly utilized due to observed heterogeneity in study data. Results: From 6,979 records, 21 studies met the inclusion criteria, involving 3,314 participants from 10 countries. The analysis included six assessment tools: GUSS, MASA, V-VST, BSST, WST, and DNTA, compared against gold-standard methods VFSS and FEES. GUSS, MASA, and V-VST showed the highest reliability, with sensitivity and specificity rates of 92% and 85% for GUSS, 89% and 83% for MASA, respectively. Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings. Conclusion: Our network meta-analysis underscores the effectiveness of GUSS, MASA, and V-VST in dysphagia screening for stroke patients, with high sensitivity and specificity making them suitable for diverse clinical settings. BSST and WST, with lower diagnostic accuracy, require more selective use. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications. [ABSTRACT FROM AUTHOR]

Background: Patients treated with definitive radiotherapy for nasopharyngeal carcinoma (NPC) develop severe dysphagia, affecting their quality of life. Traditional prognosis biomarkers are insufficient, leading to a search for new predictors like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods: We retrospectively enrolled 44 NPC patients who underwent definitive radiotherapy between 2010 and 2018. EQUATOR and STROBE network guidelines were adopted. Pre-treatment evaluations were conducted, and post-treatment oropharyngeal dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ) and FEES, then assigning a Dysphagia Outcome and Severity Scale (DOSS) level. Patients were divided based on NLR and PLR cut-offs, comparing subjective dysphagia (SSQ) scores and DOSS results at baseline and after a 5-year follow-up. Multiple linear regression was used for analysis. Results: At baseline, the mean NLR was 2.52 ± 1.10, and the PLR was 208.40 ± 94.35. Multivariate analysis indicated NLR and PLR as significant predictors of DOSS outcomes (p < 0.001). Conclusions: Baseline inflammation markers, such as NLR and PLR, may be used to predict dysphagia severity in NPC patients undergoing definitive radiotherapy. These markers could help identify patients at higher risk for severe dysphagia and implement tailored therapeutic and rehabilitative strategies to improve their quality of life. Further studies with larger cohorts are needed to confirm these findings and explore additional prognostic factors for dysphagia outcomes in NPC patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Recently, pembrolizumab plus 5-fluorouracil and cisplatin (FP), nivolumab plus FP, and nivolumab plus ipilimumab have become the first-line treatments for patients with advanced esophageal cancer. However, the treatment efficacy in primary tumors has not been reported. We assessed the outcomes of these treatments in advanced esophageal cancer, specifically focusing on esophageal dysphagia improvements and the primary tumor response. Methods: This retrospective study was conducted between October 2021 and November 2023. We investigated 23 patients with esophageal cancer and dysphagia who received an immune checkpoint inhibitor (ICI) plus FP or nivolumab plus ipilimumab. Results: The median progression-free survival (PFS) was 10.6 months (95% confidence interval [CI]: 9.0–12.5), and the median overall survival was not reached (95%CI: 13.0–NA). Improvement in dysphagia was observed in 19/23 (82.6%) patients, with a median time to improvement of 26 days (range: 15–77 days) and a median dysphagia PFS of 12.6 months (range: 8.1–NA months). Ten patients experienced immune-related adverse events (irAEs): seven had interstitial pneumonia, and three had thyroid dysfunction, pituitary dysfunction, and rash, respectively. Conclusions: Although there was a high frequency of irAEs, ICI for esophageal cancer achieved high response rates and prolonged survival. The observed improvement in dysphagia suggests the potential efficacy of the treatment against primary tumors. [ABSTRACT FROM AUTHOR]

