Diagnostic Accuracy of an Esophageal Screening Protocol Interpreted by the Speech-Language Pathologist.
Deglutition
Deglutition disorders
Diagnostic accuracy
Esophageal
Protocol
Screening
Journal
Dysphagia
ISSN: 1432-0460
Titre abrégé: Dysphagia
Pays: United States
ID NLM: 8610856
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
11
05
2020
accepted:
17
12
2020
pubmed:
21
2
2021
medline:
15
12
2021
entrez:
20
2
2021
Statut:
ppublish
Résumé
Oropharyngeal and esophageal dysphagia may occur simultaneously. However, symptoms are often evaluated separately. Few standardized, multi-texture esophageal screening protocols exist as an addition to the modified barium swallow study (MBSS). Given the gap in MBSS evaluation standards, providers may be lacking information needed to fully assess the swallowing process and create appropriate dysphagia management plans. The aim was to assess the diagnostic accuracy of a standardized esophageal screening protocol performed by an SLP compared to formal reference esophageal examinations. A cross-sectional analytic study was performed. Consecutively referred patients who underwent same-day consultation with the SLP and a gastroenterologist were included. MBSS with a standardized esophageal screen was performed. Same-day formal esophageal testing was completed and included timed barium emptying study or high-resolution manometry. Summary diagnostic accuracy measures were calculated. Seventy-three patients matched the inclusion criteria. Median age was 62.5 years (25-87), 55% were female. Sensitivity of the esophageal screen for the detection of esophageal abnormality was 83.7% (95% CI 70-91.9%); specificity was 73.7% (95% CI 55.6-85.8%). The positive likelihood ratio was 3.14 (95% CI 1.71-5.77), whereas the negative likelihood ratio was 0.22 (95% CI 0.11-0.45). Positive and negative predictive values were 82% and 76%, respectively. Use of a systematic, multi-texture esophageal screen protocol interpreted by SLPs accurately identifies multiphase dysphagia and should be considered in addition to standard MBSS testing. Inclusion of a cursory esophageal view may more adequately assess dysphagia symptoms and help to promote multidisciplinary care.
Identifiants
pubmed: 33609165
doi: 10.1007/s00455-020-10239-3
pii: 10.1007/s00455-020-10239-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1063-1071Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Références
Cangelosi MJ, Rodday AM, Saunders T, Cohen JT. Evaluation of the economic burden of diseases associated with poor nutrition status. J Parent Enteral Nutr. 2013;38(2 Suppl):35S-41S. https://doi.org/10.1177/0148607113514612 .
doi: 10.1177/0148607113514612
Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc. 2009;57(11):2101–6. https://doi.org/10.1111/j.1532-5415.2009.02526.x .
doi: 10.1111/j.1532-5415.2009.02526.x
pubmed: 20121954
Allen J, Greene M, Sabido I, Stretton M, Miles A. Economic costs of dysphagia among hospitalized patients. Laryngoscope. 2020;130(4):974–9.
doi: 10.1002/lary.28194
Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29(5):545–52. https://doi.org/10.1007/s00455-014-9543-8 .
doi: 10.1007/s00455-014-9543-8
pubmed: 24948438
pmcid: 4179977
Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9. https://doi.org/10.1177/0194599814549156 .
doi: 10.1177/0194599814549156
pubmed: 25193514
Triadafilopoulos G, Hallstone A, Nelson-Abbott H, Bedinger K. Oropharyngeal and esophageal interrelationships in patients with nonobstructive dysphagia. Dig Dis Sci. 1992;37(4):551–7.
doi: 10.1007/BF01307579
O’Rourke A, Morgan LB, Coss-Adame E, Morrison M, Weinberger P, Postma G. The effect of voluntary pharyngeal swallowing maneuvers on esophageal swallowing physiology. Dysphagia. 2014;29(2):262–8.
doi: 10.1007/s00455-013-9505-6
Borgstrom PS, Olsson R, Sundkvist G, Ekberg O. Pharyngeal and oesophageal function in patients with diabetes mellitus and swallowing complaints. Br J Radiol. 1988;61(729):817–21.
doi: 10.1259/0007-1285-61-729-817
Farwell DG, Rees CJ, Mouadeb DA, Allen J, Chen AM, Enepekides DJ, Belafsky PC. Esophageal pathology in patients after treatment for head and neck cancer. Otolaryngol Head Neck Surg. 2010;143(3):375–8.
doi: 10.1016/j.otohns.2010.05.006
Huffman JA. Esophageal considerations after spinal cord injury. Perspectives on swallowing and swallowing disorders. Dysphagia. 2011;20(1):9–13.
Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12(1):11–8.
doi: 10.1007/PL00009512
Montesi A, Pesaresi A, Cavalli ML, Ripa G, Candela M, Gabrielli A. Oropharyngeal and esophageal function in scleroderma. Dysphagia. 1991;6(4):219–23.
doi: 10.1007/BF02493531
Elkberg O. To sweep or not to sweep. Dysphagia. 2019;34(1):1–1. https://doi.org/10.1007/s00455-018-09967-4 .
doi: 10.1007/s00455-018-09967-4
American Speech-Language-Hearing Association: Practice portal for adult dysphagia (2017) http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550§ion=Assessment . Accessed 5/5/2020
Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing. Otolaryngol Head Neck Surg. 2016;152(3):488–93.
doi: 10.1177/0194599814565599
Allen JE, White C, Leonard R, Belafsky PC. Comparison of esophageal screen findings on videofluoroscopy with full esophagram results. Head Neck. 2012;34(2):264–9. https://doi.org/10.1002/hed.21727 .
doi: 10.1002/hed.21727
pubmed: 21472881
Watts S, Gaziano J, Jacobs J, Richter J. Improving the diagnostic capability of the modified barium swallow study through standardization of an esophageal sweep protocol. Dysphagia. 2019;34(1):34–42.
doi: 10.1007/s00455-018-09966-5
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.
doi: 10.1007/s00455-008-9185-9
Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AM, International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motilitydisorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl. 1):57–65.
doi: 10.1111/j.1365-2982.2011.01834.x
Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, Obuchowski N, Koehler RE, Richter JE, Baker ME. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia AJR. Am J Roentgenol. 1997;169(2):473–9.
doi: 10.2214/ajr.169.2.9242756
Blonski W, Kumar A, Feldman J, Richter JE. Timed barium swallow: diagnostic role and predictive value in untreated achalasia, esophagogastric junction outflow obstruction, and non-achalasia dysphagia. Am J Gastroenterol. 2018;113(2):196–203.
doi: 10.1038/ajg.2017.370
Edwards DAW. Discriminitive information in the diagnosis of dysphagia. J R Coll Phys Lond. 1975;9(3):257–63.
Roeder BE, Murry JA, Dierkhising RA. Patient localization of esophageal dysphagia. Dig Dis Sci. 2004;49(4):697–701.
doi: 10.1023/B:DDAS.0000026321.02927.39
Marvin S, Thibeault S. Pharyngeal versus esophageal stasis: accuracy of symptom localization. Am J Speech Lang Pathol. 2020;29(2):664–72. https://doi.org/10.1044/2019_AJSLP-19-00161 .
doi: 10.1044/2019_AJSLP-19-00161
pubmed: 32142366
Castell JA, Johnston BT, Colcher A, Li Q, Gideon RM, Castell DO. Manometric abnormalities of the oesophagus in patients with Parkinson’s disease. Neurogastroenterol Motil. 2001;13(4):361–4.
doi: 10.1046/j.1365-2982.2001.00275.x
Mendell D, Logemann JA. A retrospective analysis of the pharyngeal swallow in patients with a clinical diagnosis of GERD compared with normal controls: a pilot study. Dysphagia. 2002;17(3):220–6.
doi: 10.1007/s00455-002-0056-5
Sivit CJ, Curtis DJ, Crain M, Cruess DF, Winters C. Pharyngeal swallow in gastroesophageal reflux disease. Dysphagia. 1988;2(3):151–5.
doi: 10.1007/BF02424933
Lever TE, Cox KT, Holbert D, Shahrier M, Hough M, Kelley-Salamon K. The effect of an effortful swallow on the normal adult esophagus. Dysphagia. 2007;22(4):312–25.
doi: 10.1007/s00455-007-9107-2
Vanek AW, Diamant NE. Responses of the human esophagus to paired swallows. Gastroenterology. 1987;92(3):643–50.
doi: 10.1016/0016-5085(87)90012-6
Gullung JL, et al. Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry. Ann Otology Rhinol Laryn. 2012;121(11):738–745
doi: 10.1177/000348941212101107
Jou J, Radowsky J, Gangnon R, Sadowski E, Kays S, Hind J, Gaumnitz E, Taylor AJR. Esophageal clearance patterns in normal older adults as documented with videofluoroscopic esophagram. Gastroenterol Res Pract. 2009;1:1–6.
doi: 10.1155/2009/965062
Levine M, Rubesin S, Laufer I. Barium studies in modern radiology: do they have a role? Radiology. 2009;250(1):18–22.
doi: 10.1148/radiol.2501080806
Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018;18(1):594. https://doi.org/10.1186/s12913-018-3376-3 .
doi: 10.1186/s12913-018-3376-3
pubmed: 30068326
pmcid: 6090960