Objective: This study evaluated the effect of five levels of bolus consistency (using Japanese Dysphagia Diet 2013 by the JSDR Dysphagia Diet Committee) on swallowing function in healthy individuals by using high-resolution manometry (HRM).
Materials and Methods: Ten healthy subjects (average age 36.0±10.3 years) were instructed on five kinds of texture modified foods made of rice porridge. The Japanese Dysphagia Diet 2013 by the JSDR Dysphagia Diet Committee was used as a reference. The five kinds of texture modified foods were called code 0 to 5. For the texture evaluation, the participants received each food two times. Pressure and timing events were recorded with a 20-sensor HRM catheter. We analyzed the maximum swallowing pressure and contraction duration at the level of the velopharynx, tongue base, and lower pharynx, as well as the relaxation duration of the upper esophageal sphincter (UES).
Results: UES relaxation duration was significantly higher with an increase in bolus volume for every food texture. Contraction duration at the level of the velopharynx was significantly higher when swallowing 9 g compared with 6 g of code 2; was significantly higher when swallowing 6 g compared with 3 g of code 3; and was significantly higher when swallowing 9 g compared with 3 g of code 4. Contraction duration at the level of the tongue base was significantly higher when swallowing 9 g compared with 3 g of code 4. The peak pressure at the base of the tongue was significantly lower when swallowing 9 g compared with 3 g of code 2, and was significantly lower when swallowing 9 g compared with 6 g of code 2.
Conclusion: Each texture had no effect on relaxation duration of the upper esophageal sphincter, contraction duration or maximum swallowing pressure, at the level of the velopharynx, tongue base and lower pharynx. However, for every texture, increasing the bolus volume was shown to have a significant effect on increasing UES relaxation duration. UES relaxation duration can be detected by varying the bolus volumes of different textures. Contraction duration at the level of the velopharynx and tongue base increased by increasing the volume of particular textures. Maximum swallowing pressure at the tongue base decreased as particular textures increased.
Aims: This study aims to investigate the rate of aspiration pneumonia in patients with chronic obstructive pulmonary disease (COPD), to compare the clinical characteristics of aspiration versus non-aspiration pneumonia in patients with COPD, and to determine factors associated with aspiration pneumonia in these patients.
Methods: We studied the causes of 231 consecutive patients with COPD who were admitted to an acute hospital and calculated the rate of aspiration pneumonia among the 231 patients. There were 178 men and 53 women, and the mean age was 74.5±9.1. In 85 patients among the 231 patients who received a rehabilitation program during hospitalization, we used the following data from medical charts and databases: age, sex, serum albumin, body mass index (BMI), grip strength, gait speed, functional independence measure (FIM), Functional Oral Intake Scale (FOIS) and lung function at discharge. We divided the patients into two groups according to the presence of aspiration pneumonia (aspiration versus nonaspiration pneumonia). Comparable data between the two groups were analyzed using the Mann-Whitney U test in univariate analysis.
Results: The ratio of aspiration pneumonia was 17 cases (7.4%) among the 231 COPD patients. The ratio of aspiration pneumonia was 16.0% in 85 pneumonia patients and was 26.1% among those in their 80s and 42.9% among those in their 90s. Univariate analysis showed that the aspiration pneumonia group was significantly older than the non-aspiration pneumonia group. BMI, serum albumin, grip strength, gait speed, FIM, and vital capacity were all significantly lower in the aspiration group.
Conclusions: The ratio of aspiration pneumonia in patients with COPD increased with age. The results of the present study suggest that significant factors for aspiration pneumonia in patients with COPD are old age, malnutrition, lower physical function, and reduced lung function.
Objective: To investigate the safety of using a low osmotic nonionic iodinated contrast agent in the videofluoroscopic examination of swallowing (hereafter “VF”).
Methods: The subjects were patients who underwent VF during admission or outpatient visit to our hospital during the period from April 2015 to March 2017. Exclusion criteria were patients with iodine allergy or serious thyroid disease, and patients who did not give consent to the study. Iopamidol was used as a contrast agent, and was either diluted and mixed into a solid, or diluted as a liquid for oral intake, and the swallowing function was evaluated. For the investigation, the subject cases were investigated retrospectively from the medical records. The side effects described on the package insert of Iopamidol were examined within 7 days after VF and the presence or absence of severe pulmonary impairment complication within 5 days after the examination. In addition, when aspiration was observed, the presence or absence of contrast agent accumulation in the lungs was evaluated by chest X-ray examination.
Results: During the survey period, 452 people (300 men, 152 women, average age 69.4 years) were included. The incidence of side effects was one (0.22%) for each of itching sensation, flushing, and headache, but no serious complication was observed. Fifty-three patients (11.7%) had aspiration during the VF, but no accumulation in the lungs or severe lung injury complication was observed.
Conclusion: By using a low osmotic nonionic iodinated contrast agent, complications rarely occur even when aspiration occurs during the examination, and serious lung damage does not occur, so it is suggested that the test using VF can be conducted safely.