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November 2006
Dysphagia Resource Center News November 2006
Posted 2006-11-01 06:13:45
Information on esophageal strictures and dysphagia discussing physiology, diagnosis, and treatment.
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Del.icio.usPosted 2006-11-01 15:24:23
Clinical improvements were observed at 3, 6, and 12 months, in terms of dyspnea index, forced expiratory volume in 1 second, residual volume, partial pressure of oxygen, arterial, partial pressure of carbon dioxide, arterial, 6-minute walking distance, dysphagia, and odynophagia (p < 0.01 or p < 0.05).
Posted 2006-11-02 14:27:14
A study by A. Sanyal et Al. at Royal Cornwall Hospital, UK, of patients who had an quick (under two week) referral from their primary care doctor to a gastroenterologist for dysphagia symptoms. The study had 92 patients. Of these 30 had true dysphagia of which 7 had esophageal cancer. Other diagnoses were GERD, peptic stricture, dysmotility, pharyngeal pouch, cricopharangeal spasm, and globus. The study showed that 60% of patients referred for dysphagia evaluation did not have dysphagia.
Posted 2006-11-03 00:40:09
The Institute for Clinical Systems Improvement (ICSI) recently published a guideline on the evaluation and management of dyspepsia and gastroesophageal reflux disease (GERD). Not surprisingly, One of the criteria for urgent (within 1 day) endoscopy is "acute onset of total dysphagia".
Posted 2006-11-04 07:31:59
Two broad themes emerged: (i) effects on swallowing of underlying physical changes, with subthemes of oral-pharyngeal-laryngeal changes, manual changes, effects of fatigue and (ii) psychosocial impact, with subthemes of alterations to eating habits, feelings of stigma, need for social adjustment and carers’ issues
Posted 2006-11-07 11:44:41
Dysphagia as risk of Gastric Lap Band Surgery
Posted 2006-11-07 11:46:22
Dysphagia as a consequence of Wilson's disease.
Posted 2006-11-08 22:55:38
A thoughtful analysis of the limitations of a study posted on the VitalStim website.
Posted 2006-11-10 23:20:30
A case demonstrating the importance of considering neurotransmitter diseases in the approach to new-onset focal weakness that involves the bulbar musculature. MG was diagnosed in a patient who presented purely with swallowing abnormalities, via videofluorography during a Tensilon test. This novel diagnostic approach should be considered for patients with suspected bulbar MG.
Posted 2006-11-11 01:06:52
Pulmonary aspiration as demonstrated by overnight scintigraphy is common in children with unexplained and refractory respiratory manifestations, suggesting that GER could be the underlying cause of these manifestations. Since only a few children with chronic or recurrent respiratory symptoms have a pathologic gastroesophageal acid reflux, a normal intraesophageal pH study result does not rule out GER in these children.
Posted 2006-11-12 01:00:34
Three cases with endoscopic images of esophagial tumors causing dysphagia.
Posted 2006-11-14 20:06:21
Case presentation of a 38-year old who developed dysphagia while on Risperidone.
Posted 2006-11-14 20:09:14
Article on diagnosis GERD mentioning dysphagia and odynophagia as symptoms of GERD.
Posted 2006-11-16 05:13:07 by Dr. Irene Campbell-Taylor
Dr Campbell-Taylor notes "an interesting article including template forms. I would change some of it but, on the whole, not bad." Includes a protocol information, materials list, reading list, and still and movie images of video-fluoroscopic studies.
Posted 2006-11-17 16:17:49
Authors conclude "the results of this nonconcurrent cohort study suggest that dysphagia therapy with transcutaneous electrical stimulation is superior to traditional dysphagia therapy alone in individuals in a long-term acute care facility." This retrospective study applies "adjustments" to the data for "potentially confounding variables". However, the publication does not present the raw data before these "adjustments" and the details of these adjustments.
Posted 2006-11-18 13:16:18
Overview of this vascular anomaly cause of dysphagia.
Posted 2006-11-20 08:17:47
Recently, new endoscopic technology has become available allowing a physician to perform in-office transnasal esophagoscopy (TNE), which refers to the passage of an endoscope up through the nasal passage and down to the esophagus.
While the patient is awake, this thin tube is inserted through the nose and down the throat to view the patient's throat including the vocal folds, larynx and esophagus. The endoscope's tip contains a light and a digital video system, which produces clear, color images of the full length of the esophagus. If, during the procedure, a suspicious lesion is found, the patient will then be referred to a gastroenterologist or surgeon.
Posted 2006-11-20 08:34:13
Speechy Keen argues that patients with stroke do not good subjects for dysphagia resource. An excerpt from the post, "Please stop using stroke patients to "prove" that a dysphagia treatment "works." Stroke patients are a TERRIBLE population with which to prove almost anything about dysphagia, unless, of course, you specifically want to talk about dysphagia post CVA. But it seems like almost every study on dysphagia therapy approaches that I come across includes CVA patients in the study population."