Dysphagia, a common result of other medical conditions, is caused by malfunctions in swallowing physiology resulting in difficulty eating and drinking. The Modified Barium Swallow Study (MBSS), the most commonly used diagnostic tool for evaluating dysphagia, can be assessed using the Modified Barium Swallow Impairment Profile (MBSImP™). The MBSImP assessment tool consists of a hierarchical grouped data structure with multiple domains, a set of components within each domain which characterize specific swallowing physiologies, and a set of tasks scored on a discrete scale within each component. We lack sophisticated approaches to extract patterns of physiologic swallowing impairment from the MBSImP task scores within a component while still recognizing the nested structure of components within a domain. We propose a Bayesian hierarchical profile regression model, which uses a Bayesian profile regression model in conjunction with a hierarchical Dirichlet process mixture model to (1) cluster subjects into impairment profile patterns while respecting the hierarchical grouped data structure of the MBSImP, and (2) simultaneously determine associations between latent profile cluster membership for all components and the outcome of dysphagia severity. We apply our approach to a cohort of patients referred for an MBSS and assessed using the MBSImP. Our research results can be used to inform appropriate intervention strategies, and provide tools for clinicians to make better multidimensional management and treatment decisions for patients with dysphagia. [ABSTRACT FROM AUTHOR]

Patients treated for oral cancer, may experience restricted mouth opening (trismus). Barriers such as cost have limited the utilization of traditional jaw stretching devices, and consequently, patients experience problems with swallowing, oral care, communication, and cancer surveillance. The safety and efficacy of Restorabite™, a new device designed to overcome these barriers, is evaluated prospectively over 12 months. This phase II investigator‐led trial included patients with chronic trismus underwent 10‐weeks of trismus therapy using Restorabite™. Safety, adherence, changes in mouth opening, and patient‐reported outcomes are presented. 114/120 participants with trismus completed the intervention, and 104 had their progress monitored for 12 months. Thirteen participants withdrew due to tumour recurrence. At the completion of the intervention, mouth opening improved by 10.4 mm (p <.001). This increased to 13.7 mm at 12 months (p <.001). Patient reported outcome all significantly improved and 47 participants were no longer classified as having trismus. There were no serious treatment related adverse events. In patients with trismus following head and neck cancer treatment, a 10‐week programme of jaw stretching exercises using Restorbite™ safely improves mouth opening and associated quality of life outcomes with high adherence and the benefits are maintained for 12‐months. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to examine brain activity during dierent swallowing actions in patients with dysphagia caused by medullary infarction (MI) before and after treatment using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Methods: Fifteen patients were enrolled in this study. Brain activation during saliva swallowing and eortful saliva swallowing was observed using BOLD imaging in the acute phase of stroke and after 4 weeks of rehabilitation training. Dierences in the activation of brain regions during saliva swallowing before and after treatment, during eortful saliva swallowing before and after treatment, and between the two swallowing actions before and after treatment were compared. Results: In the acute phase of stroke, only the bilateral precentral and left lingual gyrus were partially activated during saliva swallowing, and there was no obvious activation in the insula. Eortful saliva swallowing activated more brain regions than saliva swallowing before treatment, including the bilateral supplementary motor area (SMA), postcentral gyrus, and right insular cortex. The number of brain regions activated during saliva swallowing increased after treatment, including the bilateral precentral gyrus, postcentral gyrus, insula, thalamus, and SMA. Discussion: Cortical activation increases after recovery from dysphagia, and the increased activation of the postcentral gyrus might play a functional compensatory role. Eortful saliva swallowing is a more eective rehabilitation training method for patients with dysphagia caused [ABSTRACT FROM AUTHOR]

Introduction: Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods: This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results: In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion: Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented. [ABSTRACT FROM AUTHOR]

Objective To investigate the quality of life of stroke patients with dysphagia and find the appropriate position for swallowing. Methods From January to September 2023, 90 patients with dysphagia caused by stroke were selected from the Department of Geriatrics and Rehabilitation Medicine at the Third People's Hospital of Yunnan Province as study subjects. After the water swallowing test categorization, patients were randomly divided into 3 groups based on different levels of the test - 30°, 60°, 90°examination positions, with each group containing 30 cases. The patients were given a "Stroke Dysphagia Patient Quality of Life Survey" questionnaire to analyze the impact of different positions on swallowing function and the patients' quality of life. Results The proportion of patients with abnormal self-care ability was 91.11%, the rate of mild anxiety was 6.67%, the rate of mild depression was 16.67%, the rate of moderate nutritional risk was 91.11%, and the rate of gastroesophageal reflux was 36.67%. There were differences in self-care ability and gastroesophageal reflux among patients with different levels of swallowing dysfunction (P < 0.05). There were differences in the incidence of leakage and aspiration in the 30°, 60°and 90°positions respectively (P < 0.05). Conclusion The health status of stroke patients with dysphagia is concerning. The use of the 30°and 60°positions can effectively reduce the leakage and aspiration of the patients' swallowing. By enhancing patient health education and management, actively providing nutritional guidance and psychological support, as well as comprehensive measures such as medication, care, and rehabilitation training, the quality of life of patients can be further improved. [ABSTRACT FROM AUTHOR]

Compared with acute cerebral infarction alone, the nutritional status of patients with acute cerebral infarction and dysphagia is significantly worse, which not only negatively impacts clinical treatment, but also contributes to the poor prognosis of patients. In traditional clinical treatment, more focus is placed on improving the neurological function of patients with acute cerebral infarction combined with dysphagia, often neglecting their nutritional status, leading to unsatisfactory prognosis. In this study, we explored the influence of enhanced recovery after surgery care on the neurological function and nutritional status of patients with acute cerebral infarction combined with dysphagia after thrombolytic therapy. It was found that the use of enhanced recovery after surgery care improved neurological function and nutritional status and reduced blood pressure and stress responses, while promoting the recovery of patients' muscle strength. Therefore, enhanced recovery after surgery care has high application value in the future clinical treatment of acute cerebral infarction combined with dysphagia. [ABSTRACT FROM AUTHOR]

Background/Objectives: The use of food thickeners with ciprofloxacin tablets may result in a gelatinous appearance and experience delayed dissolution, which presents a challenge for the drug's efficacy, creating a healthcare economic issue. However, the pharmacokinetic impact of this compound in humans remains uncertain. Therefore, a comparative pharmacokinetic study of ciprofloxacin was conducted on healthy adult Japanese males. Methods: We compared the effects of administering tablets with water or thickened water and crushed tablets mixed with thickened water. The maximum blood concentration (Cmax) of ciprofloxacin determines the drug's efficacy. Results: There were variations in drug absorption across different administration methods. The group who took the tablets immersed in thickened water exhibited different results in the area under the blood drug concentration–time curve (AUC) and Cmax compared to the group who took the tablets in regular water. Notably, the group that consumed the crushed tablets mixed with thickened water demonstrated equivalent results for both AUC and Cmax. Conclusions: Administering crushed tablets in thickened water may yield pharmacokinetics comparable to those of tablets taken with water. However, the process of crushing tablets may result in the loss of active ingredients and compromise the formulation, necessitating a comprehensive assessment before administration. [ABSTRACT FROM AUTHOR]

