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PubMed1994

Oral and laryngeal muscle coordination during swallowing.

The objective of this experiment was to determine the relative contributions and patterns of activity of different muscles involved during the oral phase of swallowing. Electromyographic (EMG) signals were recorded from the orbicularis oris inferior, masseter, palatal elevator, anterior and posterior genioglossus, mylohyoid, anterior belly of the digastric, and vocalis muscles of 12 normal adult subjects. Each subject swallowed 15 mL of water, under normal and bite block conditions, 15 to 20 times. The integrated EMG signals for each subject's swallows were ensemble averaged. The results of the analyses showed that swallowing function varies from individual to individual in terms of the specific muscles used and how the various muscle activity patterns are coordinated. These results suggest that swallowing is a highly complex adaptive motor activity which probably relies more on higher-level control mechanisms than previously believed.

Adult↗
PubMed2003

Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Upper gastrointestinal (UGI) swallow radiographs following laparoscopic Roux-en-Y gastric bypass (LRYGBP) may detect an obstruction or an anastomotic leak. The aim of our study was to determine the efficacy of routine imaging following LRYGBP. METHODS: Radiograph reports were reviewed for 201 consecutive LRYGBP operations between April 1999 and June 2001. UGI swallow used Gastrografin, static films, fluoroscopic video, and a delayed image at 10 minutes. Mean values with one standard deviation were tested for significance (P < 0.05) using the Mann-Whitney U test statistic. RESULTS: Of 198 available reports, UGI detected jejunal efferent (Roux) limb narrowing (n = 17), partial obstruction (n = 12), anastomotic leak (n = 3), complete bowel obstruction (n = 3), diverticulum (n = 1), hiatal hernia (n = 1), and proximal Roux limb narrowing (n = 1). A normal study was reported in 160 cases (81%). Partial obstruction resolved without intervention. Complete obstruction required re-operation. Compared to 6 patients who developed delayed leaks, early identification of a leak by routine UGI swallow resulted in a shorter hospital stay (mean 7.7 +/- 1.5 days vs 40.2 +/- 12.3 days, P < 0.03). CONCLUSIONS: Early intervention after UGI swallow may lessen morbidity. Routine UGI swallow following LRYGBP does not obviate the importance of close clinical follow-up.

Adult↗
PubMed1996

Validation of Pouch Size Measurement Following the Swedish Adjustable Gastric Banding Using Endoscopy, MRI and Barium Swallow.

BACKGROUND: Pouch volume appears to be of major importance for subsequent weight loss following any gastric restriction type of surgery for morbid obesity. In order to be able to evaluate pouch volume following Swedish Adjustable Gastric Banding (SAGB), an endoscopic pouch volume classification system was designed in which pouch volume is classified in five categories. The aim of this study was to validate the endoscopic classification system using MRI and barium swallow as reference methods for pouch volume measurement. METHODS: Twenty patients (13 women and seven men) were operated for obesity with SAGB. They were investigated a mean of 3 years (6 weeks-5.5 years) after surgery and had at that time lost a mean of 60 (12-112) kg. During the same afternoon they sequentially underwent endoscopy, MRI and barium swallow with an empty stomach. RESULTS: The mean pouch volume measured with MRI was 70 ml (0-1 80 ml) and with barium swallow was 72 ml (0-1 95 ml). In 17/20 patients the volume as measured by MRI and barium swallow was in the same volume category as with endoscopy. The correlation measured according to Pearson was significant between endoscopy on one hand and MRV barium swallow both independently and together (p < 0.001). CONCLUSION: Based on these results we are confident in using our endoscopic classification system for postoperative follow-up of pouch volume.

Journal Article↗
PubMed2006

Air swallowing caused recurrent ileus in Tourette's syndrome.

This report describes an adolescent boy who has Tourette's syndrome and developed a subtle but significant increase in vocal tics after an 8-month respite. The increase in vocal tics was associated with an acute increase in psychological stressors and resulted in recurrent air swallowing, which, in turn, caused abdominal cramping, eructation, and flatus, eventually leading to aeroenteria. Air swallowing was recognized only after a second hospital admission for recurrent ileus. Air swallowing and associated symptoms were mitigated by reinstitution of psychopharmacologic treatment and an increase in the patient's self-awareness of the air-swallowing behavior. Clinically significant air swallowing has not been described previously in Tourette syndrome or a tic disorder. This case is important for pediatricians and pediatric gastroenterologists because either may be the first to evaluate a child or an adolescent with unexplained recurrent ileus. This report also documents the importance of the connection between the brain and the body.

Adolescent↗
PubMed2004

[The influence of oral and pharyngeal phases on the swallowing dynamic].

BACKGROUND: The pharyngeal phase of swallowing has received more attention than oral phase although they are presumably interdependent. AIMS: 1. to evaluate, through the videofluoroscopic method, the oral phase of swallowing in order to observe the characteristics organization of the liquid bolus in healthy volunteers and the variations of this organization in exams of patient with dysphagia; 2. to establish the functional interrelation between both organization and ejection stages; 3. to verify the presence (or absence) of interference of the oral phase over the pharyngeal phase. CASUISTIC AND METHOD: Videofluoroscopic assessment has been performed in patients with stroke (15), patients with Parkinson disease (15) and in health volunteers (14). All of the studied individuals were submitted to the swallowing videofluoroscopic evaluation following protocol described by Junqueira and Costa. We privileged the incidence in right profile with middle of liquid contrast (solution of barium sulfate). RESULTS: According to the intra-oral organization of the contrasted bolus, we could classify the oral organization as: 1. closed, 2. open, that can be subdivided in open "anterior restricted" and "open expanded", 3. prolonged, and 4. unstable. The ejection can be defined as: 1. appropriate, 2. lentify, and 3. in two times. The correlation among the oral dynamics acted by the organization and pharyngeal phases can be noticed as: 1. appropriate, 2. adapted, and 3. altered. The organization and ejection types as well as the observed correlations are shown with statistics significance. CONCLUSIONS: The closed organization type was the one characterized as normal. The "open expanded", "prolonged" and "unstable" organization type can be associated with alteration in the swallowing process. The "lentify" and "two times" ejection types also point to swallowing physiology alteration. There are functional correlation between organization and oral ejection. The oral organization has influence, not only in the quality of the oral ejection, but also, in the effective dynamics of the pharyngeal phase.

Adult↗
PubMedDate not supplied

[Removal of sucking habits and myofunctional therapy: establishing swallowing and tongue rest position].

BACKGROUND: The prolonged habit of pacifier sucking and the prolonged use of feeding bottle may cause myofunctional disorder, such as incorrect swallowing pattern and inadequate tongue rest position. AIM: To study the effect of myofunctional therapy (MFT) associated with the removal of the habit of pacifier sucking and the use of feeding bottle (REM) on the rehabilitation of swallowing and tongue rest position. METHOD: Two groups with ten children, ages ranging from four to four years and eight months, who initially presented a pacifier sucking habit and used the feeding bottle were studied. Children on REM group underwent the process of sucking habits removal using the Modified-Counselling Method, whereas children on MFT group underwent the same procedure associated to myofunctional therapy. Pre-treatment assessments were made, as well as 60 and 180 days post-treatment assessments. Data were analyzed using the statistical tests of Mann-Whitney and Wilcoxon (p < 0.05). RESULTS: Results indicate that children in the MFT group presented adequate swallowing patterns after 60 and 80 days, and presented adequate tongue rest position after 180 days. Children on the REM group, however, presented adequate swallowing pattern only after 180 days and did not present a significant improvement on the tongue rest position during the assessments. CONCLUSION: Myofunctional therapy associated to the removal of sucking habits presented a better and faster improvement of the swallowing pattern and of the tongue rest position.

Bottle Feeding↗
PubMed2003

Glucose-dependent insulinotropic polypeptide and insulin-like immunoreactivity in saliva following sham-fed and swallowed meals.

Gastrointestinal peptides, including insulin, glucagon and glucose-dependent insulinotropic polypeptide (GIP) have previously been reported in salivary glands. Recent evidence has suggested they might influence postprandial macronutrient metabolism. This study therefore investigated and compared postprandial hormone concentrations in saliva and plasma to determine whether their secretion was influenced by oral food stimuli. In a within-subject randomised cross-over comparison of hormone concentrations in plasma and saliva following a mixed meal, 12 subjects were given two 1708 kJ mixed meals. On one occasion the meal was chewed and swallowed (swallowed meal), on the other it was chewed and expectorated (sham-fed meal). Salivary and plasma levels of immunoreactive insulin, GIP and glucagon-like peptide-1 (GLP-1), total protein, alpha-amylase, glucose and non-esterified fatty acid were measured before and for 90 min following the meals. Saliva total protein and alpha-amylase rose following both meals, indicating that the stimulus for salivary protein release is related to the presence of food in the mouth. GLP-1 was not detected in saliva. Fasting salivary insulin levels were lower in saliva than plasma (28+/-6 vs 40+/-25 pmol/l respectively). Both increased following the swallowed meal but the rise in saliva was slower and less marked than in plasma (peak levels 96+/-18 and 270+/-66 pmol/l for saliva and plasma respectively, P<0.01). Both were unchanged following the sham-fed meal. GIP was detected in saliva. Fasting GIP levels were significantly higher in saliva than plasma (183+/-23 compared with 20+/-7 pmol/l, P<0.01). They decreased in saliva following both swallowed and sham-fed meals to nadirs of 117+/-17 and 71+/-12 pmol/l respectively, but rose following the swallowed meal to peak levels of 268+/-66 pmol/l. These findings are consistent with insulin in saliva being an ultrafiltrate of that circulating in blood, but GIP in saliva being the product of local salivary gland synthesis, whose secretion is influenced, directly or indirectly, by oral stimuli. The function of salivary GIP is unknown, but we speculate that it may play a role in the regulation of gastric acid secretion in the fasting state.

