Potential (Internet) Sources for Dysphagia Pathology Anatomy Paper

7 Jun

I found at least 3 reputable sources from Google Scholar and copy/pasted verbatim just to see which pathology would be easiest to research.

eosinophillic esphogitis (3,230 results)

Decreases the ability of the esophagus to stretch and accommodate mouthfuls of swallowed food probably as a result of the presence of so many eosinophils but also, perhaps as a result of some scaring that occurs in the wall of the esophagus.

source 1:  http://www.nature.com/ajg/journal/v95/n6/abs/ajg2000372a.html

-previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it.

-Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease.

-Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials.

-Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy.

Source 2:  http://www.nature.com/modpathol/journal/v19/n1/abs/3800498a.html

-raw data

-Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy.

-Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf.

-Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or anti-inflammatory therapy may be more effective than acid suppression.

Source 3:  http://www.nejm.org/doi/full/10.1056/NEJM200408263510924

-This disease is differentiated from reflux esophagitis on the basis of the magnitude of mucosal eosinophilia and a lack of response to acid suppression.

-Approximately 71 percent were male, with a mean (±SD) age of 10.5±5.4 years. The patients presented with the typical symptoms and atopic history that have been described previously (Table 1TABLE 1Presenting Symptoms among 103 Pediatric Patients with Eosinophilic Esophagitis. and Table 2TABLE 2History of Atopy in the 103 Pediatric Patients.).1-4 However, our demographic analysis revealed a strong familial pattern

-first, a genetic predisposition and, second, a cause related to an unknown environmental exposure (e.g., infection or allergen). Both these possibilities now warrant pursuit.

schleroderma (6,550 results)

Can cause wasting of the esophageal muscle and poor contraction of the lower esophageal sphincter (LES). Often accompanied by heartburn.

Source 1:  http://ukpmc.ac.uk/abstract/MED/3491774/reload=0;jsessionid=KJfKOvTIjtnroRTv3GyC.0

-Abnormal motility characterized by loss of peristalsis in the distal esophagus was present in all patients with erosive esophagitis, including the 5 who were asymptomatic.

-The patients with erosive esophagitis also had significantly diminished lower esophageal sphincter pressures and increased frequency and duration ofgastroesophageal reflux episodes.

-The duration of disease, rate of gastric emptying, and fungal smear and culture were not significantly different in those with or without esophagitis.

Source 2:  http://www.annals.org/content/40/1/92.short

-Scleroderma is a systemic disease involving the collagenous tissues. The skin, gastrointestinal tract, and the cardiovascular, musculoskeletal, genitourinary and pulmonary systems may be involved. Dysphagia is a common complaint with esophageal involvement.

Source 3:  http://www.sciencedirect.com/science/article/pii/S0003497510639720

Source 3 (full text online):  http://ats.ctsnetjournals.org/cgi/reprint/22/2/120

-raw data

-Gastroesophageal reflux, not impaired motility, is the major cause of esophageal symptoms in scleroderma.

-The most common esophageal symptoms were heartburn and dysphagia.

ALS (9,620 results) {note to self:  type out full name to get more and better results}

bilateral degeneration of the upper motor neuron in the primary motor areas also impairs further adjusted motor areas, which leads to a strong reduction of ‘swallowing related’ cortical activation. While both hemispheres are affected by the degeneration a relatively stronger activation is seen in the right hemisphere.

Source 1:  http://www.springerlink.com/content/w7fd9x9b1a2v1ew1/

-Dysphagia severity tended to be particularly influenced by dysfunction of the posterior tongue.

-early stage of dysphagia in ALS was mainly caused by oral dysfunction, and the oral phase disorders began in some cases with a decreased function of bolus transport at the anterior part of the tongue, and in other cases with a deteriorated function of holding the bolus at the posterior part of the tongue.

