Detecting myositis as a cause of unexplained dysphagia: Proposal for a diagnostic algorithm

Labeit, Bendix; Grond, Thalia; Beule, Achim Georg; Boehmer, Maik; Thomas, Christian; Claus, Inga; Roderigo, Malte; Rudack, Claudia; Wiendl, Heinz; Dziewas, Rainer; Warnecke, Tobias; Suntrup‐Krueger, Sonja

doi:10.1111/ene.15202

Cited by 4 publications

(3 citation statements)

References 50 publications

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“…However, the importance of the length of the examination protocol was raised. In this context, it should be taken into account, that FEES protocols often provide 3 swallowing trials for 3 different consistencies, as in the following studies [9,22,23,29,[36][37][38][39][40][41]. It should be noted that the scenario of the intermittent event (with several, but < 50% of the trials of a single consistency) cannot occur with this protocol specification.…”

Section: Discussionmentioning

confidence: 99%

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

Labeit,

Lapa,

Muhle

et al. 2023

Dysphagia

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Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represents such an outcome measure but has been validated primarily for head and neck cancer collectives. The objective of this study was, therefore, to investigate the validity of the DIGEST-FEES in patients with PD. Content validity was evaluated with a modified Delphi expert survey. Subsequently, 66 FEES videos in PD patients were scored with the DIGEST-FEES. Criterion validity was determined using Spearman's correlation coefficient between the DIGEST-FEES and the Penetration-Aspiration Scale (PAS), the Yale-Residue-Rating-Scale, the Functional-Oral-Intake-Scale (FOIS), and the swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability was determined using 10 randomly selected FEES-videos examined by a second rater. As a result, the overall DIGEST-FEES-rating exhibited significant correlations with the Yale-Valleculae-Residue-Scale (r = 0.84; p < 0.001), the Yale-Pyriform-Sinus-Residue-Scale (r = 0.70; p < 0.001), the FOIS (r = − 0.55, p < 0.001), and the UPDRS-Swallowing-Item-Score (r = 0.42, p < 0.001). Further, the DIGEST-FEES-safety subscore correlated with the PAS (r = 0.63, p < 0.001). Inter-rater reliability was high for the overall DIGEST-FEES rating (quadratic weighted kappa of 0.82). Therefore, DIGEST-FEES is a valid and reliable score to evaluate overall pharyngeal dysphagia severity in PD. Nevertheless, the modified Delphi survey identified domains where DIGEST-FEES may need to be specifically adapted to PD or neurological collectives in the future.

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Section: Discussionmentioning

confidence: 99%

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

Labeit,

Lapa,

Muhle

et al. 2023

Dysphagia

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“…This test has been shown to be highly reliable [ 79 ] and, both, sufficiently sensitive and specific [ 47 ]. Due to these robust clinical properties the FEES-Edrophonium test is key part of an algorithm for the diagnostic workup of neurogenic dysphagia of undetermined etiology [ 80 ]. The FEES-L-Dopa test evaluates whether dysphagia in patients with parkinsonian syndromes improves after application of a sufficiently high dose of fast-dissolving L-Dopa.…”

Section: Recommendationsmentioning

confidence: 99%

“…In cases where an acute inflammatory polyneuropathy comes into account, lumbar puncture and neurography may be the next diagnostic steps at hand. Finally, as outlined elsewhere in detail, the diagnostic-workup of suspected inflammatory myopathies includes antibody-testing, neurophysiological studies, magnetic resonance imaging of the muscles and a muscle biopsy, among others [ 80 ].…”

Section: Recommendationsmentioning

confidence: 99%

Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia– towards an integrated FEES report

Dziewas,

Warnecke,

Labeit

et al. 2024

Neurol. Res. Pract.

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Flexible endoscopic evaluation of swallowing (FEES) is one of the most important methods for instrumental swallowing evaluation. The most challenging part of the examination consists in the interpretation of the various observations encountered during endoscopy and in the deduction of clinical consequences. This review proposes the framework for an integrated FEES-report that systematically moves from salient findings of FEES to more advanced domains such as dysphagia severity, phenotypes of swallowing impairment and pathomechanisms. Validated scales and scores are used to enhance the diagnostic yield. In the concluding part of the report, FEES-findings are put into the perspective of the clinical context. The potential etiology of dysphagia and conceivable differential diagnoses are considered, further diagnostic steps are proposed, treatment options are evaluated, and a timeframe for re-assessment is suggested. This framework is designed to be adaptable and open to continuous evolution. Additional items, such as novel FEES protocols, pathophysiological observations, advancements in disease-related knowledge, and new treatment options, can be easily incorporated. Moreover, there is potential for customizing this approach to report on FEES in structural dysphagia.

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Flexible endoscopic evaluation of swallowing in neurology

Lapa

2023

Nervenarzt

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Detecting myositis as a cause of unexplained dysphagia: Proposal for a diagnostic algorithm

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 4 publications

References 50 publications

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia– towards an integrated FEES report

Flexible endoscopic evaluation of swallowing in neurology

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