Leda Maria Tavares Alves

Gender effect on the clinical measurement of swallowing.

BACKGROUND Swallowing coordination is affected by cortical and subcortical inputs from the central nervous system. Our hypothesis is that the swallowing dynamics may be influenced by gender. AIM To evaluate the influence of gender on water swallowing dynamics. METHODS We studied 111 health subjects, 36 men, aged 24-77 years (mean: 46.3 +/- 16.1 years) and 75 women, aged 22-75 years (mean: 39.6 +/- 13.3 years). All volunteers swallowed in triplicate 50 mL of water at 4 degrees C while precisely timed, when we measured the time to swallow all the volume and counted the number of swallows. We calculated the inter-swallow interval: the time to complete the task, in seconds, divided by the number of swallows; swallowing velocity: volume drunk (mL) by the time taken (s); swallowing volume capacity: volume drunk (mL) divided by the number of swallows. RESULTS Women had a shorter inter-swallow interval, slower swallowing velocity and lower volume capacity than men. CONCLUSION Gender has an effect on water swallowing dynamics, with women having a lower swallowing velocity and a lower volume capacity in each swallow than men.

Clinical measurement of swallowing and proximal esophageal contractions in Chagas’ disease

BackgroundChagas’ disease causes esophageal motility impairment similar to that seen in idiopathic achalasia. Our hypothesis is that the disease could affect the results of swallowing evaluation and the esophageal response to swallows.MethodsWe studied, by the water-swallowing test, the swallowing dynamics of 40 patients with esophageal involvement by Chagas’ disease and 75 controls. During the clinical test, each subject ingested 50 ml of water while we precisely timed and counted the number of swallows. We calculated the interswallow interval, the swallowing flow rate, and the swallowing volume capacity. We also evaluated the proximal esophageal contractions of 32 patients with Chagas’ disease and 31 controls. After swallows in duplicate of 3 ml water, the pharyngeal contractions 1 cm above the upper esophageal sphincter and the proximal esophageal body contractions 5 cm from the pharyngeal recording point were recorded.ResultsIn the water-swallowing test, patients with Chagas’ disease took a longer time to drink all the volume, had a higher number of swallows, a longer interswallow interval, a lower swallowing flow rate, and took a smaller volume in each swallow than the control subjects. Patients with Chagas’ disease had a longer interval between onset of pharyngeal and onset of proximal esophageal contractions and had contractions of lower amplitude.ConclusionsWe conclude that patients with esophageal involvement by Chagas’ disease ingest water more slowly, with a smaller volume in each swallow, and have a later proximal esophageal response to swallows than normal subjects.

Effect of bolus taste on the esophageal transit of patients with stroke

Stroke is a frequent cause of oropharyngeal dysphagia but may also cause alterations in esophageal motility. The aim of this investigation was to evaluate the effect of bolus taste on the esophageal transit of patients with stroke and controls. Esophageal transit and clearance were evaluated by scintigraphy in 36 patients in the chronic phase of stroke (44-82 years, mean: 63 years) and in 30 controls (33-85 years, mean: 59 years). The patients had a stroke 1-84 months (median: 5.5 months) before the evaluation of esophageal transit. Eight had dysphagia. Each subject swallowed in random order and in the sitting position 5 mL of liquid boluses with bitter (pH=6.0), sour (pH=3.0), sweet (pH=6.9), and neutral (pH=6.8) taste. Transit and clearance duration and the amount of residues were measured in the proximal, middle, and distal esophageal body. There was no difference between patients and controls in esophageal transit or clearance duration. In the distal esophagus, the transit and clearance durations were longer with the sour bolus than with the other boluses in both patients and controls. The amount of residues in the esophageal body was greater in patients than in controls after swallows of the neutral bolus. In control subjects, after swallows of a sour bolus, there was an increase in the amount of residues in the middle and distal esophagus compared with the other boluses. In conclusion, a sour bolus with low pH causes a longer transit and clearance duration in the distal esophageal body. There was no effect of bolus taste or pH on the esophageal transit of patients in the chronic phase of stroke compared with normal volunteers. The longer transit and clearance duration in the distal esophageal body with the sour bolus appears to be a consequence of the low pH of the bolus.