Source 2:  http://www.ncbi.nlm.nih.gov/pubmed/11681400

-abnormal lingual movement may result in pharyngeal residue that is aspirated after the swallow is completed and respiration is resumed. ALS patients with bulbar involvement demonstrate more severe swallowing problems (such as aspiration)

Source 3:  http://jama.jamanetwork.com/article.aspx?volume=234&issue=7&page=715

-Until a definitive treatment is found for amyotrophic lateral sclerosis, there will continue to be a need to provide symptomatic care.

Using amyotrophic lateral sclerosis as the search term:

Source 4:  http://www.ajcn.org/content/63/1/130.short [abstract]

http://www.ajcn.org/content/63/1/130.full.pdf+html [full text]

-fatal neurodegenerative disease characterized by progressive muscle atrophy and weakness.

-Although dysphagia is a universal feature of this illness, the nutritional and metabolic status of ALS patients has received little attention.  Regression analysis demonstrated progressive decreases in body fat, lean body mass, muscle power, and nitrogen balance and an increase in resting energy expenditure as death approached.

-We conclude that ALS patients have a chronically deficient intake of energy and recommended augmentation of energy intake rather than the consumption of high-protein nutritional supplements.

Source 5:  http://www.nejm.org/doi/full/10.1056/NEJM200105313442207

–  no cut & paste allowed

-good overview/history

Source 6:  http://ukpmc.ac.uk/abstract/MED/11854102

Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease in adults.

-The clinical picture consists of generalized fasciculations, progressive atrophy and weakness of the skeletal muscles, spasticity and pyramidal tract signs, dysarthria, dysphagia, and dyspnea. Pseudobulbar affect is common.

Nutritional deficiency caused by dysphagia can be relieved by a percutaneous endoscopic gastrostomy. Respiratory insufficiency can be effectively treated by non-invasive home mechanical ventilation. The terminal phase of the disease should be discussed at the latest when symptoms of dyspnea appear, in order to prevent unwarranted fears of “choking to death.” Psychological and spiritual care of patients and families are important. Collaboration with hospice institutions and completion of advance directives can be of invaluable help in the terminal phase.

mysthenia gravis (7,320 results)

Antibodies block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction which prevents the muscle contraction from occurring. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder.

Source 1:  http://jnnp.bmj.com/content/76/9/1297.short

-Oesophageal manometry was carried out in two patients and showed generalised weakness of peristaltic contractions which included the smooth muscle part of the oesophagus. These disturbances worsened with repeated swallows.

-They were partly reversed by intravenous edrophonium and by rest

Source 2:  http://jnnp.bmj.com/content/65/6/848.short

-In patients with myasthenia gravis with dysphagia, it was found that the time necessary for the larynx to remain in its superior position during swallowing and swallowing variability in successive swallows increased significantly compared with normal subjects and with patients with myasthenia gravis without dysphagia.

-a coordination disorder between normal CP sphincter muscle and the affected striated muscles of the laryngeal elevators may be one of the reasons for dysphagia in myasthenia gravis.

Source 3:  http://www.ncbi.nlm.nih.gov/pubmed/8017368

-Myasthenia gravis is an autoimmune disorder of the neuromuscular junction that causes muscle weakness. Involvement of oropharyngeal musculature is not uncommon, which leads to dysphagia. Timely consideration of myasthenia gravis in evaluating dysphagia is crucial to prevent complications and to improve the quality of life of these patients. We report four patients who underwent extensive investigations for dysphagia, by gastroenterologists as well as otolaryngologists, before the diagnosis of myasthenia gravis was established.

Source 4:  http://jama.jamanetwork.com/article.aspx?volume=134&issue=12&page=987

-some difficulty in swallowing being the first sign of abnormal muscular fatigue. The defect in the swallowing reflex is due to weakness of the buccopharyngeal muscles, usually with relaxation of the constrictors.

-Both the feeble power of the reflex act, as shown by the slowness of movement, and the relaxation, with dilation of the pharyngeal tube, are easily demonstrated by roentgenoscopic examination.

-The tightening of these muscles and the increased rate of swallowing, after stimulation by an appropriate amount of neostigmine (“prostigmine”) methylsulfate, was observed and recorded in cases of myasthenia gravis

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