OBJECTIVETo compare the therapeutic effects on dysphagia in post-stroke pseudobulbar palsy between the combined treatment with acupuncture and rehabilitation training and the combined treatment with low-frequency electrical therapy and rehabilitation training and to explore its more effective therapy, using the ultrasonographic examination.

METHODSA total of 60 patients of dysphagia in post-stroke pseudobulbar palsy were randomly assigned into an observation group and a control group, 30 cases in each one. The rehabilitation treatment was provided in the two groups. Additionally, in the observation group, acupuncture was used at the three-tongue points [Shanglianquan (Extra), located in the depression between the lingual bone and the border of lower jaw, 1 inferior to the midline of the jaw; and the other two points, located at 0.8 bilateral to Shanglianquan (Extra)], bilateral Fengchi (GB 20) and Fengfu (GV 16). After arrival of , the last two tongue-points were stimulated with electricity, with disperse-dense wave, periodically at 2 Hz, 10 Hz and 100 Hz, at the interval of 3 s, lasting for 30 min. Bilateral Fengchi (GB 20) was stimulated with electricity, with disperse-dense wave and the same frequency as above, lasting for 30 min. In the control group, the low-frequency electrical stimulation was adopted. The electrodes were placed on the bilateral sides of the midline of the throat, 30 min each time. The treatment was for 1 month in the two groups, once a day. The scores of the standardized swallowing assessment (SSA) and the videofluoroscopy swallowing study (VFSS) were observed and the reducing rate of the hyoid-thyroid cartilage distance was determined with ultrasound quantitative measure.

RESULTSAfter treatment, SSA scores of the two groups were all lower than those before treatment and VFSS scores were higher than those before treatment (all <0.05). The above scores in the observation group were better than those in the control group (both <0.05). The reducing rates of the hyoid-thyroid cartilage distance were higher than those before treatment in the two groups (both <0.05). The result in the observation group was higher than that in the control group (<0.05).

CONCLUSIONThe treatments with acupuncture and rehabilitation training or with the low-frequency electrical therapy and rehabilitation obtain the effects on dysphagia in post-stroke pseudobulbar palsy in the patients. The effects of the combined treatment with acupuncture and rehabilitation training are better. The ultrasonographic technology effectively and quantitatively analyzes the changes in the glossopharyngeal complex in the patients of dysphagia.

Acupuncture Points ; Acupuncture Therapy ; Deglutition Disorders ; rehabilitation ; therapy ; Humans ; Pseudobulbar Palsy ; etiology ; rehabilitation ; therapy ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo observe the clinical efficacy of deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training for post-stroke dysphagia.

METHODSSixty cases of post-stroke dys phagia were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the observation group, based on the regular acupuncture treatment, were treated with deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17), once a day, 30 min per treatment; also swallowing training was combined, twice a day, 20 min per treatment. Patients in the control group were treated with swallowing training. All the patients were treated with regular treatment of stroke. Six days of treatment were taken as one session, and totally 3 sessions were given with an interval of one day between sessions. The video fluoroscopic swallowing study (VFSS) dysphagia evaluation scale and Watian water swallow test (WWST) were evaluated before and after treatment also the clinical efficacy and the recovery time of two groups were compared.

RESULTSAfter treatment, the VFSS score in the observation group was significantly superior to that in the control group (P < 0.01); the WWST in the observation group was significantly superior to that in the control group (P < 0.01). The cured rate was 70.0% (21/30) in the observation group, which was significantly superior to 43.3% (13/30) in the control group (P < 0.01); the total effective rate was 86.7% (26/30) in the observation group, which was significantly superior to 66.7% (20/30) in the control group (both P < 0.01). The clinical recovery time in the observation group was significantly shorter than that in the control group (P < 0.01).

CONCLUSIONDeep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training could effectively improve post-stroke swallow function.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Combined Modality Therapy ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; rehabilitation ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

BACKGROUND/AIMS: Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE. METHODS: Six patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with > or =15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated. RESULTS: The median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence. CONCLUSIONS: PPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.
Adult ; Asian Continental Ancestry Group ; Chest Pain/etiology ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/*drug therapy/*pathology ; Esophagus/pathology ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/etiology ; Heartburn/etiology ; Humans ; Male ; Middle Aged ; Pharyngitis/etiology ; Phenotype ; Proton Pump Inhibitors/*therapeutic use ; Republic of Korea ; Retrospective Studies ; Sensation Disorders/etiology ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.

METHODSA total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.

RESULTSA total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.

CONCLUSIONSAcupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.