He further agrues that patients with strokes are a heterogenous group and that dysphagia in many of these patients resolve spontaneously.
Posted 2006-11-20 10:16:38 by Phyllis M. Palmer
I've added a new service to the Dysphagia Resource Center: web forum discussion. Please join and participate in this online Dysphagia resource.
Posted 2006-11-20 15:20:10 by Dr. Irene Campbell-Taylor
Dr. Campbell-Taylor comments on a recent study: the recent presentation of results from Project 201 are interesting even though entirely predictable: Dehydration was significantly more prevalent in patients on thickened fluids (p =<05) (as assessed by physician.)
No significant difference between chin down and thickened liquids - both groups developed pneumonia.
"Honey thick" associated with twice as much pneumonia as "nectar".
VFSS results did not carry over to real life situation.
"Current Clinical Notion": The thicker the liquid the safer the swallow - Not true in patients who aspirate thick liquids - worse health outcomes. Caution advised.
(The important message is that patients do aspirate thick liquids.)
February FEES course in Orlando: Medical Aspects of Voice, Swallowing and the Airway
Posted 2006-11-21 09:45:50 by Cindy Bart
Cindy Bart notes: 2 day Hands On Endoscopy Practicum with Mike Crary and Giselle Mann.
This very well attended and regarded course is being offered February 24th and 25th, 2007. It is offered for 13 hours of credit (1.3 ASHA CEUs), and promises the most passes with the scope on healthy normals during the 2 days of any similar course, and well as many passes on head dummies as you would care to do.
Please let me (bartcyn@cs.com) know if you are also interested in a 3 hour course the Friday evening before, on February 23rd, 2007 at the same hotel. "Medical Aspects of Voice, Swallowing, and the Airway" with Dr. Richard Beck, ENT, and Amy Moss, SLP. This is a case study based course with excellent visuals of Endoscopy before and after treatment, and an in depth look at non-surgical interventions provided by SLPs in situations historically to have been managed surgically.
Posted 2006-11-24 15:19:25 by Dr. Irene Campbell-Taylor
One of the future forms of therapy we are looking at is different ways of giving the drugs to the patients. We have been using oral medications for years and years for Parkinson's disease. Over the last couple of years we have an injectable form, the short acting apomorphine. In the next few months you will see a new delivery system in Parkinson's disease, which is going to be a transdermal system. When you look at the transdermal system, it is pretty much composed of 3 layers. You have a film, you have self-adhesive, which basically has the loaded matrix, and you have a release liner. This pretty much ends up being a patch that is put on the skin and releases the medication that is absorbed through the skin, and provides more constant levels. Rotigotine is a dopamine agonist that will be available as a patch form.Rotigotine has been looked at in pharmacokinetic studies, and if the patch is applied in the abdomen part, shoulder, upper arm, thigh, hip, or flank -- so
pretty much wherever in the body the patient can apply it -- the pharmacokinetics show that it is well absorbed through all these sites, produces a much more constant level in the blood stream, and here if you look at 24 hours, the levels are pretty constant throughout the day.
Posted 2006-11-24 22:15:56
Background: Percutaneous endoscopic gastrostomy tube has now become a preferred option for the long-term nutritional support device for patients with dysphagia. There is a considerable debate about the health issues related to the quality of life of these patients. Our aim of the study was to assess the outcome and perspectives of patients/care givers, regarding the acceptability of percutaneous endoscopic gastrostomy tube placement.
Conclusion: PEG-tube placement was found to be relatively free from serious immediate and long- term complications. Majority of caregivers and patient felt that PEG-tube helped in feeding and prolonging the survival. Studies are needed to assess the real benefit in terms of actual nutritional gain and quality of life in such patients.
Posted 2006-11-29 20:39:45
The New England Journal of Medicine reports a 68-year-old woman with a 6-month history of erosive mucositis of the hard palate, accompanied by intense pain and dysphagia. The patient had an edentulous superior arch and wore a removable upper denture. She had a 2x3 cm ulceration of her hard palate with regular margins and a necrotic center (photo on the link). Evaluation and management suggests that her biphosphonate, alendronate, which she took for osteoporosis was the cause of the ulceration. By changing her pill-taking habit (removing her plate and avoiding holding the pill in her mouth), she was able to cure the ulcer and stay on the alendronate.
I've seen cases of esophageal ulceration due to bisphosphonates taken for osteoporosis, but this is the first case study I've seen of palatal ulceration.
Posted 2006-11-30 13:13:56 by Silvia Quevedo
New Resource for Academic and Clinical Faculty.
A series of quality indicators has been developed to assist your program in assessing how well clinical practice and research are integrated. The Indicators were developed by Department of Communication Sciences and Disorders at the University of Wisconsin-Milwaukee faculty as part of the Focused Initiative on the PhD Shortage in Higher Education addressing Issue 2, Outcome 1 “increasing the availability and use of new models of education applicable for all levels of education and all types of programs”.
[American Speech and Hearing Association Membership required]