title: Assessment of swallowing by oropharyngoesophageal scintigraphy in patients with amyotrophic lateral sclerosis.
abstract: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease in adults, and dysphagia is one of its most frequent and disabling symptoms. Oropharyngoesophageal scintigraphy (OPES) permits a functional and semiquantitative study of the various stages of swallowing. We studied 28 ALS patients (12 females and 16 males; mean age = 63.57 +/- 10.39 yr SD), who were clinically rated against the ALSFRS scale (Amyotrophic Lateral Sclerosis Functioning Rating Scale) and underwent OPES with (99m)Tc-nanocolloid using either a liquid or a semisolid bolus. The semiquantitative parameters we analyzed were Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER(10s)). Hence, the OPES performed with a semisolid bolus produced a higher proportion of pathologic values for the swallowing variables than when liquid bolus was used. Analyzed by grouping the patients into classes according to their bulbar ALSFRS scores, we found a significant increase in the OTT (p < 0.005), PTT (p < 0.02), and Oropharyngeal Retention Index (OPRI) (p < 0.0004) variables in ALS patients with more severe bulbar involvement. OPES has turned out to be a very important examination for detecting tracheal-bronchial inhalation and it also offers the possibility of acquiring a semiquantitative evaluation of the amount of food inhaled. In our experience, OPES in patients with ALS has been easy to use, economic, well tolerated, and capable of supplying precise indications with regard to the extent of the swallowing disorder, which permits a better clinical definition of the ALS patient.
authors.affiliation: Department of Neuroscience, ENT Unit, University of Pisa, Pisa, Italy, bfattori@ent.med.unipi.it
authors.forename: Bruno
authors.initials: B
authors.lastname: Fattori
authors.forename: Mariano
authors.initials: M
authors.lastname: Grosso
authors.forename: Paolo
authors.initials: P
authors.lastname: Bongioanni
authors.forename: Andrea
authors.initials: A
authors.lastname: Nacci
authors.forename: Renza
authors.initials: R
authors.lastname: Cristofani
authors.forename: Abedallatif
authors.initials: A
authors.lastname: AlSharif
authors.forename: Rosaria
authors.initials: R
authors.lastname: Licitra
authors.forename: Fabio
authors.initials: F
authors.lastname: Matteucci
authors.forename: Bruno
authors.initials: B
authors.lastname: Rossi
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Francesco
authors.initials: F
authors.lastname: Ursino
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging*; D015995:Prevalence; D011877:Radionuclide Imaging; D012720:Severity of Illness Index