Acupuncture Therapy ; adverse effects ; Aged ; Deglutition ; physiology ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stroke ; complications

PURPOSE: The purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer. MATERIALS AND METHODS: A retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score. RESULTS: Reduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%). CONCLUSION: Reduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.
Adult ; Aged ; Aged, 80 and over ; *Barium Sulfate ; Combined Modality Therapy ; Contrast Media ; Deglutition ; *Deglutition Disorders/diagnosis/etiology/physiopathology ; Enteral Nutrition ; Female ; Head and Neck Neoplasms/complications/*radiotherapy ; Humans ; Male ; Middle Aged ; *Respiratory Aspiration/diagnosis/etiology/physiopathology ; Retrospective Studies

Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.
Botulinum Toxins/administration & dosage ; Deglutition Disorders/etiology ; Diagnostic Errors ; Endoscopy, Digestive System ; Esophageal Achalasia/*diagnosis/etiology/physiopathology/therapy ; Esophageal Sphincter, Lower ; Esophagus/physiopathology/surgery ; Gastroesophageal Reflux/diagnosis ; Humans ; Injections, Subcutaneous ; Manometry ; Neurotransmitter Agents/administration & dosage ; Recurrence

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option.
Administration, Topical ; Adrenal Cortex Hormones/*therapeutic use ; Adult ; Child ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/diagnosis/*therapy ; Esophageal Stenosis/etiology/*surgery ; Esophagoscopy ; Esophagus/*pathology ; *Food Habits ; Gastroesophageal Reflux/diagnosis ; Humans

OBJECTIVETo assess the effectiveness and safety on post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points.

METHODSNinety cases of post-apoplexy dysphagia in chronic stage were randomized into an auricular points group and an acupuncture group. In the auricular points group, the magnetic-ball sticking therapy was applied to subcortex (pizhixia, AT4), brainstem (naogan, AT(3,4i)), mouth (kou, CO1), cheek (mianjia, LO(5,6i)), tongue (she, LO2) and throat (yanhou, TG3) on one ear each time, and were changed on the other ear once every 3 days. In the acupucnture group, acupuncture was applied to Feng-chi (GB 20), Yifeng (TE 17), Shanglianquan (Extra), Jinjin (EX-HN 12), Yuye (EX-HN 13), Shuigou (GV 26) and Tongli (TH 5), etc. The needles were retained for 30 min in each treatment. The treatment was gi-yen once a day in the two groups and the treatment of 6 days made one session. There was 1 day at an interval among the sessions. Totally, 3 sessions of treatment were required. The video fluoroscopic swallowing study (VFSS) was performed for 4 kinds of food with different properties and shapes in each patient. The main indices were Rosenbek penetration-aspiration score, oral-retaining score and throat-retaining score. The efficacy, and the incidences of aspiration pneumonia and malnutrition were compared between the two groups. The nutrition indices were compared before and after treatment between the two groups, such as the skinfold thickness of triceps brachii muscle, serum albumin and peralbumin.

RESULTSIn 21 days of treatment, in the auricular points group, the 1 mL liquid loversol Rosenbek penetration-aspiration score (1.51 +/- 0.69), oral-retaining score (1.17 +/- 0.38) and throat-retaining score (1.30 +/- 0.66) were all lower than those (2.51 +/- 0.67, 1.63 +/- 0.72, 1.67 +/- 0.7) in the acupuncture group separately. The 10 mL liquid loversol Rosenbek penetration-aspiration score (2.27 +/- 0.65), oral-retaining score (1.60 +/- 0.50) and throat-retaining score (1.49 +/- 0.51) were all lower than those (4.19 +/- 0.73, 2.30 +/- 0.51, 2.41 +/- 0.50) in the acupuncture group separately. The 10 mL paste loversol Rosenbek penetration-aspiration score (1.68 +/- 0.81), oral-retaining score (1.11 +/- 0.31) and throat-retaining score (1.10 +/- 0.31) were all lower than those (3.91 +/- 0.68, 1.63 +/- 0.76, 1.60 +/- 0.76) in the acupuncture group separately. The 1/4 cake-form loversol Rosenbek penetration-aspiration score (2.60 +/- 0.65), oral-retaining score (1.40 +/- 0.50) and throat-retaining score (1.74 +/- 0.49) were all lower than those (4.14 +/- 1.10, 2.40 +/- 0.73, 2.30 +/- 0.83) in the acupuncture group separately. The incidence of aspiration pneumonia was 14.9% (7/47) in the auricular points group, which was lower than 55.0% (22/40) in the acupuncture group (P < 0.01). The incidence of malnutrition was 8. 5% (4/47) in the auricular points group, which was lower than 50.0% (20/40) in the acupuncture group (P < 0.01). In 21 days of treatment, the results of the skinfold thickness of triceps brachii muscle and serum albumin in the auricular points group were better than those in the acupuncture group (both P < 0.05).