Background: Patients with benign esophageal strictures may not maintain a response to endoscopic dilation, stenting, incisional or injectional therapies. For patients with these refractory esophageal strictures, esophageal self-dilation therapy (ESDT), performed to maintain luminal patency, may provide persistent symptomatic benefit while reducing patients' reliance on healthcare services and the risk associated with repeated endoscopic procedures. Aims: The aim of this study was to evaluate the efficacy and safety of EDST in a randomized controlled trial and prospective observational study. Methods: Twenty-five patients with refractory benign esophageal strictures were recruited at two esophageal clinics between November 2018 and June 2021. Twelve patients participated in the randomized trial and 13 in the prospective observational study. The number of endoscopic dilations, impact of therapy on dysphagia, adverse events, and complications were recorded. Results: In the randomized study, 50% of patients performing ESDT and 100% of controls required endoscopic dilation during follow-up (P = 0.02). In the observational study, the median (IQR) number of endoscopic dilations fell from 7 [7–10] in the 6 months prior to commencing ESDT to 1 [0–2] in the 6 months after (P < 0.0001). Most patients (22/25) were able to learn self-dilation. Few serious adverse events were noted. Dysphagia severity remained unchanged or improved. Conclusions: ESDT appears to be a safe effective therapy for benign esophageal strictures refractory to endoscopic treatment. Clinical Trial Number: NCT03738566. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of dysphagia worldwide are increasing yearly requiring a change in food texture to avoid malnutrition, dehydration, or sever complications. Riceberry porridges fortified with protein hydrolysate (1.5%), bio‐calcium (589 mg), and thickened with xanthan gum (XG) of varying concentrations (0%, 0.255, 0.50%, 0.75%, 1.0%, and 2.0%) showed suitability for use in enriching diets of these patients. Porridges were examined using specified tests from the International Dysphagia Diet Standardization Initiative (IDDSI) and National Dysphagia Diet (NDD), and coupled with rheological, textural analyses, in vitro swallowing simulator and sensory analysis performed by a trained panel. Porridges with 0%–0.25% and 0.50%–2.0% XG were classified as IDDSI level 3 and 4, respectively, and apparent viscosities of porridges showed samples with XG displayed shear thinning behavior beneficial for patients with dysphagia. Increasing XG concentrations increased the consistency coefficient and decreased the flow behavior index (p <.05) with positive correlation of XG concentration with textural properties including firmness, consistency, cohesiveness, adhesiveness, and stickiness values. The relationship between instrumental measurements, in vitro and in vivo swallowing behavior showed high correlations with regards to XG concentration (r =.995). The findings indicate Riceberry porridges containing XG have significantly improved textural properties over those without XG for patients with dysphagia. [ABSTRACT FROM AUTHOR]

The development of thickening powders for the management of dysphagia is imperative due to the rapid growth of aging population and prevalence of the dysphagia. One promising thickening agent that can be used to formulate dysphagia diets is basil seed mucilage (BSM). This work investigates the effects of dispersing media, including water, milk, skim milk, and apple juice, on the rheological and tribological properties of the BSM‐thickened liquids. Shear rheology results revealed that the thickening ability of BSM in these media in ascending order is milk < skim milk ≈ apple juice < water. On the other hand, extensional rheology demonstrated that the longest filament breakup time was observed when BSM was dissolved in milk, followed by skim milk, water, and apple juice. Furthermore, tribological measurements showed varying lubrication behavior, depending on the BSM concentration and dispersing media. Dissolution of BSM in apple juice resulted in the most superior lubrication property compared with that in other dispersing media. Overall, this study provides insights on BSM's application as a novel gum‐based thickening powder in a range of beverages and emphasizes how important it is for consumers to have clear guidance for the use of BSM in dysphagia management. [ABSTRACT FROM AUTHOR]

