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[Dysphagia] Esophageal examination etc
Dear Irene - Wow! Great articles! Thanks! Diane
----- Original Message -----
From: Irene Campbell-Taylor <eripley at yahoo.com>
Date: Thursday, November 16, 2006 10:52 am
Subject: [Dysphagia] Esophageal examination etc
To: dysphagia at b9.com
> Michael Feinberg was one of the most highly respected radiologists
> in the field of swallowing. The following article is a seminal
> one. Often cited.
> 1: AJR Am J Roentgenol. 1991 Jun;156(6):1181-4
> Altered swallowing function in elderly patients without
> dysphagia: radiologic findings in 56 cases.
> Ekberg O,
> Feinberg MJ.
> Available at:
> http://www.ajronline.org/cgi/reprint/156/6/1181.pdf
> This article describes how the esophagus was examined as well as
> the oropharynx. He always included the esophagus.
>
> Of interest is
> Dysphagia and Esophageal Motility Disorders
> Peter J. Kahrilas
> At:
>
>
> http://www.worldgastroenterology.org/publications/archive/2006_1/sci/sci2.htm
> and:
> Am J Med. 2004 Sep 6;117 Suppl 5A:44S-48S.
> Management of acid-related disorders in patients with dysphagia.
> Howden CW.
> Division of Gastroenterology, Northwestern University, Feinberg
> School of Medicine, Chicago, Illinois 60611, USA.
> Dysphagia affects a large and growing number of individuals in
> the United States, particularly the elderly and those who are
> neurologically impaired. Swallowing difficulties may be due to age-
> related changes in oropharyngeal and esophageal functioning as
> well as central nervous system diseases such as stroke, Parkinson
> disease, and dementia. Among institutionalized individuals,
> dysphagia is associated with increased morbidity and mortality. An
> appreciation of the physiology of swallowing and the
> pathophysiology of dysphagia is necessary for proper patient
> management. Careful history, physical examination, and evaluation
> of radiologic and endoscopic studies should differentiate
> oropharyngeal and esophageal etiologies of dysphagia and
> distinguish mechanical (anatomic) disorders from functional
> (motor) disorders. A significant percentage of patients with
> dysphagia have concomitant acid-related disorders that are managed
> best with proton pump inhibitor (PPI) therapy. Three of
> the currently available PPIs are manufactured as capsules
> containing enteric-coated granules that may be mixed with soft
> foods or fruit juices before oral administration to those with
> swallowing difficulties. In addition, omeprazole and lansoprazole
> may be administered via gastrostomy or nasogastric feeding tubes
> as suspensions in sodium bicarbonate. Novel dosage formulations of
> lansoprazole that may be appropriate for patients with dysphagia
> include the commercially manufactured lansoprazole strawberry-
> flavored enteric-coated granules for suspension and lansoprazole
> orally disintegrating tablets.
>
>
> Radiology. 1990 Sep;176(3):637-40.
> Deglutition after near-fatal choking episode: radiologic evaluation.
> Feinberg MJ,
> Ekberg O.
> Department of Radiology, Albert Einstein Medical Center,
> Philadelphia, PA 19141.
> Acute airway obstruction during oral intake is a relatively
> common event that may be fetal if not relieved immediately.
> Deglutition was studied in 75 individuals who had experienced a
> near-fatal choking episode (NFCE) or sudden inability to breathe
> during food intake that was promptly relieved by means of a
> Heimlich maneuver, suctioning, or intubation. Videofluoroscopy
> supplemented by static imaging revealed abnormal stages of
> deglutition in 58 individuals: oral, 32; pharyngeal, 19;
> pharyngoesophageal segment (PES), 28; and esophageal, 23. Forty
> individuals aspirated a liquid bolus; this was more often due to
> oral dysfunction (bolus leakage, n = 17; delayed initiation, n =
> 18) than pharyngeal abnormality (defective closure, n = 13;
> incomplete transport, n = 9). Oral-stage dysfunction was common in
> those with neurologic disease, a history of dysphagia, and
> structural or motor abnormalities of the PES or esophagus.
> Fourteen patients were able to vocalize during the NFCE,
> and each demonstrated an abnormality of the PES or esophagus that
> could obstruct a solid bolus, suggesting that symptoms were not
> due to airway obstruction. A variety of unsuspected deglutition
> abnormalities were documented, indicating the usefulness of
> radiographic evaluation after NFCE.
>
> Dysphagia. 1992;7(4):205-8
> Clinical and demographic data in 75 patients with near-fatal
> choking episodes.
> Ekberg O,
> Feinberg M.
> Department of Radiology, Hospital of the University of
> Pennsylvania, Philadelphia 19104.
> The clinical background and circumstances of 75 patients who had
> survived a near-fatal choking episode, i.e., had undergone a
> Heimlich maneuver, oropharyngeal suctioning, or intubation, is
> reported. Sixty had choked on a solid bolus (often of a complex
> texture like sandwiches and chicken soup). Four patients had
> choked on mashed banana. In 30 patients neurologic disease (such
> as cerebrovascular disease, Parkinson disease, or dementia) was
> present. Choking occurred during breakfast (16 patients), lunch
> (21), dinner (26), and snacks (12). Twenty-five choked at home, 18
> in nursing homes, 14 in hospitals, nine in restaurants, and nine
> in drinking establishments. Twelve were being fed at the time of
> choking. Fifty-eight of the individuals had oral, pharyngeal, or
> esophageal abnormalities on radiographic examination that could
> explain the choking episode. Fourteen patients who were able to
> vocalize during the choking episode had probably suffered from
> esophageal impaction. Our
> study indicates that elderly individuals and those with
> neurogenic dysphagia are at risk for choking. Dysphagia diet
> (semisolids) may actually contribute to the risk in these
> patients. Young adults may also be at risk during episodes of
> consumption of alcohol and snacks.
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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