CONCLUSIONThe magnetic-ball sticking therapy at auricular points achieves the definite efficacy on post-stoke dysphagia in chronic stage and decreases the incidences of aspiration pneumonia and malnutrition. The efficacy of this therapy is better than acupuncture.

Acupuncture, Ear ; instrumentation ; Aged ; Deglutition Disorders ; etiology ; therapy ; Female ; Humans ; Magnetics ; instrumentation ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of endoscopic balloon dilatation, stenting and surgery in treating corrosive esophageal stricture of children.

METHODWe retrospectively analyzed the management of 31 children who were treated with endoscopic balloon dilatation, stenting or gastric tube esophagoplasty because of corrosive esophageal stricture between August 2005 and December 2012. Dysphagia was graded into 4 grades according to Stooler grading methods. The efficacy was divided into 3 grades which were very effective, effective and ineffective according to the improvement of dysphagia.

RESULTAmong 31 children with corrosive esophageal stricture, in 22 children the problem was caused by alkali, in 9 by acid; 23 children had long-segment stricture and 8 had short-segment stricture. The number (rates) of cases in whom the endoscopic balloon dilatation was very effective, effective, and ineffective were 12 (38.7%) , 7 (22.6%) , 12 (38.7%) , respectively. The number of cases in whom stenting was effective or ineffective was 1 and 3, respectively. The gastric tube esophagoplasty was very effective and effective in 8 and 2 cases, respectively. Total rates of very effective, effective, and ineffective of 3 treatments were 64.5%, 29%, 6.5% respectively. The efficacy of endoscopic balloon dilatation was better in short-segment stricture and bigger caliber stricture, the efficacy was not so good for other types of strictures. The efficacy of balloon dilatation was not related with the nature of substances (either alkaline or acidic). Compared with very effective group, the ineffective group with longer course of disease before dilatation (t = -2.091, P = 0.048) , smaller stricture calibre (t = 2.855, P = 0.009) , longer stricture segment (t = -3.405, P = 0.003) and longer dilatation time (t = -2.103, P = 0.047) , had statistical significance.

CONCLUSIONEndoscopic balloon dilatation was the preferred treatment for corrosive esophageal stricture of children. The efficacy was better in shorter course of disease, short-segment stricture and bigger caliber stricture, for other situations the efficacy was not so good. The efficacy of balloon dilatation was not related with the nature of substances.Stent or surgery can be considered if efficacy of balloon dilatation was not so good.Gastric tube esophagoplasty is an effective treatment for complicated corrosive esophageal stricture.

Burns, Chemical ; complications ; therapy ; Child ; Child, Preschool ; Deglutition Disorders ; etiology ; surgery ; therapy ; Dilatation ; instrumentation ; methods ; Esophageal Stenosis ; etiology ; surgery ; therapy ; Female ; Gastroscopy ; Humans ; Infant ; Male ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo observe the impacts on the recovery of swallowing function in patients of dysphagia after acute stroke treated with acupuncture and functional electric stimulation.

METHODSSeventy-four patients were randomized into an acupuncture plus electric stimulation group (38 cases) and an electric stimulation group (36 cases). The functional electric stimulator was used in the two groups. The electric pads were placed on the hyoid bone, the upper part of thyroid cartilage, the masseter muscle and the mandibular joint. The treatment lasted for 30 mm each time. In the acupuncture plus electric stimulation group, acupuncture was supplemented at motor area of Jiao's scalp acupuncture, lower 2/5 of sensory area, Baihui (CV 20), Lianquan (CV 23), Jinjin (EX-HN 12) and Yuye (EX-HN 13), 30 mm each time. The treatment was given once a day, 6 treatments for one session and there was 1 day at interval between the sessions, 4 sessions were required totally in the two groups. The dysphagia scale was adopted for efficacy evaluation before treatment and after 4 sessions of treatment in the two groups. The removal rate of nasal feeding tube was observed after treatment.

RESULTSThe dysphagia score was increased apparently after treatment compared with that before treatment in the two groups (both P < 0.05). After treatment, in the acupuncture plus electric stimulation group, the dysphagia score was increased much more apparently than that in the electric stimulation group (8.01 +/- 1.25 vs 6.73 +/- 1.36, P < 0.05). The remarkably effective rate was 84.2% (32/38) in the acupuncture plus electric stimulation group, better than 58.3% (21/36) in the electric stimulation group (P < 0.05). The removal rate of nasal feeding tube was 89.5% (34/38) in the acupuncture plus electric stimulation group, which was higher than 50. 0% (18/36) in the electric stimulation group (P < 0.05).

CONCLUSIONAcupuncture combined with electric stimulation achieves the much better efficacy on dysphagia after acute stroke and promotes the early removal of nasal feeding tube. The efficacy is better than that of the simple electric stimulation therapy.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Electric Stimulation ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome