Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

Objective:Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).Methods:A systematic literature review was conducted, searching MEDLINE from inception to 05/2020 for FEES findings in neurological diseases of interest. Based on a retrospective analysis of FEES-videos in neurological diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1012 randomly selected FEES-videos of patients with various neurological disorders. Chi-square-tests were used to compare the distribution of dysphagia phenotypes between the underlying neurological disorders.Results:159 articles were identified of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) “Premature bolus spillage” and (2) “delayed swallowing reflex” occurred mainly in stroke patients, (3) “predominance of residue in the valleculae” was most common in Parkinson's disease, (4) “predominance of residue in the piriform sinus” occurred only in myositis, motoneuron disease and brainstem stroke patients, (5) “pharyngolaryngeal movement disorder” was found in atypical Parkinsonian syndromes and stroke patients, (6) “fatigable swallowing weakness” was common in patients with myasthenia gravis, and (7) “complex disorder” with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic later sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).Conclusion:Neurogenic dysphagia is not a mere symptom, but a multi-etiological syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.

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“…Prolonged oral or pharyngeal transit time 47 Piecemeal deglutition 47 Impaired secretion management e6…”

Section: Amyotrophic Lateral Sclerosismentioning

confidence: 99%

Neurogenic Dysphagia

et al. 2021

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“…Across the included studies, the number of participants sampled per study ranged from 16 participants 20 to 486 participants 17 . Age related data was only reported by Sreeraj et al 17 (18 to 90 years) study, and the other studies 18-20 did not report any data with respect to age of the participants. Sex distribution of the participants was not clearly described in any of the four studies.…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of identified dysphagia ranged from 11.1% 18 to 87.5%. 20 However, only two studies 17,19 reported occurrence of associated pneumonia. In Sreeraj et al 17 study, aspiration pneumonia was reported in 91 (22.8%) patients among 154 patients identified with dysphagia.…”

Section: Resultsmentioning

confidence: 99%

“…Sex distribution of the participants was not clearly described in any of the four studies. [17][18][19][20] All the four studies [17][18][19][20] included in the final review consisted of both ischemic and hemorrhagic stroke.…”

Section: Age Sex and Type Of Strokementioning

confidence: 99%

Section: Frequency Of Dysphagia and Associated Pneumoniamentioning

confidence: 99%

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Dysphagia and associated pneumonia in stroke patients from India

Krishnamurthy

Premkumar

Balasubramanium

2020

Preprint

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Background: India has high incidence (116-163 per 100,000) of stroke compared to western countries. Stroke is reported to be the fourth leading cause of death and fifth leading cause of disability in India. Dysphagia is seen approximately in half of the stroke patients and if unidentified may result in pulmonary complications such as aspiration pneumonia. However, there is no estimate of post stroke dysphagia and associated pneumonia in India. Method: Using the PRISMA methodology, a systematic search for recent literature on dysphagia in stroke was carried out across all the major databases. Two authors independently screened the titles and the abstracts, and those selected articles were assessed for quality using the GRADE approach. Comparisons were made of reported dysphagia and pneumonia frequencies, the relative risks of developing pneumonia were calculated. Data on duration of hospital stay and rates of mortality were also extracted. Results: We identified 86 citations, out of which only four articles were deemed eligible for critical analyses and data extraction. A high incidence (11.1% - 87.5%) of dysphagia was observed among stroke patients. Only two studies reported on incidence of pneumonia (22.8% - 32%); only one study stratified patients by both dysphagia and pneumonia. A relative risk of 5.82 (95% CI 4.6, 7.2) was found for pneumonia in patients with stroke and dysphagia. Data on length of hospital stay and rates of mortality secondary to aspiration pneumonia are also presented. Conclusion: Despite high incidence of dysphagia and associated pneumonia the methodological quality of studies are low. There is a dire need for methodologically sound studies to accurate determine the incidence of dysphagia and its impact on stroke patients in India. Keywords: deglutition; deglutition disorders; dysphagia; stroke; incidence; india;

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