Higher risk of complications in odynophagia-associated dysphagia in amyotrophic lateral sclerosis

Abstract

Objective: This investigation aimed to identify associated factors with dysphagia severity in amyotrophic lateral sclerosis (ALS). Method: We performed a cross-sectional study of 49 patients with ALS. All patients underwent fiberoptic endoscopy evaluation of swallowing and answered a verbal questionnaire about swallowing complaints. The patients were divided into groups according to dysphagia severity. Results: Among the factors analyzed, only odynophagia was associated with moderate or severe dysphagia. Conclusion: Odynophagia was associated with moderate and severe dysphagia in ALS and suggests a high risk of pulmonary and nutritional complications.Keywords: amyotrophic lateral sclerosis, dysphagia, neurodegenerative disorders, malnutrition, pneumonia, pain. RESUMOObjetivo: Identificar fatores associados com a gravidade da disfagia na esclerose lateral amiotrófica (ELA). Método: Estudo transversal incluindo 49 sujeitos com esclerose lateral amiotrófica. Todos foram submetidos à videoendoscopia da deglutição e responderam a um questionário sobre queixas de deglutição. Foram divididos em grupos de acordo com a gravidade da disfagia. Resultados: Dentre os fatores estudados, apenas a odinofagia foi significantemente associada à disfagia moderada ou grave. Conclusão: A odinofagia foi associada à disfagia moderada ou grave na ELA e sua presença sugere maior risco para complicações pulmonares e nutricionais.Palavras-chave: esclerose lateral amiotrófica, disfagia, doenças neurodegenerativas, desnutrição, pneumonia, dor.

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

“…Further, the clinical presentation and progression of swallowing impairment and dysphagia in MND is heterogeneous – even between subtypes classic ALS, grouped by onset-type (i.e., bulbar- vs. spinal-onset). Several factors reported to influence or predict the severity and rate of progression of dysphagia in MND (particularly ALS), include: age at disease onset (i.e., older individuals often progress faster, require non-oral feeding sooner) [27–29], sex (i.e., females often present with bulbar symptoms earlier, and possibly greater severity) [27,30,31], and symptom onset (i.e., bulbar-onset ALS and PBP show faster rate of decline, different clinical presentation) [13,15,30,32,29]. Disease duration and the length of time since onset of bulbar symptoms have also been reported as prognostic indicators of function and severity [29,33].…”

“…This has provided a rationale for using sensory tricks in dysphagia management – on the assumption that these strategies exploit unimpaired mechanisms to compensate for impaired motor function (e.g., [30,101]). However, we were surprised to find that 7 articles (i.e., 4.5% of all reviewed articles) reported observing silent aspiration [13,16,39,41,45,62,122], and an additional subset of articles reported sensory changes such as reduced laryngeal sensitivity, changes in taste, and odynophagia [32,37,46,112,123]. These observations support a more contemporary view of MND as a multi-system disorder [124].…”

Identificação das alterações de deglutição: percepção de pacientes com doenças neurodegenerativas

“…According to the literature, sensations such as odynophagia can be explained by spasticity, atrophy, stiffness and changes in muscle tone. The perception of this sensation on swallowing may consequently alter mobility, reduce motor coordination, and affect muscle function for bolus feeding and opening of pharyngoesophageal transition (13) .…”

Prediction of prognosis of ALS: Importance of active denervation findings of the cervical-upper limb area and trunk area

“…Swallowing is controlled by muscles that are innervated mainly by the pons and medulla oblongata such as the glossopharyngeal nerve, vagal nerve and hypoglossal nerve (21,22), and bulbar onset and tongue atrophy are associated with loss of this function. Breathing is controlled by complex relationships among many muscles, of which the diaphragm and the anterior, middle and posterior scalene muscles, which function in intake, are innervated by C3-C4, C4-C7, C2-C7 and C5-C8, respectively.…”