Background: Esophageal motility disorders can be diagnosed by either high‐resolution manometry (HRM) or the functional lumen imaging probe (FLIP) but there is no systematic approach to synergize the measurements of these modalities or to improve the diagnostic metrics that have been developed to analyze them. This work aimed to devise a formal approach to bridge the gap between diagnoses inferred from HRM and FLIP measurements using deep learning and mechanics. Methods: The "mechanical health" of the esophagus was analyzed in 740 subjects including a spectrum of motility disorder patients and normal subjects. The mechanical health was quantified through a set of parameters including wall stiffness, active relaxation, and contraction pattern. These parameters were used by a variational autoencoder to generate a parameter space called virtual disease landscape (VDL). Finally, probabilities were assigned to each point (subject) on the VDL through linear discriminant analysis (LDA), which in turn was used to compare with FLIP and HRM diagnoses. Results: Subjects clustered into different regions of the VDL with their location relative to each other (and normal) defined by the type and severity of dysfunction. The two major categories that separated best on the VDL were subjects with normal esophagogastric junction (EGJ) opening and those with EGJ obstruction. Both HRM and FLIP diagnoses correlated well within these two groups. Conclusion: Mechanics‐based parameters effectively estimated esophageal health using FLIP measurements to position subjects in a 3‐D VDL that segregated subjects in good alignment with motility diagnoses gleaned from HRM and FLIP studies. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder, and more than 80% of PD patients will develop oropharyngeal dysphagia. Despite its striated histology, proximity to airway, and potential negative impact of its dysfunction on bolus transport and airway safety, the contractile function of the striated esophagus in PD patients has not been systematically studied. Methods: Using our repository of clinical manometry and the Milwaukee ManoBank, we analyzed high‐resolution manometry (HRM) studies of 20 PD patients, mean age 69.1 (range 38–87 years); 30 non‐PD patients with dysphagia, mean age 64.0 (44–86 years); and 32 healthy volunteers, mean age 65.3 (39–86 years). Patients with abnormal findings based on Chicago Classification 4.0 were identified. Repeat analysis was performed in 20% of the manometric tracings by a different investigator with inter‐rater concordance between 0.91 and 0.99. Key Results: The striated esophageal contractile integral in PD patients was significantly lower than that in non‐PD dysphagic patients and healthy controls (p = 0.03 and <0.01, respectively). This significant difference persisted after excluding patients with concurrent Chicago Classification motility disorders (p = 0.02 and 0.01, respectively). In both analyses, the distal esophageal contractile integral did not show any significant difference between groups (p = 0.58 and 0.93, respectively). Conclusions & Inferences: PD is associated with a significant decrease in striated esophagus contractility compared to non‐PD and healthy controls. This finding may play a pathophysiologic role in development of dysphagia in this patient population. [ABSTRACT FROM AUTHOR]

The cerebellum is known to play a supportive role in swallowing-related functions; however, wide discrepancies about the incidence rate of swallowing disorders following cerebellar strokes exist within the literature. This study aimed to investigate the incidence rate of dysphagia and the factors which may affect the presence of dysphagia and clinical recovery in individuals diagnosed with cerebellar stroke. A retrospective chart audit of 1651 post-stroke patients (1049 males and 602 females) admitted with a cerebellar stroke to a comprehensive tertiary hospital in China was conducted. Data on demographics, medical, along with swallowing function assessment were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t-tests and Pearson's chi-square test. Univariate logistic regression analysis was performed to establish factors associated with the presence of dysphagia. A total of 11.45% of participants were identified with dysphagia during inpatient admission. Individuals with mixed types of stroke, multiple lesions in the cerebellum, and ages older than 85 years old were more likely to develop dysphagia. Moreover, the prognosis of dysphagia following a cerebellar stroke was associated with lesions in different parts of the cerebellum. The cumulative recovery rates from the best to worse were the right hemisphere group, the cerebellum vermis or peduncle group, and both the hemisphere group and the left hemisphere group, respectively. [ABSTRACT FROM AUTHOR]

