Oropharingeal dysphagia in patients with chronic Chagas disease: phonoaudiological, videofluoroscopic, and manometric evaluations

Abstract

Objective: To determine the frequency of episodes of laryngeal penetration and aspiration in chronic Chagas patients and to evaluate the interpreted relationship not only with the patterns displayed in videofluoroscopy and manometry, but also with clinical screening and structural and functional phonoaudiological evaluation. Method: Clinical and phonoaudiological (structural and functional) evaluation, fluoroscopy, and computed manometry were performed on all patients. Results: Twenty-two patients were included in the study, fifteen females and seven males. Age ranged between 37 and 70 years, mean 55.9 ± 10.2 years. Among the complaints in clinical screening, 18.2% were choking, 13.6% reported throat-clearing, 40.9% heartburn, 22.7% regurgitation, and 36.4% had the sensation of food stuck in the throat. Only 18.2% of patients had adequate dentition. Functional assessment of swallowing detected only 31.8% capable of functional swallowing. In videofluoroscopy, lingering residues were found in the pharynx in 18.2% of cases, followed by multiple swallows 95.4% and 100% posterior escape. There were 4 cases of grade 2 laryngeal penetration (dysphagia) and, in 82% of cases, the findings were similar for the non-occurrence of laryngeal penetration in the videofluoroscopy and in the functional assessment of swallowing. The apertures of the upper esophageal sphincter indicated a relationship with the volume of swallowed bolus. In the manometry, 42.1% of changes were found in the body of the esophagus and 5.3% in the pharynx. Conclusion: Laryngeal penetration was prevalent in 18.2% of cases with an important interpretation of the functional relationship between clinical assessment and videofluoroscopic findings regarding the absence of laryngeal penetration, with similar results in 82% of cases.

Symptoms Associated With Different Degrees of Megaesophagus in Chagas Disease

“…The most frequent voice alteration was hoarseness. Previous paper describe the occurrence of multiple swallowings (14%), coughing (18%), phlegm (9%), hoarseness (36%) and, in the videofluoroscopy, pharyngeal residues (18%) and laryngeal penetration (18%) (8) . In a paper including patients without megaesophagus, the described symptoms, besides dysphagia, were heartburn (40%), regurgitation (6%), odynophagia (4%), retrosternal pain (12%), and coughing (6%) (17) .…”

“…Jaline de Araujo OLIVEIRA 1 , Aretuza Zaupa Gasparim El GHARIB 1 and Roberto Oliveira DANTAS 2 either oropharyngeal or esophageal, as changes in the esophagus, pharyngoesophageal transit, and pharynx are observed in the disease (4)(5)(6)(7)(8) .…”

Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease

“…Assessments of oral and pharyngeal phases of swallowing in Chagas disease have been previously reported. The description includes long pharyngeal transit with a more consistent bolus [ 12 ], multiple swallows and reduced laryngeal elevation [ 21 ], residues in the pharynx and laryngeal penetration [ 22 ], and a similar sequence of the events associated with swallowing [ 23 ]. Studies with scintigraphy have described a longer time to clear the pharynx and for the bolus to pass from the pharynx to the esophagus [ 24 , 25 ].…”

“…This investigation found 79% of the patients with residues in the vallecula and pharynx (impaired efficiency) and 28% with laryngeal penetration (impaired safety). The larynx does not elevate properly [ 21 , 22 ], and there is a higher pressure on the upper esophageal sphincter and slow pharyngeal transit [ 11 ], which can cause food to be retained in the pharynx.…”

Diet Quality of patients with chronic Chagas disease in a tertiary hospital: a case-control study

“…The HUCFF at Federal University of Rio de Janeiro/Brazil is a reference center dedicated to treatment and research of esophagopathy and colopathy in Cd, hence, a high esophagus and colon diseases are expected. The Cd and the cohort at HUCFF include patients with early involvement of the esophagus/colon according to Cabral et al 32 However, this study was limited in that it was not possible to evaluate esophagus/colon disease in all patients in this study, because the most accurate diagnostic test uses the application of radioisotope and is not performed routinely. Digestive disease can affect the BMI and patients with digestive form of Cd receive nutritional counselling that can affect their diet quality.…”