Assessment of Swallowing by Oropharyngoesophageal Scintigraphy in Patients with Amyotrophic Lateral Sclerosis

Abstract

Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease in adults, and dysphagia is one of its most frequent and disabling symptoms. Oropharyngoesophageal scintigraphy (OPES) permits a functional and semiquantitative study of the various stages of swallowing. We studied 28 ALS patients (12 females and 16 males; mean age = 63.57 +/- 10.39 yr SD), who were clinically rated against the ALSFRS scale (Amyotrophic Lateral Sclerosis Functioning Rating Scale) and underwent OPES with (99m)Tc-nanocolloid using either a liquid or a semisolid bolus. The semiquantitative parameters we analyzed were Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER(10s)). Hence, the OPES performed with a semisolid bolus produced a higher proportion of pathologic values for the swallowing variables than when liquid bolus was used. Analyzed by grouping the patients into classes according to their bulbar ALSFRS scores, we found a significant increase in the OTT (p < 0.005), PTT (p < 0.02), and Oropharyngeal Retention Index (OPRI) (p < 0.0004) variables in ALS patients with more severe bulbar involvement. OPES has turned out to be a very important examination for detecting tracheal-bronchial inhalation and it also offers the possibility of acquiring a semiquantitative evaluation of the amount of food inhaled. In our experience, OPES in patients with ALS has been easy to use, economic, well tolerated, and capable of supplying precise indications with regard to the extent of the swallowing disorder, which permits a better clinical definition of the ALS patient.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment

“…It is related to dysphagia and respiratory complications, which are major causes of morbidity and mortality in ALS. Decline in respiratory function occurs as disease progresses, due to diaphragmatic fatigue and weakness, atelectasis and broncoaspiration 3,4 .…”

“…Although ALS patients with bulbar involvement suffer from more severe swallowing problems, "non-bulbar" ALS patients may also have dysphagia 3 . There are few data devoted to the combined assessment of nutritional and respiratory status of ALS patients.…”

Respiratory Support in Patients With Amyotrophic Lateral Sclerosis

“…For example, in a study that assessed swallowing with scintigraphy, the ALSFRS-R bulbar score correlated with the degree of swallowing, but swallowing dysfunction was present even at the highest scores (less symptoms). 22 The evaluation of bulbar function remains subjective as a clinical assessment, where some clinical tests (swallowing and speech) and patient recall define the level of bulbar involvement. This is in contrast to the evaluation of ventilation, where several objective functional markers are followed through time.…”

Fiberoptic Endoscopic Evaluation of Swallowing as possible index of ALS clinical development

“…Dysphagia affects the first three phases of swallowing (buccal, oral and pharyngeal) 8,9 and progresses to make it impossible for the patient to feed orally. Dysphagia in patients with ALS has been studied with Videofluoroscopy, with FEES, and with OroPharyngeal-Esophageal Scintigraphy (OPES) 3,[10][11][12][13] .…”