Resumen
Introducción: la disfagia es un trastorno de la deglución, el cual es habitualmente desatendido por profesionales de la salud, en especial la disfagia orofaríngea neurogénica, que es capaz de producir varios síntomas, signos y complicaciones secundarias en los pacientes. Objetivo: realizar una caracterización clínica incluyendo percepción de síntomas de disfagia en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares en Antioquia, Colombia entre los años 2019 y 2021. Metodología: estudio transversal realizado en 80 pacientes con disfagia orofaríngea neurogénica confirmada a través de la herramienta Eating Assessment Tool-10, evaluación clínica y/o resultados de video fluoroscopia de la deglución. Resultados: 71 pacientes presentaron causas neurológicas centrales. La enfermedad cerebrovascular y la enfermedad de Parkinson fueron las etiologías más frecuentes. Solo 18% de los pacientes con causas neurológicas y 33% con causas neuromusculares reportaron tolerancia a todas las consistencias de alimentos. Mediana de 16 puntos en cuanto a autopercepción de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10, con puntuaciones más altas en pacientes con presencia de gastrostomía, antecedente de neumonía, odinofagia y alteración en la oclusión mandibular al examen físico. En los pacientes con causas neurológicas hubo mayor presencia de signos motores linguales y apraxias orofaciales. Conclusión: existen características clínicas como sensación de comida pegada, dificultad para tragar alimentos sólidos, tos y ahogo al tragar, que son útiles en el reconocimiento de casos de disfagia orofaríngea, y apoyan que esta genera más síntomas que signos al examen físico en pacientes con condiciones neurológicas y neuromusculares.
Referencias
Leopold NA, Daniels SK. Supranuclear control of swallowing. Dysphagia. 2010;25(3):250–257.
Miller AJ. The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev. 2008;14(2):77–86.
Warnecke T, Labeit B, Schroeder J, Reckels A, Ahring S, Lapa S, et al. Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System. Neurology. 2021;96(6):876–889.
Ciucci M, Hoffmeister J, Wheeler-Hegland K. Management of Dysphagia in Acquired and Progressive Neurologic Conditions. Semin Speech Lang. 2019;40(3):203–212.
López-Liria R, Fernández-Alonso M, VegaRamírez FA, Salido-Campos MÁ, Padilla-Góngora D. Tratamiento y rehabilitación de la disfagia tras enfermedad cerebrovascular. Rev Neurol. 2014;58(6):259–267.
Malandraki GA, Johnson S, Robbins J. Functional MRI of swallowing: from neurophysiology to neuroplasticity. Head & Neck. 2011;33(1):14-20.
McCarty EB, Chao TN. Dysphagia and Swallowing Disorders. Med Clin North Am. 2021;105(5):939– 954.
Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–769.
Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med. 2007;20(2):144–150.
Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia. 2015;30(2):114–120.
Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–1428.
Rajati F, Ahmadi N, Naghibzadeh ZA, Kazeminia M. The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis. J Transl Med. 2022;20(1):175.
Pfeiffer R. Chapter 15: Neurogenic Dysphagia. In: Daroff R, Jankovic J, Mazziotta J, Pomeroy S, editors. Bradley’s Neurology in Clinical Practice. Seventh Edition. New York: Elsevier Inc; 2016. p. 148-157.
Aydogdu I, Kiylioglu N, Tarlaci S, Tanriverdi Z, Alpaydin S, Acarer A, et al. Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17 years of experience in 1278 adults. Clin Neurophysiol. 2015;126(3):634–643.
Verin E, Maltete D, Ouahchi Y, Marie JP, Hannequin D, Massardier EG, et al. Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: a pilot study. Ann Phys and Rehabil Med. 2011;54(6):366–375.
Altman KW, Richards A, Goldberg L, Frucht S, McCabe DJ. Dysphagia in stroke, neurodegenerative disease, and advanced dementia. Otolaryngol Clin North Am. 2013;46(6):1137–1149.
Espitalier F, Fanous A, Aviv J, Bassiouny S, Desuter G, Nerurkar N, et al. International consensus (ICON) on assessment of oropharyngeal dysphagia. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(1S):S17–S21.
Carucci LR, Turner MA. Dysphagia revisited: common and unusual causes. Radiographics. 2015;35(1):105–122.
Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior? Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):485–9.
Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49–59.
Daniels SK, Foundas AL, Iglesia GC, Sullivan MA. Lesion site in unilateral stroke patients with dysphagia. J Stroke Cerebrovasc Dis. 1996;6(1):30–34.
Barrett KE. Esophageal Motility. En: Barret KE, editor. Gastrointestinal Physiology. 2nd ed. New York: The McGraw-Hill Companies; 2014.
Morgan AT, Mageandran SD, Mei C. Incidence and clinical presentation of dysarthria and dysphagia in the acute setting following paediatric traumatic brain injury. Child Care Health Dev. 2010;36(1):44–53.
Buswell CA, Leslie P, Embleton ND, Drinnan MJ. Oral-motor dysfunction at 10 months corrected gestational age in infants born less than 37 weeks preterm. Dysphagia. 2009;24(1):20–25.
Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D. Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review. Dysphagia. 2018;33(3):282-292.
Palmer JB, Pelletier CA, Matsuo K. Rehabilitation 83 Disfagia orofaríngea neurogénica: caracterización clínica y percepción de síntomas en Enero-abril Antioquia, Colombia entre los años 2019 a 2021 of patients with swallowing disorders. 4th ed. Philadelphia: Elsevier Saunders; 2011.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–924.
Burgos R, Sarto B, Segurola H, Romagosa A, Puiggrós C, Vázquez C, et al. Traducción y validación de la versión en español de la escala EAT-10 (Eating Assessment Tool-10) para el despistaje de la disfagia. Nutr Hosp. 2012;27(6):2048–2054.
Giraldo Cadavid LF, Gutiérrez Achury AM, Ruales Suárez K, Rengifo Varona ML, Barros C, Posada A, et al. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study. Dysphagia. 2016;31(3):398–406.
González Fernández M, Huckabee ML, Doeltgen SH, Inamoto Y, Kagaya H, Saitoh E. Dysphagia Rehabilitation: Similarities and Differences in Three Areas of the World. Curr Phys Med Rehabil Rep. 2013;1(4):296–306. 31. Carnaby Mann G, Lenius K. The bedside examination in dysphagia. Phys Med Rehabil Clin N Am. 2008;19(4):747–68.
González Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: an Overview. Curr Phys Med Rehabil Rep. 2013;1(3):187–196.
Vose A, Nonnenmacher J, Singer ML, González Fernández M. Dysphagia Management in Acute and Sub-acute Stroke. Curr Phys Med Rehabil Rep. 2014;2(4):197–206.
Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing studies for neurologic disease: a primer. Radiographics. 2006;26(1):e22.
Nacci A, Ursino F, La Vela R, Matteucci F, Mallardi V, Fattori B. Fiberoptic endoscopic evaluation of swallowing (FEES): proposal for informed consent. Acta Otorhinolaryngol Ital. 2008;28(4):206–211.
Carod Artal FJ. Neurological rehabilitation and continuity of care after stroke. Neurologia. 2011;26(3):190.
Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and Collaborative Management. Am Fam Physician. 2021;103(2):97– 106.
Labeit B, Mueller H, Muhle P, Claus I, Warnecke T, Dziewas R, et al. Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential. Cerebrovasc Dis. 2018;46(3– 4):152–60.
Souza GAD, Silva RG, Cola PC, Onofri SMM. Pharyngeal residue in neurogenic oropharyngeal dysphagia. Codas. 2019;31(6):e20180160.
Suárez-Escudero JC, Lema-Porto KS, PalacioPatiño D, Izquierdo-Moreno M, Bedoya-Londoño CL. Disfagia orofaríngea neurogénica: concepto, fisiopatología clínica y terapéutica. Arch Neurocien. 2022;27(4):44-56.
Suárez-Escudero JC, Alarcón-Bolívar D, CorreaHernández SA, Bechara-Mestra MD, LariosGómez M, Toro-Correa S, et al. Caracterización clínica y etiológica de una muestra de niños y adultos con disfagia atendida en dos centros asistenciales en Medellín (Colombia): Estudio retrospectivo. Iatreia. 2022;35(3):249–257.
Blanco OFS, Aristizábal DS, Pineda AM, Rodríguez MMMM, Escobar PÁ, Ochoa JWC, et al. Características clínicas y videofluoroscópicas de la disfagia orofaríngea en niños entre un mes y cinco años de vida. Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2004. Iatreia. 2008;21(1):13-20.
Bours GJJW, Speyer R, Lemmens J, Limburg M, de Wit R. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs. 2009;65(3):477–493.
Rofes L, Arreola V, Mukherjee R, Clavé P. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):1256–1265.
Cook IJ. Diagnostic evaluation of dysphagia. Nat Clin Pract Gastroenterol Hepatol. 2008;5(7):393– 403.
Kaspar K, Ekberg O. Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care. Nestle Nutr Inst Workshop Ser. Obesidad. 2012;72:19–31.
Obesidad. Organización Mundial de la Salud [Internet]. [Citado 2022 Jun 9]. Disponible en: https://www.who.int/es/health-topics/obesity#tab=tab_3
Cook IJ, Kahrilas PJ. AGA technical review on 84 Suárez-Escudero JC, Moreno-Ochoa MJ, Sánchez-Munera JL, Gómez-Ríos E, Rueda-Vallejo ZV MÉD.UIS. 2022;36(1):69-84 management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455–478.
Leslie P, Carding PN, Wilson JA. Investigation and management of chronic dysphagia. BMJ. 2003;326(7386):433–436.
Ropper AH, Samuels MA, Klein JP, Prasad S. Disorders of the Autonomic Nervous System, Respiration, and Swallowing. Adams and Victor’s Principles of Neurology. 11.aed. New York: McGraw-Hill Education; 2019.
Takizawa C, Gemmell E, Kenworthy J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease, Head Injury, and Pneumonia. Dysphagia. 2016;31(3):434–441.
Lobo PP, Pinto S, Rocha L, Reimão S, de Carvalho M. Orofacial apraxia in motor neuron disease. Case Rep Neurol. 2013;5(1):47–51.
Leonard RJ, Kendall KA, Johnson R, McKenzie S. Swallowing in myotonic muscular dystrophy: a videofluoroscopic study. Arch Phys Med Rehabil. 2001;82(7):979–985.
Groher ME. Dysphagic patients with progressive neurologic disease. Semin Neurol. 1996;16(4):355–363.
Colton-Hudson A, Koopman WJ, Moosa T, Smith D, Bach D, Nicolle M. A prospective assessment of the characteristics of dysphagia in myasthenia gravis. Dysphagia. 2002;17(2):147–151.
Ertekin C, Seçil Y, Yüceyar N, Aydoğdu I. Oropharyngeal dysphagia in polymyositis/ dermatomyositis. Clin Neurol Neurosurg. 2004;107(1):32–37.
Willig TN, Paulus J, Lacau Saint Guily J, Béon C, Navarro J. Swallowing problems in neuromuscular disorders. Arch Phys Med Rehabil. 1994;75(11):1175–1181.
Zambran-Toledo N. Maintenance of logopedic orientation in a patient with oropharyngeal dysphagia of neurogenic origin. Rev Neurol. 2001;32(10):986–989.
Cook IJ. Oropharyngeal dysphagia. Gastroenterol Clin North Am. 2009;38(3):411–431.
Logemann JA. Screening, diagnosis, and management of neurogenic dysphagia. Semin Neurol. 1996;16(4):319–327.
Palmer JB, Drennan JC, Baba M. Evaluation and treatment of swallowing impairments. Am Fam Physician. 2000;61(8):2453–2462.
Shaker R. Oropharyngeal Dysphagia. Gastroenterol Hepatol (NY). 2006;2(9):633–634.
Lind CD. Dysphagia: evaluation and treatment. Gastroenterol Clin North Am. 2003;32(2):553– 675.
Nazarko L. The management of dysphagia in palliative care. Int J Palliat Nurs. 2017;23(4):162– 164.
Arslan SS, Demir N, Kılınç HE, Karaduman AA. The Ability of the Eating Assessment Tool-10 to Detect Aspiration in Patients With Neurological Disorders. J Neurogastroenterol Motil. 2017;23(4):550–554.
Garon BR, Sierzant T, Ormiston C. Silent aspiration: results of 2,000 video fluoroscopic evaluations. J Neurosci Nurs. 2009;41(4):178– 185.
Ramsey DJC, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34(5):1252– 125
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2023 Médicas UIS