In patients with dysphagia that is not explained by upper endoscopy, high-resolution esophageal manometry (HRM) is the next logical step in diagnostic testing. This study investigated predictors of failure to refer for HRM after an upper endoscopy that was performed for but did not explain dysphagia. This was a retrospective cohort study of patients >18 years of age who underwent esophagogastroduodenoscopy (EGD) for dysphagia from 2015 to 2021. Patients with EGD findings that explained dysphagia (e.g. esophageal mass, eosinophilic esophagitis, Schatzki ring, etc.) were excluded from the main analyses. The primary outcome was failure to refer for HRM within 1 year of the index non-diagnostic EGD. We also investigated delayed referral for HRM, defined as HRM performed after the median. Multivariable logistic regression modeling was used to identify risk factors that independently predicted failure to refer for HRM, conditioned on the providing endoscopist. Among 2132 patients who underwent EGD for dysphagia, 1240 (58.2%) did not have findings to explain dysphagia on the index EGD. Of these 1240 patients, 148 (11.9%) underwent HRM within 1 year of index EGD. Endoscopic findings (e.g. hiatal hernia, tortuous esophagus, Barrett's esophagus, surgically altered anatomy not involving the gastroesophageal junction, and esophageal varices) perceived to explain dysphagia were independently associated with failure to refer for HRM (adjusted odds ratio 0.45, 95% confidence interval 0.25–0.80). Of the 148 patients who underwent HRM within 1 year of index EGD, 29.7% were diagnosed with a disorder of esophagogastric junction outflow, 17.6% with a disorder of peristalsis, and 2.0% with both disorders of esophagogastric outflow and peristalsis. The diagnosis made by HRM was similar among those who had incidental EGD findings that were non-diagnostic for dysphagia compared with those who had completely normal EGD findings. Demographic factors including race/ethnicity, insurance type, and income were not associated with failure to refer for HRM or delayed HRM. Patients with dysphagia and endoscopic findings unrelated to dysphagia have a similar prevalence of esophageal motility disorders to those with normal endoscopic examinations, yet these patients are less likely to undergo HRM. Provider education is indicated to increase HRM referral in these patients. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia, a serious symptom of oral cancer, is also the most common. Further, patients who are more uncertain regarding their illness tend to catastrophize, which may affect their rehabilitation and long-term survival rate. Considering this relationship, this study aimed to investigate the occurrence of dysphagia in Chinese patients with oral cancer and explore the correlation between catastrophic cognition, illness uncertainty, and dysphagia. Methods: Applying a cross-sectional design, convenience sampling was used to recruit 180 patients with oral cancer. Advanced statistical methods were employed to analyze the mediating effects of catastrophic cognition on illness uncertainty and dysphagia. Results: Chinese patients with oral cancer had a mean dysphagia score of 52.88 ± 10.95. Catastrophic cognition and illness uncertainty in patients with oral cancer were significantly positively correlated (r = 0.447, P < 0.001). There was a significant negative correlation between dysphagia score and catastrophic cognition (r = -0.385, P < 0.001), and between dysphagia and illness uncertainty (r = -0.522, P < 0.001). Bootstrapping results indicated that the mediating effect of catastrophic cognition between illness uncertainty and dysphagia was -0.07 (95% CI: [-0.15, -0.03]) and significant, and the mediation effect accounted for 15.6% of the total effect. Conclusions: Chinese patients with oral cancer have poor swallowing function. Results suggest that catastrophic cognition partially mediated the relationship between illness uncertainty and dysphagia in patients with oral cancer. Medical staff can improve patients’ swallowing function by reducing the level of catastrophic cognition via decreasing the level of illness uncertainty. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is an increasingly prevalent immune‐mediated disease that leads to chronic changes in the oesophagus. These changes can include strictures, narrowing, and stenosis, mediated by an interleukin (IL)‐13 pathway, which leads to remodelling and fibrosis through increasing migration of fibroblasts and subepithelial fibrosis via collagen deposition 1. IL‐13 downregulates TSPAN12, a gene whose expression regulates fibrosis and causes changes in barrier function and higher rates of fibrostenosis in EoE. Dupilumab, a biologic therapy aimed at blocking IL‐13, has been shown to improve EoE‐related inflammation and fibrosis in clinical trials. We report here four unique patients with documented oesophageal stenosis with inability to pass a paediatric endoscope due to structuring disease, requiring dilation, who had resolution of their oesophageal narrowing following dupilumab therapy. [ABSTRACT FROM AUTHOR]

Objective: To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. Methods: Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. Results: A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. Conclusion: The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing. [ABSTRACT FROM AUTHOR]

