Post‐operative swallowing in multiple system atrophy

Ueha, Rumi; Nito, Takaharu; Sakamoto, Takashi; Yamauchi, Akio; Tsunoda, Koichi; Yamasoba, Tatsuya

doi:10.1111/ene.12880

Cited by 25 publications

(39 citation statements)

References 18 publications

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“…Vocal fold immobility is another frequent complication of MSA ( 3 ). Swallowing dysfunction and vocal fold immobility are related, as both the thyropharyngeal and cricopharyngeal muscles are innervated by the vagus nerve ( 3 , 7 ). Few studies have evaluated the relationship between vocal fold immobility and dysphagia in MSA.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have evaluated the relationship between vocal fold immobility and dysphagia in MSA. We previously reported that vocal fold abductor paralysis tended to precede dysphagia in MSA-C patients ( 19 ) and the MSA-C patients with severe vocal fold abductor paralysis also suffered from severe dysphagia ( 3 ). Impaired UES opening and bolus stasis at the pyriform sinuses have been reported as associated with vocal fold abductor paralysis in MSA ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Deterioration of swallowing function is one of the manifestations of MSA that dramatically affects quality of life and prognosis of patients ( 3 ) and dysphagia- related complications such as respiratory infections (mostly aspiration pneumonia) and malnutrition are most the common causes of death ( 4 , 5 ). Delayed oral and pharyngeal phases of swallowing, in combination with impaired airway protection and esophageal sphincter contraction disturbances, may lead to acute aspiration and pneumonia ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Impaired relaxation of the upper esophageal sphincter (UES) has been reported regardless of MSA phenotype ( 7 ). It is hypothesized that neurodegenerative changes in the brain stem and vagus nerve might contribute to a dysfunctional cricopharyngeous muscle, resulting in impairment of UES opening and bolus residue in the pyriform sinuses ( 3 , 6 , 7 ). Despite the prevalence of swallow dysfunction in persons with MSA, swallowing function in MSA has not been investigated systematically, and the underlying pathophysiological mechanisms of dysphagia, especially the incipient swallowing changes in MSA, remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

et al. 2018

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Introduction: Multiple system atrophy (MSA) has detrimental effects on swallowing function. The swallowing function of patients with MSA has not been systematically characterized and the underlying pathophysiological mechanisms of dysphagia remain poorly understood.Objectives: To investigate the characteristics of swallow function in MSA using high-resolution manofluorography (HRMF).Methods: We conducted a retrospective review of twenty-five MSA patients who underwent HRMF from 2016 to 2017. HRMF was utilized on patients with only oral diet (Functional Oral Intake Scale (FOIS) >3). Pharyngoesophageal and proximal esophageal pressure profiles were evaluated and compared to established normative data. The frequency and characteristics of upper esophageal sphincter (UES) and proximal esophageal abnormalities during rest and swallow were calculated.Results: The ages of patient cohort in our study ranged from 48–81 years (median 65 years) with male predominance (68%). We observed a distinct abnormal deglutitive proximal esophageal contraction (ADPEC) in 14 (56% of patients), which appears to reflect a discoordinated response of the striated muscle esophagus. Deficient UES relaxation duration, impaired UES relaxation, hypertensive resting UES pressure and hypotensive resting UES pressure were detected in 8 patients (32%), 3 patients (12%), 1 patient (4%), and 11 patients (44%) respectively.Conclusions: In patients with MSA, abnormal UES resting pressure is common. A discoordinated proximal esophageal pressure response was identified and may be a pathognomonic manometry finding for MSA. These findings may serve as indications of early stage swallowing dysfunction in patients with MSA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

et al. 2018

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“…Parkinson disease (PD) in its early years can be well managed with symptomatic dopaminergic therapy , whilst other movement disorders are less satisfactorily treated . The development of motor complications is a significant limitation to the long term use of levodopa.…”

mentioning

confidence: 99%

Advances and insights into neurological practice 2016−17

Schapira¹

2017

Euro J of Neurology

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Esophageal Dysmotility is Common in Patients With Multiple System Atrophy

et al. 2020

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Objectives: Esophageal dysmotility (ED) in patients with multiple system atrophy (MSA) are poorly understood. This study aimed to investigate the prevalence of ED in patients with MSA and to assess the relationship of esophageal abnormalities with other clinical findings and characteristics in these patients. Methods: A retrospective chart review was conducted to identify patients with MSA and to compare them to the elderly controls without MSA (65+ years) who underwent a videofluorographic esophagram from 2014 to 2019. Disease type, disease severity, vocal fold mobility impairment, abnormal deglutitive proximal esophageal contraction (ADPEC), and intra-esophageal stasis (IES) were reviewed and compared between groups. Results: Thirty-seven patients with MSA were identified. The median age was 63 and 26 (70%) were male. These patients were matched to 22 elderly adults with presbylarynx but not MSA (median age 77, 68% male). In MSA patients, cerebellar variant type was predominant (59%), and ADPEC was recognized in 18 patients (49%). Disease severity level (P = 0.028) and existence of IES (P = 0.046) were associated with higher risks of developing ADPEC. The prevalence of IES was significantly higher in patients with MSA (95%) compared to controls without MSA (46%) (P < 0.001). Disease severity level and the existence of IES were significantly associated with the presence of ADPEC (p < 0.05). Conclusion: ADPEC and IES were significantly more common in MSA than in elderly subjects without MSA. MSA severity is associated with the development of ADPEC. The data suggest that esophageal motility is predominantly affected in MSA.

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Post‐operative swallowing in multiple system atrophy

Abstract: Considering the impacts of TR and LC on survival time, postoperative feeding and swallowing, LC is a good option for treating MSA patients with dysphagia.

Cited by 25 publications

References 18 publications

High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

Advances and insights into neurological practice 2016−17

Esophageal Dysmotility is Common in Patients With Multiple System Atrophy

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