Abnormal esophageal clearance, swallowing physiology, penetration and aspiration among stroke survivors with dysphagia
10.3760/cma.j.issn.0254-1424.2023.12.003
- VernacularTitle:脑卒中吞咽障碍患者食管清除功能异常与口咽期吞咽生理及渗漏误吸的相关性分析
- Author:
Baomei DENG
1
;
Lisi LIANG
;
Jiaxin ZHAO
;
Haiqing ZHENG
;
Xiquan HU
Author Information
1. 中山大学附属第三医院康复医学科，广州 510630
- Keywords:
Esophageal dysphagia;
Esophageal clearance;
Stroke;
Barium swallowing impairment profiles;
Swallowing components;
Penetration;
Aspiration
- From:
Chinese Journal of Physical Medicine and Rehabilitation
2023;45(12):1078-1083
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the incidence and severity of esophageal clearance impairment in stroke survivors with dysphagia, the clinical characteristics of patients with abnormal esophageal clearance, and their relationship with swallowing physiology, penetration and aspiration.Methods:Clinical data were collected describing 174 stroke survivors whose swallowing had been studied videofluoroscopically. In each selected case there was a good anterior-posterior view of esophageal clearance. Their anterior-posterior and lateral imaging results while swallowing 5ml of high-consistency food were analyzed. The esophageal clearance item of the modified barium swallow impairment profile was then used to rate each subject′s esophageal clearance and each physiological component of swallowing in the oral and pharyngeal phases. The Rosenbek penetration aspiration scale was employed evaluate the safety of their swallowing.Results:Seventy of the patients (40.2%) displayed abnormal esophageal clearance, and more than half of the 70 (43 patients, 24.7%) showed mid- to distal esophageal retention. Those with abnormal esophageal clearance had a higher average age and more severe overall impairment in the pharyngeal phase of swallowing. Esophageal clearance was not, however, significantly correlated with swallowing physiology in the oral phase or with penetration or aspiration grade. There were, however, significant positive correlations with laryngeal elevation, anterior hyoid excursion, pharyngeal stripping waves, pharynx contraction, upper esophageal sphincter opening, tongue base retraction and pharyx residue.Conclusion:Stroke survivors with dysphagia may display abnormal esophageal clearance. The risk is closely related to age and the severity of the dysphagia. Abnormal physiology during the pharyngeal phase of swallowing and reduced pharyngeal stripping may predict abnormal esophageal clearance. Swallowing assessment can be made more comprehensiveness and systematic by incorporating anterior-posterior videography in routine barium swallowing studies.