Background: Clinically assisted nutrition and hydration via percutaneous endoscopic gastrostomy (PEG) is a therapeutic option to ameliorate the difficulties associated with enhanced catabolism, weight loss, and dysphagia in Huntington's disease (HD). Objectives: The objective is to provide insights into demographics, staging (Shoulson‐Fahn), complications, weight trajectories, and survival rates in people with HD (pwHD) who underwent PEG. Methods: This retrospective study included 705 consecutive pwHD who attended our HD clinic between July 2006 and March 2024, of whom 52 underwent PEG. A control group (n = 52), comprising pwHD without PEG, were closely matched for sex, stage, age, CAG length, and disease burden score at PEG. The study was registered as a service evaluation at the National Hospital for Neurology and Neurosurgery. Results: PEG prevalence was 15.0% (n = 52/347) among manifest pwHD: 4.8% (n = 3/62) for Stage 3; 33.3% (n = 16/48) for stage 4; and 44.1% (n = 30/68) for stage 5. Commonest indications were dysphagia, weight loss, and inadequate oral intake. Complications included chest infection, tube dislodgement, and peristomal and skin infections. Modeling of weight trajectories after PEG found no difference between PEG and non‐PEG groups. Mortality rate was 34.6% (n = 18/52) in the PEG and 36.5% (n = 19/52) in the non‐PEG groups (P = 0.84). Treatment duration (until study endpoint or death) was 3.48 years (interquartile range = 1.71–6.02; range = 0.23–18.8), with 65.4% (n = 34/52) alive at the study endpoint. Conclusion: PEG in pwHD at‐risk for weight loss may help slow weight loss. Prospective studies are required to strengthen PEG decision‐making in pwHD. PEG survival was much longer than other dementias, highlighting the need to consider PEG independently in pwHD. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Anti‐N‐methyl‐d‐aspartate receptor encephalitis is an autoimmune disorder characterized by various neurological symptoms with a relatively favorable prognosis. We present a case of prolonged dysphagia successfully managed with outpatient rehabilitation, including interferential current stimulation and resistance exercises. Significant improvement was observed, highlighting the efficacy of combined treatment in overcoming chronic dysphagia. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case emphasizes the need for early recognition and accurate diagnosis of achalasia in young adults to avoid exacerbation of the condition and misdiagnosis as GERD. Patient outcomes and quality of life are greatly enhanced by suitable diagnostic techniques, appropriate therapy, interdisciplinary care, and comprehensive patient education along with frequent follow‐ups. Achalasia results from the degeneration of inhibitory ganglion cells within the esophageal myenteric plexus and the lower esophageal sphincter (LES), leading to a loss of inhibitory neurons and resulting in the absence of peristalsis with failure of LES relaxation. Its origins are multifactorial, potentially involving infections, autoimmune responses, and genetics, with equal incidence in males and females. The hallmark symptoms include progressive dysphagia for solids and liquids, along with regurgitation, heartburn, and non‐cardiac chest pain. A 22‐year‐old female patient initially diagnosed with gastroesophageal reflux disease (GERD) received proton pump inhibitors and antacid gel for persistent dysphagia and regurgitation. Subsequent tests including barium esophagogram and manometry indicated Type II Achalasia Cardia. The patient showed clinical improvement with relief of dysphagia, regurgitation, and heartburn symptoms after pneumatic balloon dilatation (PBD). She was advised to follow up after 6 months with upper gastrointestinal (UGI) endoscopy and manometry in the outpatient clinic for regular endoscopic surveillance as there is a risk of transformation to esophageal carcinoma. Diagnosing achalasia in young adults poses challenges due to its diverse presentation and resemblance to other esophageal disorders like GERD. Diagnosis relies on clinical symptoms and imaging studies such as barium esophagogram revealing a bird's beak appearance and esophageal manometry showing absent peristalsis. UGI endoscopy is needed to rule out malignancy. Treatment options include non‐surgical approaches like medication and Botox injections, as well as surgical methods such as pneumatic balloon dilation, laparoscopic Heller myotomy, and per‐oral endoscopic myotomy (POEM). The treatment options depend upon the patient's condition at presentation and their individual choices. This case report emphasizes that it is crucial to consider achalasia as a potential differential diagnosis in young adults with dysphagia, especially if conventional treatments for acid peptic disorder do not alleviate symptoms. Prompt diagnosis and appropriate management can lead to significant clinical improvement and better patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal‐abnormal ratings, objective measurements have been developed. We compared the inter‐rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods: Two blinded raters analyzed the subjective normal‐abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter‐rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results: In the pharyngeal findings, the subjective analysis inter‐rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter‐rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions: The subjective analysis had moderate to strong inter‐rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter‐observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence: 4. [ABSTRACT FROM AUTHOR]