The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson's disease

Abstract

Dysphagia occurs in the majority of patients with Parkinson's disease (PD) and is known to correlate with abnormalities of oropharyngeal function. The aim of this study was to evaluate pharyngoesophageal activity in patients with early-stage PD. Newly diagnosed PD patients with a symptom duration not exceeding 3 years were included. All PD patients were questioned about symptoms of dysphagia and underwent combined multichannel intraluminal impedance manometry and multiple rapid swallow tests. Fifty-four patients (22 men and 32 women, 67.1 ± 10.3 years) were enrolled. The duration of Parkinsonian motor symptoms was 11.5 ± 8.8 months, the Hoehn and Yahr stage was 1.6 ± 0.4, and the total Unified Parkinson's Disease Rating Scale was 25.1 ± 18.6. Esophageal manometry in the liquid swallow and viscous swallow tests was abnormal in 22 (40.7%) and 31 (67.4%) patients, respectively. Although manometric abnormalities were more common in patients with more severe dysphagia symptoms, many patients with no or minimal symptoms also had manometric abnormalities. Repetitive deglutition significantly correlated with failed peristalsis and incomplete bolus transit. Abnormal responses to multiple rapid swallow tests were found in 33 out of 54 patients; 29 with incomplete inhibition (repetitive contraction) and 4 with failed peristalsis. These results suggest that the majority of patients with early-stage PD showed pharyngeal and esophageal dysfunction even before clinical manifestations of dysphagia, which may reflect selective involvement of either the brain stem or the esophageal myenteric plexus in early-stage PD.

Perceived changes to swallowing in people with Parkinson's disease

“…In line with surveys of Such a process does not seek to replace assessments for aspiration and penetration or identification of other red flags around swallowing assessment, but insights from such discussion can alert to when (conscious or subconscious) self-management has reached its limits (Sung et al 2010, Suntrup et al 2013) and when an issue has reached the stage of requiring more active clinician support.…”

“…Objective measures reveal changes in deglutition from the earliest stages of Parkinson's disease (Coriolano et al 2012, Troche et al 2011, Miller et al 2009, Sung et al 2010, Rodrigues et al 2011, Kalf et al 2012. The strong association of chest infection, hospital admission, mortality and chronic undernourishment (Nobrega et al 2008, Monteiro et al 2014) suggest dysphagia is a risk factor for poorer health and quality of life outcomes in Parkinson's.…”

“…Conscious or unconscious compensation by individuals may further blur the picture. It is often only when the underlying deterioration reaches a critical stage or the onset or severity of a parallel symptom undermines compensation that a clear swallowing disorder becomes obvious to the patient and/or clinicians (Suntrup et al 2013, Sung et al 2010). …”

“…Consequently dysphagia may not initially be apparent at clinic or on 'bedside' assessments, and individuals themselves may be unaware of a swallowing problem (Sung et al 2010, Miller et al 2009, Bayés-Rusiñol et al 2011, Ding and Logemann 2008, or they attribute alterations to eating to other causes (Cheon et al 2008). Hence asking the standard question, "Have you any swallowing problems?"…”

“…PROM can enhance communication, especially about living with a long term condition, and support shared decision making about treatments and their effectiveness (Yorkston, Baylor, Amtmann (2014). Studies indicate that when PROM results are correlated with physiological bolus flow or other objective measures associations are modest or low, indicating their distinct contributions to information gathering (Leow et al 2010, Miller et al 2006, Sung et al 2010, Miller et al 2009, Bayés-Rusiñol et al 2011, Ding and Logemann 2008. This highlights the importance of combining objective measurement of dysphagia (e.g.…”