M.V. Petrova – Dr.Sc. (Med.), Professor, Deputy Director for Scientific and Clinical Work, 

Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (Moscow); 

Head of the Department of Anesthesiology and Resuscitation with a Course of Medical Rehabilitation,  Medical Institute of the Peoples’ Friendship University of Russia (Moscow) E-mail: mail@petrovamv.ru

I.M. Pichugina – Ph.D. (Med.), Head of the Laboratory of the Study of Comorbidity and Autonomic 

Dysfunction, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (Moscow); 

Associate Professor, Department of Internal Medicine, Kaluga State University n.a. K.E. Tsiolkovsky E-mail: dr.pichugina@gmail.com

Statement of the problem. Dysphagia is one of the most dangerous complications of brain damage. Impaired swallowing and underestimation of this symptom can lead to life-threatening consequences such as aspiration, exhaustion and dehydration of the patient. Therefore, it is necessary to timely and correct diagnosis of swallowing disorders at the earliest stages of recovery of the patient after brain damage.

Dysphagia in patients after brain damage is estimated more as oropharyngeal, this issue is devoted to a lot of scientific research. On the study of esophageal dysphagia in neurological patients works with evidence base is extremely small, and in severe brain damage they do not exist at all. There are only a few descriptions of cases of joint observations of patients by a neurologist and a gastroenterologist, but more often they are aimed at the diagnosis and treatment of the symptom of "lump in the throat". However, the study revealed the importance of high-resolution manometry in patients with Parkinsonism, as well as the positive effect on dysphagia in such patients by transcranial magnetic stimulation.

Aim of the work – to study esophageal dysphagia in patients with brain damage is due to the high disability of patients after brain damage, low quality of life of such patients. 

Results. The problem is also related to the stereotype in the medical community of the study of only the oropharyngeal phase. Although the violation of mouth and pharyngeal phase of swallowing involves an infringement of the esophageal phase. Therefore, the problem of esophageal dysphagia becomes acute when restoring the oropharyngeal phase, or in the absence of its damage.

A number of studies show the high role of autonomic dysfunction in patients with esophageal diseases, including esophageal dysphagia. However, the study of the role of autonomic dysfunction and its role in esophageal dysphagia in this group of patients has not previously been engaged.

An algorithm of diagnosing the esophageal phase of swallowing has not been developed and high-resolution manometry has not previously been performed on patients with brain damage. There is no algorithm for feeding such patients depending on the nature of the revealed motor disorders in the pharynx and esophagus.

The role of the influence of pharmacological (including psychopharmacological) drugs, psychotherapy on the course of esophageal dysphagia in this group of patients has not been studied. The role of speech therapy in the treatment of esophageal dysphagia also has not been studied.

Practical significance. Therefore, we can say about the undeserved underestimation and prospects of studying the esophageal phase of swallowing in patients with brain damage. Research in this area will help to accelerate the rehabilitation of this group of patients and improve its effectiveness.

Petrova M.V., Pichugina I.M. Esophageal dysphagia in patients with severe brain damage. Technologies of living systems. 2020. V. 17. № 2. P. 55–61. DOI: 10.18127/j20700997-202002-06 (In Russian).