Adult↗
PubMed2006

Evaluating cytochrome p450 in lesser scaup (Aythya affinis) and tree swallow (Tachycineta bicolor) by monooxygenase activity and immunohistochemistry: possible nonlethal assessment by skin immunohistochemistry.

Six-month-old lesser scaup (Aythya affinis) and nestling tree swallows (Tachycineta bicolor) were injected intraperitoneally with beta-naphthoflavone (BNF) in corn oil or in vehicle alone. Liver samples were taken and stored at -80 degrees C until microsome preparation and monooxygenase assay. Skin samples were placed in buffered formalin for subsequent immunohistochemical (IHC) analysis for cytochrome P4501A (CYP1A). Lesser scaup treated with BNF at 20 or 100 mg/kg body weight showed approximately 6- to 18-fold increases in four monooxygenases (benzyloxyresorufin-O-dealkylase, ethoxyresorufin-O-dealkylase, methoxyresorufin-O-dealkylase, and pentoxyresorufin-O-dealkylase). No IHC response was observed for CYP1A in the skin of vehicle-injected ducks, whereas in the skin from BNF-treated ducks, the positive IHC response was of similar magnitude for both dose levels of BNF. Tree swallows injected with BNF at 100 mg/kg, but not at 20 mg/kg, showed significant increases (approximately fivefold) in hepatic microsomal O-dealkylase activities. Cytochrome P4501A was undetectable by IHC response in skin from corn oil-treated swallows, but positive IHC responses were observed in the skin of one of five swallows at 20 mg/kg and four of five swallows at 100 mg/kg. Although these data do not allow construction of significant dose-response curves, the IHC responses for CYP1A in skin support the possible use of this nonlethal approach for biomonitoring contaminant exposure of birds. In addition, the CYP1A signal observed at the bases of emerging feathers suggest that these might provide less invasive sampling sites for IHC analysis of CYP1A.

Animals↗
PubMed2005

Assessment of fetal swallowing with gray-scale and color Doppler sonography.

OBJECTIVE: Our study was focused on the evaluation of fluid dynamics to assess the value of gray-scale and color Doppler sonography for evaluating the development of fetal swallow-related movements from early gestation until birth. MATERIALS AND METHODS: We examined 56 fetuses from weeks 15-39 of gestation. Each fetus was examined throughout four distinct periods of gestation: weeks 15-18, 22-25, 30-34, and 37-39. During the examination, seven gray-scale sonography or color Doppler sonography patterns and their prevalence were considered. RESULTS: Mandibular and/or labial movements (chi2 = 56.4, p < 0.0001) and their rhythmic activity (chi2 = 41.4, p < 0.0001) were seen on gray-scale sonography in an increasing percentage of fetuses as gestational age increased. Doppler findings showed an increase for nose-mouth flow signals (chi2 = 57.6, p < 0.0001), larynx-esophagus flow signals (chi2 = 13.2, p = 0.0003), and effective swallowing (chi2 = 36.0, p < 0.0001) as gestational age increased. CONCLUSION: There is a trend in the fetus toward development of increased coordinated movement and more functional nose-mouth flow with increasing gestational age: 32.1% of the 56 fetuses in our series achieved effective swallowing at 37-39 weeks, on the basis of gray-scale and Doppler evaluations. Knowledge of the physiologic mechanism involving swallowing development may allow identification of altered swallow-related movements in fetuses with malformations of the digestive tract or with neurologic disorders.

Adult↗
PubMed1989

The effect of high- vs low-density barium preparations on the quantitative features of swallowing.