Effect of age on proximal esophageal response to swallowing

CONTEXT It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION We conclude that the age may affects the response of the proximal esophagus to wet swallows.

Possible interaction of gender and age on human swallowing behavior

CONTEXT The swallowing behavior is affected by age and possibly by gender. However, the interaction of the effects of age and gender on swallowing is not completely known. OBJECTIVES To evaluate the possibility of interaction of gender and age on human swallowing behavior. METHOD Swallowing was evaluated in 89 healthy subjects by the water swallowing test, 43 men and 46 women aged 20-40 years (younger, n = 38), 41-60 years (middle-aged, n = 31) and 61-80 years (older, n = 20). Each subject ingested in triplicate 50 mL of water while precisely timed and the number of swallows needed to ingest all the volume was counted. RESULTS The interval between swallows was shorter and the volume in each swallow was smaller in women compared to men. In older subjects the time to ingest the 50 mL of water was longer, the interval between swallows was longer, and swallowing flow and volume in each swallow were smaller than in younger and middle-aged subjects. The swallowing flow was lower in women compared to men in younger subjects. The volume of each swallow was smaller in women than in men in younger and middle-aged subjects. There was no difference in swallowing flow and volume between older men and older women. CONCLUSION Age and gender influence swallowing behavior, with the effect of gender being more evident in younger subjects and the effect of age being more evident in men.

Gender differences in proximal esophageal contractions

CONTEXT There are reports showing that gender has an influence on swallowing and on the contractions of the distal esophageal body. OBJECTIVE In this investigation we studied the effect of gender on proximal esophageal contraction. METHODS We studied 20 men (22-68 years old, median 39 years) and 44 women (18-61 years old, median 41 years) without symptoms and without gastrointestinal or respiratory diseases. We measured the time interval between the onset of pharyngeal contraction 1 cm proximal to the upper esophageal sphincter and the onset of the proximal esophageal contraction 5 cm from the pharyngeal recording. We also measured the amplitude, duration and area under the curve of the proximal esophageal contractions. The recording was performed by the manometric method with continuous perfusion. The contractions were recorded in duplicate after swallows of a 5 mL bolus of water. RESULTS There were no differences between men and women in the interval between the onset of pharyngeal and of esophageal contractions or in the amplitude of esophageal contractions. The duration of contractions was longer in women (2.35 +/- 0.60 s) than in men (2.07 +/- 0.62 s) but the difference did not reach statistical significance (P = 0.087). The area under the curve of the esophageal contraction was higher in women (130.2 +/- 55.2 mm Hg x s) than in men (97.4 +/- 49.4 mm Hg x s, P = 0.026). CONCLUSION We conclude that there is a difference between men and women in the proximal esophageal contractions in response to wet swallows, although this difference is of no clinical relevance.

Evaluation of liquid ingestion after bariatric surgery

CONTEXT Bariatric surgery is an effective treatment for obesity; however, after surgery the patient may have difficulty in swallowing liquid and solid foods. OBJECTIVES To evaluate liquid ingestion in patients who had undergone bariatric surgery. METHOD We studied 43 volunteers with normal body mass index (BMI) (BMI: 18.5-24.9 kg/m²), 55 subjects with class III obesity (BMI: >40.0 kg/m²), and 48 subjects with bariatric surgery for treatment of class III obesity. The method chosen for evaluation was the water swallowing test. The subjects drank in triplicate 50 mL of water while being precisely timed and the number of swallows were counted. RESULTS There was no difference between subjects with normal BMI and subjects with class III obesity. During the first 2 months after bariatric surgery the patients showed an increase in the time needed to drink the entire volume, in the number of swallows, and in the inter-swallow interval, and a decrease in the volume swallowing capacity (volume/swallowing) and swallowing flow rate (volume swallowed/second). After 2 months, the results of the swallowing measurements moved in the direction of normal values. CONCLUSION Bariatric surgery may cause more intense alterations of liquid bolus swallowing within 2 months after the procedure, which moved to normal values after this time.