Swallowing dysfunction in myasthenia gravis patients examined with high-resolution manometry

Kumai, Yoshihiko; Miyamoto, Takumi; Matsubara, Keigo; Satoh, Chisei; Yamashita, Satoshi; Orita, Yorihisa

doi:10.1016/j.anl.2021.05.002

Cited by 5 publications

(22 citation statements)

References 15 publications

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“…In the present case, the only bulbar symptom was a very slight feeling of discomfort in the pharynx. MG patients with dysphagia present decreased pharyngeal clearance [ 3 , 7 , 9 ], but VE revealed no abnormalities, such as pooling of the saliva. Although pharyngeal residues have been reported in MG-related dysphagia [ 2 , 7 , 9 , 10 ], VF revealed no pharyngeal residues or penetration/aspiration in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…MG patients with dysphagia present decreased pharyngeal clearance [ 3 , 7 , 9 ], but VE revealed no abnormalities, such as pooling of the saliva. Although pharyngeal residues have been reported in MG-related dysphagia [ 2 , 7 , 9 , 10 ], VF revealed no pharyngeal residues or penetration/aspiration in our patient. Interestingly, we could identify mild bulbar symptoms that were undetectable by evaluation of swallowing function using VE or VF.…”

Section: Discussionmentioning

confidence: 99%

“…HRM has 36 circumferential pressure sensors spaced 1 cm apart and provides precise pharyngeal pressure information. Pharyngeal findings of HRM have been clinically applied to identify pharyngeal weakness in MG [ 7 ]. However, changes in pharyngeal pressure during the EC test have not yet been evaluated with HRM.…”

Section: Introductionmentioning

confidence: 99%

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The Usefulness of Swallowing Pressure Assessment in the Identification of Mild Pharyngeal Weakness of Myasthenia Gravis: A Case Report

et al. 2022

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Despite the clinical impact of dysphagia in myasthenia gravis (MG), a standard protocol for diagnosing dysphagia reliably has not yet been established. High-resolution manometry (HRM) provides precise information on pharyngeal pressure. We hypothesized that swallowing pressure assessment using HRM during the edrophonium chloride (EC) test could identify mild bulbar symptoms with no abnormalities on videoendoscopic (VE) and videofluorographic (VF) examination of swallowing, and we tested this hypothesis on a 72-year-old female patient diagnosed with ocular MG who developed slight pharyngeal discomfort over 3 months. The patient’s ocular symptoms were stable with pyridostigmine medication. VE and VF revealed no abnormalities. The swallowing pressure along the pharynx was measured using HRM during the EC test. HRM parameters, including velopharyngeal contractile integral and meso-hypopharyngeal contractile integral, were evaluated. These parameters were assessed for three swallows using 3 mL of water. After EC injection, the values of the velopharyngeal contractile integral (78.0 ± 5.4 vs. 134.7 ± 1.3 mm Hg cm·s) and the meso-hypopharyngeal contractile integral were both higher (130.6 ± 1.5 vs. 284.2 ± 11.9 mm Hg cm·s) than those observed before EC injection. Chest computed tomography revealed a thymoma that had not been observed in previous examinations. The patient was diagnosed with thymoma-associated MG. Intravenous immunoglobulin therapy improved the mild dysphagia. We concluded that swallowing pressure assessment during the EC test may be helpful in identifying mild bulbar symptoms in patients with MG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Usefulness of Swallowing Pressure Assessment in the Identification of Mild Pharyngeal Weakness of Myasthenia Gravis: A Case Report

et al. 2022

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“…studies. 6,8,9,[20][21][22][23][24][25][26][27][28][29] Four studies were published in Korea, four studies were published in the United States of America and the rest in Japan. Included studies were published between 1993 and 2022.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two of the included studies reported maximum swallowing pressure at meso-hypopharynx. 22,24 One study explored the maximum SP at meso-hypopharynx based on high-resolution manometry (HRM)…”

Section: Effects On Maximum Swallowing Pressure At Meso-hypopharynxmentioning

confidence: 99%

The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis

Li,

Huang,

Ding

et al. 2023

J of Oral Rehabilitation

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AimThe chin‐down posture is a widely used compensatory manoeuvre for patients with dysphagia. The aim of this study was designed to systematically measure the effectiveness of chin‐down manoeuvre application.MethodologyWe retrieved the PubMed, Web of Science, Embase, Cochrane Library, EBSCO, Medline, CNKI, WANFANG, VIP and SinoMed databases from inception to 30 August 2022. Raters independently screened literature according to inclusion and exclusion criteria. The quality of the included literature was evaluated, and data were extracted. The software Review Manager software 5.3 was used for statistical analysis.ResultsFourteen studies with a total of 571 patients were included in this meta‐analysis. The meta‐analysis indicated that chin‐down manoeuvre could significantly reduce the risk of aspiration (MD = −1.35, 95% CI [−2.25, −0.44], Z = 2.92, p < .01), decrease the chin angle (MD = −12.20, 95% CI [−14.61, −9.79], Z = 9.91, p < .001), shorten oral transit time (MD = −0.81, 95% CI [−1.20, −0.43], Z = 4.17, p < .001), reduce the maximum swallowing pressure at upper oesophageal sphincter (MD = −82.07, 95% CI [−112.77, −51.37], Z = 5.24, p < .001) and decrease pharyngeal residue.ConclusionsExisting evidence indicated that chin‐down manoeuvre could reduce the risk of aspiration and pharyngeal residue, decrease the maximum swallowing pressure at UES. More large‐sample, high‐quality clinical trials are still needed in the future to further ascertain the results of this research.

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Rheology for Safe Swallowing 1

Nishinari,

Zhang,

Yang

et al. 2023

J. Soc. Rheol., Jpn

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In aged society, the number of persons with difficulty in mastication and swallowing is increasing, and the aspiration-induced pneumonia is one of the top causes of death in the elderly. Although the detailed mechanism of aspiration is still not well understood, great efforts have been done to prevent the aspiration, and thickening of bolus has been found effective to reduce the risk of aspiration. It was pointed out earlier that excessive thickening reduces the palatability and the intake of fluids leading to dehydration and malnutrition and to formation of the residue as a risk of aspiration. In the present review, the physiological aspects of food oral processing conducted in the mouth by teeth, tongue, saliva have been introduced, and practical evaluation methods of rheological properties used in hospitals and nursing care facilities are described. Viscosity of commonly used polysaccharide-based thickening agents is described in relation with yield stress, thixotropy together with tribological aspects which play important roles in swallowing. To improve the control of texture, new thickening agents and modifying methods of rheological properties are described. Emerging methods to study the swallowing process have been also discussed. Finally, the importance of integration and collaboration of different disciplines is emphasized.

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Swallowing dysfunction in myasthenia gravis patients examined with high-resolution manometry

Cited by 5 publications

References 15 publications

The Usefulness of Swallowing Pressure Assessment in the Identification of Mild Pharyngeal Weakness of Myasthenia Gravis: A Case Report

The Usefulness of Swallowing Pressure Assessment in the Identification of Mild Pharyngeal Weakness of Myasthenia Gravis: A Case Report

The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis

Rheology for Safe Swallowing 1

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