Oropharyngeal dysphagia in polymyositis/dermatomyositis.

Department of Clinical Neurophysiology, Medical School Hospital Ege University, Bornova, Izmir, Turkey.
Clinical Neurology and Neurosurgery (Impact Factor: 1.23). 01/2005; 107(1):32-7. DOI: 10.1016/j.clineuro.2004.02.024
Source: PubMed

ABSTRACT The nature of the oropharyngeal dysphagia in polymyositis/dermatomyositis (PM/DM) has been investigated by EMG methods. Nineteen patients with PM/DM were studied. The oropharyngeal phase of swallowing was evaluated by the electrophysiological methods measuring the laryngeal relocation time, pharyngeal transit time and the triggering of the pharyngeal phase of swallowing reflex. The EMG of cricopharyngeal muscle of the upper esophageal sphincter was also recorded in 10 patients. The patients have been compared with a group of 22 healthy controls matched with age and gender. Dysphagia limit was also measured for all patients and control subjects. Fourteen out of 19 patients could not swallow 20 ml or less amount of water at one go and divided the bolus into two or more pieces (piecemeal deglutition) in comparison to normal subjects. In PM/DM patients, the triggering of the swallowing reflex for the voluntarily initiated swallow was normal while the pharyngeal phase of swallowing was significantly prolonged. The cricopharyngeal sphincter muscle EMG demonstrated severe abnormalities in halves of the patients investigated. These findings demonstrated the weakness of the striated oropharyngeal muscles. Cricopharyngeal sphincter muscle was affected less frequently and showed either hyperreflexic or hyporeflexic states during swallowing. It is concluded that the pharyngeal stage of oropharyngeal swallowing is mainly involved in patients with PM/DM.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF). A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9 - 26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal - Wallis test. Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356 - 0.544). Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.
    Disability and Rehabilitation 02/2008; 30(7):517-22. · 1.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up is critical for early diagnosis and management which can mitigate its complications and be cost-saving. Aims of this study are to provide a comprehensive investigation of the dysphagia limit in a large diverse cohort and to provide a longitudinal assessment of dysphagia in in a subset of subjects. Methods We developed a quantitative and non-invasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. Dysphagia Limit (DL) is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1,278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia and 202 patients without dysphagia. One hundred and ninety two of all patients were also re-evaluated longitudinally over a period of 1-19 months. Results DL has 92% sensitivity; 91% specificity; 94% positive predictive value and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r=-0.67, p<0.0001). Conclusions We propose the DL as a reliable, quick, non-invasive, quantitative test to detect and follow both clinical and subclinical dysphagia and it can be performed in an EMG laboratory. Significance Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions.
    Clinical Neurophysiology. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alterations in the physiological mechanism of swallowing involve several anatomical structures performing complex and coordinated activities. These alterations can be secondary to various pathological conditions with highly varied causes. Consequently, the approach to patients with swallowing disorders represents a diagnostic challenge. The first difficulty arises in establishing a diagnosis of the syndrome, in which the presence of dysphagia is often the key symptom. The second difficulty lies in identifying the alteration: distinguishing between those affecting the oral and pharyngeal phases and those affecting the pharyngeal phase is clinically important since the etiology and diagnostic strategy will differ. Whenever possible, treatment should be etiological and should aim to restore the swallowing mechanism. Alternative routes for nutrition are sometimes required, either because etiological treatment is lacking or to avoid complications.
    Gastroenterología y Hepatología 11/2007; 30(8):487-97. · 0.57 Impact Factor


Available from
Jun 2, 2014