Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Labeit, Bendix; Perlova, Ksenia; Pawlitzki, Marc; Ruck, Tobias; Muhle, Paul; Claus, Inga; Suntrup‐Krueger, Sonja; Wiendl, Heinz; Dziewas, Rainer; Warnecke, Tobias

doi:10.1002/mus.27225

Cited by 11 publications

(8 citation statements)

References 34 publications

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“…Swallowing disorders not only impair the quality of life, but further lead to severe complications such as malnutrition and aspiration pneumonia, thus increasing mortality ( Cabre et al, 2010 ; Serra-Prat et al, 2012 ). A number of age-related diseases such as stroke ( Yang et al, 2013 ; Labeit et al, 2018 ; Warnecke et al, 2021b ), Parkinson’s disease ( Kalf et al, 2012 ; Warnecke et al, 2021b ), and neuromuscular disorders ( Labeit et al, 2020b , 2021b ; Warnecke et al, 2021a ,b), play a decisive role as predisposing factors. Much less research has been devoted to age-related changes of oropharyngeal swallowing in otherwise healthy elderly individuals, also referred to as presbyphagia ( Azzolino et al, 2019 ; Namasivayam-MacDonald and Riquelme, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Labeit

Muhle

Itter

et al. 2022

Front. Aging Neurosci.

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Background“Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.Materials and methods64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.Results32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.ConclusionsSwallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.

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Section: Introductionmentioning

confidence: 99%

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Labeit

Muhle

Itter

et al. 2022

Front. Aging Neurosci.

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“…In swallowing endoscopy, owing to increased intrapharyngeal pressure, the tip of the endoscope is pressed against the pharyngeal wall for approximately half a second, resulting in a white superimposition, also known as white-out. 38,39 Consequently, intradeglutitive penetrations or aspirations must be detected in the postdeglutitive stage. The results of our study suggest that this is not always successful and that intradeglutitive penetration and aspiration may in some cases be missed in swallowing endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

Labeit¹,

Ahring

Boehmer

et al. 2022

Journal of the American Medical Directors Association

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Objective: In the evaluation of oropharyngeal dysphagia, instrumental procedures, for example, flexible endoscopic evaluation of swallowing or videofluoroscopic swallowing study, are essential to improve diagnostic accuracy for salient findings such as penetration, aspiration, or pharyngeal residue. To date, it is unclear which of the 2 methods represents the diagnostic gold standard. The aim of this study, therefore, was to compare videofluoroscopy and swallowing endoscopy during a simultaneous swallowing examination in a large cohort of patients with oropharyngeal dysphagia. Designs: Prospective observational study. Setting and participants: In this study, 49 patients with oropharyngeal dysphagia (mean age 70.0 AE 10.8 years) were evaluated using simultaneous swallowing endoscopy and videofluoroscopy. Furthermore, the effect of narrow-band imaging in swallowing endoscopy on the assessment of penetration and aspiration was investigated in a subgroup of 19 patients. Measures: The Penetration-Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale were rated independently based on both modalities. Results: Both modalities showed a high correlation between penetration, aspiration, and pharyngeal residue. Causes for a higher score on the Penetration-Aspiration Scale in videofluoroscopy were intradeglutitive events that were not visible in swallowing endoscopy or false-positive events because of the loss of the lateral dimension in videofluoroscopy. A typical reason for a higher score on this scale in swallowing endoscopy was the better visualization of the anatomical structures. Narrow-band imaging in swallowing endoscopy resulted in a higher score on the Penetration-Aspiration Scale for liquids and semisolids in individual cases, although overall there was no statistically significant difference between scores using white light or narrow-band imaging. Conclusions and Implications: Videofluoroscopy and swallowing endoscopy may equally be considered as a diagnostic gold standard for oropharyngeal dysphagia regarding penetration, aspiration, and pharyngeal residue. Narrow-band imaging may increase the sensitivity for penetration and aspiration in individual cases.

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“…Interestingly, most of these IIM patients had laryngeal pathology among the presenting symptoms of myositis (105). Furthermore, in a study retrospectively reviewing the flexible endoscopic evaluation of swallowing videos of IIM patients, pharyngeal residue with risk of post-deglutition aspiration was the most common dysphagia pattern, and the at-tenuation of the endoscopic white-out was related to residue severity (106). Importantly, dysphagia severity was an independent predictor for pneumonia, which occurred in almost a quarter of the patients (106).…”

Section: Antisynthetase Syndromementioning

confidence: 99%

Idiopathic inflammatory myopathies: one year in review 2022

Cardelli

Zanframundo

Cometi

et al. 2023

Clinical and Experimental Rheumatology

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Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of disorders in which chronic inflammation of the skeletal muscle, leading to muscle weakness, is a common feature. Different phenotypes have been identified within the IIM spectrum based on extra-muscular manifestations, immunology, muscle histology, responsiveness to therapy, and prognosis. The pathogenesis, classification, treatment, and prognosis of the different IIM subtypes are subject to active discussion and research. This review highlights the most relevant literature published on this topic over the last year.

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Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Cited by 11 publications

References 34 publications

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

Idiopathic inflammatory myopathies: one year in review 2022

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