We compared the effect of high-density and low-density barium preparations on the quantitative features of swallowing. The two barium preparations differed primarily in density but also differed somewhat in viscosity. Concurrent videofluoroscopic and manometric studies were done in nine healthy control subjects. Videofluoroscopy was recorded in the lateral projection at 30 frames/sec while concurrent manometry was done with five intraluminal transducers that straddled the pharynx and upper esophageal sphincter. Swallows of 5 and 10 ml of high- and low-density barium preparations were recorded. Analysis indicated that, compared with the low-density barium (1.4 g/cm3), the high-density barium (2.5 g/cm3) preparation had a slower oral and pharyngeal bolus transit time and caused significant quantitative differences in the function of the upper esophageal sphincter. Compared with low-density barium boluses, the high-density barium boluses were associated with later sphincter opening and closure, longer duration of sphincter opening and flow, lower flow rate, greater maximal anterior hyoid movement, greater sagittal sphincter diameter, and higher intrabolus pressure upstream of and within the sphincter. We conclude that the density as well as the viscosity of the barium preparation used in radiologic examination of the oral-pharyngeal phases of swallowing has an influence on bolus transit time through the mouth and pharynx, and on the quantitative features of upper esophageal sphincter opening. Although these quantitative differences cannot generally be recognized visually at fluoroscopy, they become important for the quantitative assessment of swallowing in patients with suspected disorders of oral-pharyngeal swallowing. Therefore, the basic barium preparations used to examine such patients should be either standardized or at least specified.

Adult↗
PubMed1991

Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases.

Swallowing disorder is an increasing problem in our aging population. A majority of these patients have a functional abnormality of the oral, pharyngeal, and/or esophageal stage of swallowing. However, what constitutes normalcy is not well understood, and baseline swallowing in elderly persons without dysphagia has not been adequately described. We therefore evaluated 56 persons with a mean age of 83 years who had no symptoms of dysphagia or eating difficulty. Videofluoroscopy and radiographs with the subject erect and recumbent were obtained. Normal deglutition, as defined in young persons, was present in only 16%. Oral abnormalities (difficulty ingesting, controlling, and delivering bolus relative to swallowing initiation) were seen in 63%. Pharyngeal dysfunction (bolus retention and lingual propulsion or pharyngeal constrictor paresis) was seen in 25%. Pharyngoesophageal segment abnormalities were observed in 39% (mostly cricopharyngeal muscle dysfunction). Esophageal abnormalities (mostly motor in nature) were observed in 36%. What has been described as swallowing dysfunction in young persons may not be abnormal in very elderly persons. It is difficult to distinguish the effect of normal aging from the effects of specific diseases or gradual degenerative changes.

Aged↗
PubMed1993

Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture.

OBJECTIVE: We investigated the frequency with which changes in the position of a patient's head or body eliminated aspiration of liquid barium during videofluoroscopic swallowing studies in patients with oropharyngeal dysphagia. We also studied factors that influenced the effect of posture on aspiration. SUBJECTS AND METHODS: The study group comprised 165 patients consecutively referred for videofluoroscopic examination of the oropharyngeal stages of swallowing in whom aspiration of barium occurred while swallowing 1, 3, 5, or 10 ml of thin liquid barium or drinking barium from a cup. When aspiration occurred, the patient changed to one of five postures (chin down, chin up, head rotated, head tilted, and lying down), selected on the basis of the specific swallowing abnormality causing the aspiration. RESULTS: Changes in head or body position eliminated aspiration of at least one bolus of barium in 127 (77%) of the 165 patients, and of all four boluses plus drinking barium from a cup in 41 patients (25%). Postural changes were less beneficial in preventing aspiration in patients with substantial language or cognitive defects or restricted head movement. CONCLUSIONS: Postural techniques can eliminate aspiration of barium of at least small volumes in most patients. Expansion of the oropharyngeal swallowing study to include the effect of various postures can be done with minimal risk of increased aspiration.

Barium Sulfate↗
PubMed2000

Videofluoroscopy of swallowing in symptomatic patients who have undergone long-term intubation.

