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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objective of this study was to validate a dysphagia screening test to identify patients in the rehabilitation phase post stroke at risk for pneumonia, recurrent upper airway obstruction, and death. The setting was an inpatient stroke rehabilitation unit. One hundred thirty-nine consecutive patients met the following criteria: stroke confirmed by clinical history and neurological exam with compatible computed tomography (CT) or magnetic resonance imaging (MRI) scan; ages 20 to 90 years inclusive; and no known history of significant oral or pharyngeal anomaly. The main outcome measures were pneumonia, recurrent upper airway obstruction, and death. The Burke Dysphagia Screening Test (BDST) identified 11 of 12 patients who subsequently developed pneumonia, recurrent upper airway obstruction, or death (Fisher's exact test: p = .03). The relative risk for the occurrence of any of these complications was 7.65 times greater for those failing versus passing the BDST. The BDST identified 9 of 9 patients who developed pneumonia (Fisher's exact test: p = .01). We concluded that the BDST is of value in identifying patients in the rehabilitation phase poststroke at risk for pneumonia, recurrent upper airway obstruction, and death.
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PMID:The Burke dysphagia screening test: validation of its use in patients with stroke. 763 37

The purpose of this study was to investigate the relationship between aspiration, as identified by videofluoroscopic swallowing (VFS) study, and pneumonia in children with suspected dysphagia. Data were retrospectively collected and analysed from 142 children referred for VFS over a one-year period. The median age was 33 months. Aspiration was identified in 44 per cent of the children studied. A history of pneumonia within one year of the VFS was found in 35 per cent. Aspiration, gastro-oesophageal reflux, and age one year or less were significant risk factors for pneumonia. Children with traumatic brain-injury were at less risk for pneumonia than all other children with suspected dysphagia. These results lend objective support to the previously suspected relationship between aspiration and pneumonia in this patient population.
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PMID:Assessment of risk factors for pneumonia in dysphagic children: significance of videofluoroscopic swallowing evaluation. 800 60

Of all strokes 75% occur in people over age 65, and the incidence of stroke rises with age. Because swallowing problems often result, the elderly stroke patient is at risk for dysphagia and its complications. Acute and chronic swallowing problems are associated with many complications including dehydration, malnutrition, aspiration, pneumonitis, depression and even death. These complications make swallowing problems in the aged stroke patient an important focus for nursing attention. Nurses must be aware of the complexity of normal swallowing mechanisms, knowledgeable about the aged stroke patient's risk for dysphagia, aware of the importance of early detection and treatment of dysphagia and confident about their role in dysphagia assessment and treatment regimen. This information can be used in the assessment, treatment and rehabilitation of the elderly dysphagic stroke patient.
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PMID:Dysphagia in the elderly stroke patient. 807 79

The 12-month clinical outcomes of nursing home patients who underwent videofluoroscopic swallowing evaluation was determined. A retrospective review of 40 patients in a teaching nursing home who had videofluoroscopic swallowing studies from 1987 through 1989 was performed. Clinical outcomes measured included feeding tube placement, rehospitalization within 1 year, prolonged nursing home stay (> 6 months), pneumonia, and pneumonia death. It was determined if outcomes were associated with the presence of aspiration on videofluoroscopy and subsequent feeding tube placement. In the 12-month follow-up period, 17 of 40 patients (43%) who underwent videofluoroscopic swallowing evaluation developed pneumonia and 18 of 40 (45%) died. Twenty-two patients demonstrated aspiration on videofluoroscopy. Increased rehospitalization was the only outcome measure that was associated with the presence of aspiration on videofluoroscopy (p < or = 0.05). Of 22 patients with aspiration, 15 had feeding tubes placed. This group had a higher rate of pneumonia (p < or = 0.05) and pneumonia death (p < or = 0.05) compared with the 7 patients with aspiration who did not receive feeding tubes. Patients with nasogastric tubes had a higher death rate (7/9) than patients with gastrostomy tubes (2/8; p < or = 0.05), but similar rates of rehospitalization and pneumonia. Nursing home patients who underwent video-fluoroscopic swallowing evaluation had poor clinical outcomes at 12 months, regardless of their test results.(ABSTRACT TRUNCATED AT 250 WORDS)
Dysphagia 1994
PMID:Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy. 808 20

Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 1985 and July 1992, 49 consecutive patients (38 men and 11 women) underwent extended esophagectomy for esophageal cancer where the neoplasm was mobilized through an initial right thoracotomy and then resected and reconstructed through an abdomino-cervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle third in five. Thirty-three patients had squamous cell carcinoma, 14 had adenocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in six, wound infection in five, and postoperative bleeding in one. Three patients required tracheostomy. There was one postoperative death (2.0%). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty-one patients were alive at the time this article was written, 28 without evidence of cancer. Cause of death was recurrent disease in 13 patients, unrelated to cancer in three, and unknown in one. Overall actuarial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-year survival for stage II disease was 44.6% as compared to 24.9% for stage III (p < 0.02). The presence of lymph node metastases significantly affected survival. Three-year survival for patients with N0 disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01). Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-term results are reasonable.
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PMID:Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus. 812 21

