Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction

Wei, Pengxu

doi:10.3390/toxins14050321

Cited by 9 publications

(12 citation statements)

References 86 publications

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“…It is important to note that botulinum toxin injection should only be administered by specialists who are experienced with this technique and when other simple interventions have been attempted with unsatisfactory results. Side effects, including worsening of reflux and temporary worsening of dysphagia, have been reported ( Wei, 2022 ).…”

Section: Dysphagia In Parkinson’s Diseasementioning

confidence: 99%

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

Bhidayasiri

Phuenpathom

Tan

et al. 2022

Front. Aging Neurosci.

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Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson’s disease (PD). Those that affect the lower GI tract, such as constipation, are the most frequently reported GI problems among patients with PD. Upper GI issues, such as swallowing dysfunction (dysphagia) and delayed gastric emptying (gastroparesis), are also common in PD but are less well recognized by both patients and clinicians and, therefore, often overlooked. These GI issues may also be perceived by the healthcare team as less of a priority than management of PD motor symptoms. However, if left untreated, both dysphagia and gastroparesis can have a significant impact on the quality of life of patients with PD and on the effectiveness on oral PD medications, with negative consequences for motor control. Holistic management of PD should therefore include timely and effective management of upper GI issues by utilizing both non-pharmacological and pharmacological approaches. This dual approach is key as many pharmacological strategies have limited efficacy in this setting, so non-pharmacological approaches are often the best option. Although a multidisciplinary approach to the management of GI issues in PD is ideal, resource constraints may mean this is not always feasible. In ‘real-world’ practice, neurologists and PD care teams often need to make initial assessments and treatment or referral recommendations for their patients with PD who are experiencing these problems. To provide guidance in these cases, this article reviews the published evidence for diagnostic and therapeutic management of dysphagia and gastroparesis, including recommendations for timely and appropriate referral to GI specialists when needed and guidance on the development of an effective management plan.

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Section: Dysphagia In Parkinson’s Diseasementioning

confidence: 99%

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

Bhidayasiri

Phuenpathom

Tan

et al. 2022

Front. Aging Neurosci.

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“…& ]. Different techniques can be used to guide botulinum toxin injection, such as transcutaneous EMG, endoluminal injection under endoscope guidance, as well as ultrasound-guided transcutaneous injection and computed tomography [113 ]. Serious complications, including pharyngocutaneous fistulas, mediastinitis, and perforation of the esophagus have also been rarely reported [113 & ].…”

Section: Acupuncturementioning

confidence: 99%

“…Reduced or absent opening of the UES can represent a pivotal pathophysiological mechanism of dysphagia in patients with stroke and Parkinson's disease [54,55,56 ▪▪ ,112,113 ▪ ,114]. In such cases, botulinum toxin injection into the cricopharyngeal muscle (the main component of the UES) can markedly improve the safety and efficacy of swallowing [55,113 ▪ ].…”

Section: Treatment Strategiesmentioning

confidence: 99%

“…These latter are due to the diffusion of the toxin to nearby muscles, that is, hypopharynx and laryngeal muscles, respectively [55,113 ▪ ]. Serious complications, including pharyngocutaneous fistulas, mediastinitis, and perforation of the esophagus have also been rarely reported [113 ▪ ]. Thus, this off-label treatment should be performed after careful patient selection and discussion with the patient.…”

Section: Treatment Strategiesmentioning

confidence: 99%

“…Different techniques can be used to guide botulinum toxin injection, such as transcutaneous EMG, endoluminal injection under endoscope guidance, as well as ultrasound-guided transcutaneous injection and computed tomography [113 ▪ ].…”

Section: Treatment Strategiesmentioning

confidence: 99%

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Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

Cosentino

Todisco

Giudice

et al. 2022

Current Opinion in Neurology

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Purpose of reviewNeurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice.Recent findingsThe pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues.SummaryScreening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing.

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Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT

Gao,

Inamoto,

Saitoh

et al. 2024

J of Oral Rehabilitation

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BackgroundUpper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established.ObjectiveThis study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320‐row area detector computed tomography (320‐ADCT).MethodsNinety‐four healthy adults (43 males; 22–90 years) underwent 320‐ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann–Whitney U test and Spearman's correlation coefficient.ResultsUES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = −.312, p = .002), but the negative correlation was low at maximum displacement (r = −.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = −.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = −.555, p < .001), although this effect was unclear when analysed by sex.ConclusionMales showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.

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Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction

Cited by 9 publications

References 86 publications

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT

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