OBJECTIVE: The aim of this study was to evaluate whether specific patterns of swallowing dysfunction occur in symptomatic patients after long-term intubation. SUBJECTS AND METHODS: Twenty-one patients (16 men, five women; mean age, 66 years) who presented with clinical signs of aspiration after long-term intubation (mean duration, 24.6 days) underwent videofluoroscopy. They were analyzed for functional abnormalities of the tongue, soft palate, epiglottis, hyoid and larynx, pharynx, and the upper esophageal sphincter. We assessed the presence or absence of aspiration, the type of aspiration (pre-, intra-, and postdeglutitive), and a spectrum of other swallowing abnormalities. RESULTS: There were 18 patients (86%) with radiologically proven aspiration. In another patient only laryngeal penetration occurred. There were 11 combinations of pre-, intra-, and postdeglutitive aspiration. Predeglutitive aspiration was predominant and present in 52% of our patients. We found functional abnormalities of the tongue in 48%, of the soft palate in 10%, of the epiglottis in 48%, of the pharynx in 71%, and of the upper esophageal sphincter in 24%. CONCLUSION: Patients who are symptomatic after undergoing long-term intubation do not develop a specific type or pattern of swallowing dysfunction or aspiration, but show a large variety of aspiration types and associated swallowing disorders. Nevertheless, videofluoroscopy has the ability to reveal complex deglutition disorders and to aid precise planning of individualized functional swallowing therapy.

Aged↗
PubMedDate not supplied

Oro-pharyngeal sensitivity and elicitation of swallowing in man.

In dry swallowings repeated at maximum frequency, manometric recording on healthy volunteers showed that the swallowing intervals successively increased. After surface anaesthesia of the oro-pharynx the difficulties in dry swallowing increased. A corresponding increase did not occur in sham tests. The results show that the elicitation of swallowing is dependent upon oro-pharyngeal sensitivity and further that the reflexive elicitation of swallowing cannot instantly be fully replaced by other mechanisms.

Adolescent↗
PubMed2001

Drooling in Parkinson's disease: a novel tool for assessment of swallow frequency.

A non-invasive way to obtain objective measurements of swallowing frequency and thus indirectly, drooling was required as part of the study 'Drooling in Parkinson's disease: objective measurement and response to therapy'. A hard disk, digital recorder was developed, for use on a laptop computer, which was capable of collecting large quantities of swallowing data from an anticipated 40 patients and 10 controls. An electric microphone was taped to the subjects' larynx for recording the swallow sounds when drinking 150 ml of water and at rest for 30 minutes. The software provides an accurate visual display of the audio-signal allowing the researcher easy access to any segment of the recording and to mark and extract the swallow events, so that swallow frequency may be efficiently and accurately ascertained. Preliminary results are presented.

Case-Control Studies↗
PubMed1990

When it's hard to swallow. Feeding techniques for dysphagia management.

There are three phases of swallowing: oral, where the food is chewed; pharyngeal, where the bolus begins to move downward; and esophageal, where the bolus enters the esophagus. Signs of difficulty in swallowing may include difficulty initiating the swallow, packing food into cheeks, drooling, cough after a swallow or absent or weak cough, or fluid leaking from the nose after swallowing. Take your time when feeding patients and do not wash food down with liquids. Also, remember to position the patient properly and teach both the patient and his family effective feeding techniques.

Deglutition Disorders↗
PubMed2000

Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke.

Swallowing problems can affect as many as one in three patients in the period immediately after a stroke. In some cases this can lead to serious morbidity, in particular malnutrition and pulmonary aspiration. Despite this, swallowing usually recovers to a safe level in the majority of patients within weeks. This propensity for recovery is likely to relate to how the swallowing motor cortex is organized and then reorganized after cerebral injury. In this review, we examine present knowledge on the cortical control of swallowing in humans, and examine the aspects of its organization that are important for compensating for recovery after damage. In addition, we examine approaches which may be useful in speeding up the process of recovery. Swallowing may turn out to be a useful model for studying central nervous system plasticity.

Animals↗
PubMed2000

[Videofluorographic study of swallowing in patients with severe motor and intellectual disabilities--I. Recurrent pulmonary infections].

We studied swallowing movements of 8 patients with severe motor and intellectual disabilities and recurrent pulmonary infectious diseases. All the patients were orally fed with no problems, but had frequent episodes of pyrexia, mostly due to pulmonary infections. Videofluorographic studies revealed severe impairments in the transitional and pharyngeal phases. The patients aspirated liquids, most frequently during swallowing. Prior to swallowing pooling of liquid barium was frequently observed in the hypopharynx, and that of purees in the pharynx after swallowing. The delay of cricopharyngeal relaxation was also frequently observed. Based on the videofluorographic findings, we made some efforts to provide patients with evident or latent aspiration with better management: changes in food textures and posture during drinking and eating. These efforts significantly reduced the frequency of pyrexic episodes. Since latent aspiration is not uncommon among patients with severe motor and intellectual disabilities, swallowing disturbance should be evaluated in detail by videofluorographic examination to improve QOL.

Adult↗