The medical literature has emphasized that aspiration of gastric contents or oral bacteria is a common cause of aspiration pneumonia. Swallowing disorders have been implicated in this disease but not studied at the time that aspiration pneumonia was diagnosed. A significant difference was found in the incidence of videofluoroscopically confirmed oropharyngeal swallowing problems in a group of patients diagnosed with aspiration pneumonia (AP) when compared with patients with nonaspiration pneumonia (NAP). Six of the 9 patients in the AP group aspirated during the videofluoroscopic evaluation and 2 others were considered to be at risk for aspiration. None of the 7 NAP patients demonstrated swallowing problems or aspiration. A significant difference in oral transit time also occurred between the two groups. Liquid was found to have a significantly faster oral transit time than paste or a cookie. Pharyngeal transit times were not found to be significantly different. Although there were only a small number of patients who met the criteria for this pilot study, a strong association was found between swallowing dysfunction and aspiration pneumonia.
Dysphagia 1994
PMID:The association of swallowing dysfunction and aspiration pneumonia. 813 18

In order to assess the risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration following stroke, the clinical records of 26 patients with aspiration and 33 randomly selected, case-matched, dysphagic controls without videofluoroscopic evidence of aspiration were reviewed. The videofluoroscopic modified barium swallow technique included 5 ml-thin and thick liquid barium, 5 ml barium pudding, and 1/4 cookie coated with barium, plus additional 20 and 30 ml of thin liquid barium. Patients were assessed a mean of 2 +/- 1 SD months poststroke and were followed for a mean of 16 +/- 8 SD months poststroke. The odds ratio for developing pneumonia was 7.6 times greater for those who aspirated any amount of barium irrespective of its consistency (p = 0.05). The odds ratio for developing pneumonia was 5.6 times greater for those who aspirated thickened liquids or more solid consistencies compared with those who did not aspirate, or who aspirated thin liquids only (p = 0.06). Dehydration was unrelated to the presence or absence of aspiration. The odds ratio for death was 9.2 times greater for those aspirating thickened liquids or more solid consistencies compared with those who did not aspirate or who aspirated thin liquids only (p = 0.01). Aspiration documented by modified videofluoroscopic barium swallow technique is associated with a significant increase in risk of pneumonia and death but not dehydration following stroke.
Dysphagia 1994
PMID:Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. 813 29

Children with neurologically-based dysphagia are at high risk for silent aspiration. Aspiration can lead to complications such as acute pneumonia and chronic lung disease. Thorough evaluation of the oral, pharyngeal, and esophageal phases of swallowing is crucial for patients with dysphagia. The videofluoroscopic modified barium swallow study (MBS) is the procedure of choice for children to delineate the pharyngeal and upper esophageal phases of the swallow that can only be inferred by bedside clinical assessment. This study describes attributes of aspiration and pharyngeal motility in a large sample of infants and children assessed with MBS. Aspiration was observed in 48 (26%) of 186 children, primarily on liquid before or during swallows. Aspiration was trace (less than 10% of a bolus) and silent in 94%. Relationships to clinical history and implications for management are discussed. Given the lack of objective clinical information to identify children at risk for aspiration, MBS should be considered in all children with severe dysphagia to rule out or confirm aspiration.
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PMID:Silent aspiration prominent in children with dysphagia. 815 16

Surgery is indicated when gastro-oesophageal reflux disease (GORD) is resistant to medical treatment. Manometry, upper GI series, pH-metry, gastric emptying studies and gastric acid sampling are performed in order to demonstrate that GORD is caused by a deficient gastro-oesophageal valve mechanism, and hence that surgical treatment will be beneficial. The surgical principle is restoring an anti-reflux barrier by recreating a sufficient pressure gradient in the distal oesophagus, and by correcting the gastro-oesophageal Hiss. Nissen' fundoplication is probably the most efficient anti-reflux procedure. However, it can cause dysphagia, gas bloating and inability to burp. One hundred and fifty-six laparoscopic Nissen fundoplications have been performed by the author. Operating time average 120 min. No perioperative death was observed. There were 3 conversions to laparotomy and 4 peroperative complications: 1 gastric perforation, 2 lesions of the pleura and 1 liver laceration. Four postoperative complications occurred: 1 pneumonia, 1 necrosis of the wrap, 1 small bowel perforation and 1 obstruction due to migration of the entire stomach into the chest. Hospitalisation time ranged between 2 and 14 days (median 2), with a follow up of a median of 10 months. Long-term postoperative complications were: 1 recurrent heartburn 6 months postoperatively and 2 severe dysphagia.
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PMID:[Anti-reflux surgery: indications, principles and contribution of laparoscopy]. 819 Nov 68

As the population continues to age, older patients are being referred for thoracic surgical procedures with increasing frequency. From 1985 through 1992, 38 patients (32 men, 6 women) 70 years of age or older underwent esophagectomy for primary esophageal carcinoma. Histologic findings included adenocarcinoma in 28 (74%) and squamous carcinoma in 10 (26%). Patients suffered dysphagia for a mean of 3.8 months (range, 0 to 30 months) and had a mean weight loss of 5.8 kg (range, 0 to 22 kg). The tumors ranged from 1 to 14 cm in length and averaged 4.7 cm. Preoperative chemotherapy and radiation therapy were administered in 11 patients (46%). Clinical staging suggested all patients were curable, and esophagectomy was performed in a transthoracic fashion in 27 (71%) and from a transhiatal approach in 11 (29%). Cervical anastomoses were undertaken in 16 patients (42%). The mean blood loss was 1,165 mL and ranged from 500 to 4,000 mL. The mean number of transfused units was 2.3 (range 0 to 8 U). Overall operative mortality was 18% (7 of 38). Major morbidity included pneumonia in 11 (29%), anastomotic leak in 4 (11%), chylothorax in 4 (11%), pulmonary embolus in 3 (8%), and stroke and myocardial infarction in 1 patient each (3%). Three patients have been cured of their esophageal cancer with survivals of 65, 70, and 72 months and an additional 7 patients are still alive. Three patients (8%) have been lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Esophagectomy in the septuagenarian. 821 64


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