1. Varakin Yu.Ya. Epidemiologicheskie aspekty profilaktiki narushenij mozgovogo krovoobrashcheniya. Aktual'nye voprosy nevrologii. 2005. № 2. S. 4–10.
2. Fraerman A.P. Tyazhelaya cherepno-mozgovaya travma (intraoperacionnaya diagnostika i hirurgicheskaya taktika). N. Novgorod. 1995. 208 s.
3. Kadykov A.S. Reabilitaciya posle insul'ta: Rukovodstvo. M.: Miklosh. 2003. 176 s.
4. Parfyonov V.A., Hasanova D.R. Ishemicheskij insul't. M.: Medicinskoe informacionnoe agentstvo. 2012.
5. Mann G., Hankey G.J., Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999. Apr. V. 30(4).  P. 744-8.
6. Gosney M., Martin M.V., Wright A.E. The role of selective decontamination of the digestive tract in acute stroke. Age Ageing. 2006. Jan. V. 35(1). P. 42–7.
7. Terré R., Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil. 2006. Mar.  V. 18(3). P. 200–5.
8. Remesso G.C., Fukujima M.M., Chiappetta A.L., Oda A.L., Aguiar A.S., Oliveira Ade S., do Prado G.F. Swallowing disorders after ischemic stroke. Arq. Neuropsiquiatr. 2011. Oct. V. 69(5). P. 785–9.
9. Baroni A.F., Fábio S.R., Dantas R.O. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol. 2012. Apr–Jun. V. 49(2). P. 118–24.
10. Martino R., Foley N., Bhogal S., Diamant N., Speechley M., Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005. Dec. V. 36(12). P. 2756–63. Epub. 2005. Nov 3. Review. PMID: 1626963.
11. Falsetti P., Acciai C., Palilla R., Bosi M., Carpinteri F., Zingarelli A., Pedace C., Lenzi L. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J. Stroke Cerebrovasc Dis. 2009. Sep.-Oct. V. 18(5). P. 329–35.  DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009.
12. Cichero J.A., Altman K.W. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr. Inst. Workshop Ser. 2012. V. 72. Pl. 1–11. DOI: 10.1159/000339974. Epub 2012 Sep 24.
13. Flowers H.L., Silver F.L., Fang J., Rochon E., Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after firstever acute ischemic stroke. J. Commun Disord. 2013. May–Jun. V. 46(3). P. 238–48. DOI: 10.1016/j.jcomdis.2013.04.001. Epub 2013 Apr 12.
14. Kruger D. Assessing esophageal dysphagia. Journal of the American Academy of Physician Assistants. 2014. V. 27. Is. 5. P. 23–30.
15. Siddiqui A., Rodriguez-Stanley S., Zubaidi S., et al. Esophageal visceral sensitivity to bile salts in patients with functional heartburn and in healthy control subjects. Dig. Dis. Sci. 2005. V. 50(l). P. 81–5.
16. Mayer E.A., Tillish K., Chang L., et al. Neurobiological mechanisms of stress and emotions in FGID. Neurogastroenterology & Motility. V.24. Supplement 2. September 2012. Wiley-Blackwell. P.4.
17. Nutricionnaya podderzhka v gastroenterologii. Pod red. prof. L.N. Kostyuchenko. M.: BINOM. 2012. 496 s.
18. Firsova L.D., Tunik N.V. Oshchushchenie koma v gorle kak klinicheskij simptom. Medicinskij alfavit. 2016. T. 4. № 34 (297). S. 27–30.
19. Pandolfino J.E., Ghosh S., Rice J. et al. Classifying esophageal motility by pressure tomography characteristics: A study of 400 patients and 75 controls. Am. J. Gastroenterol. 2008. V. 103 (1). P. 27–37. 
20. Sung H.Y., Kim J.S., Lee K.S. et al. The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson’s disesase. Mov. Disord. 2010. V. 25 (14). P. 2361–2368.
21. Derrey S., Chastan N., Maltete D. et al. Impact of deep brain stimulation on pharyngo-esophageal motility: a randomized cross-over study. Neurogastroenterol Motil. 2015. V. 27 (9). P. 1214–1222.
22. Omari T.I., Dejaeger E., Tack J. et al. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia. 2013. V. 28. P. 146–152.
23. Menard-Katcher P., Falk G.W. Normal aging and the esophagus. In: Shak R.R., Belafsky P.C., Postma G.N., Easterling C. (Hrsg). Principles of deglutition: a multidisciplinary text for swallowing and its disorders. New York: Springer. 2013. P. 287–293.
24. Richter J.E., Wu W.C., Johns D.N. et al.  Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of  “abnormal”  contractions. Dig. Dis. Sci. V. 32. P. 583–592.
25. Wiley J., Hong S., Zheng G. Epigenetic regulating in GI neuromuscular function. Neurogastroenterology & Motility. September 2012. V.24. Supplement 2. Wiley-blackwell. P. 13.
26. Dzhulaj G.S., Sekareva E.V. Kliniko-endoskopicheskaya harakteristika ezofagita i emocional'no-lichnostnaya sfera bol'nyh gastroezofageal'noj reflyuksnoj bolezn'yu. Klinicheskaya i eksperimental'naya gastroenterologiya. 2009. № 4. S. 35–39.
27. Bordin D.S. Kliniko-patogeneticheskie varianty gastroezofageal'noj reflyuksnoj bolezni i ih differencirovannaya terapiya: Diss. … dokt. med. nauk. M. 2010.
28. Pichugina I.M. Ezofagospazm: kliniko-instrumental'noe issledovanie: Diss. … kand. med. nauk. M. 2016.
29. Drossman D.A., Hasler W.L. Rome IV – Functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016. V. 150(6). P. 1257–61.
30. Dobrohotova T.A. Nejropsihiatriya. Izd. 2-e. M.: BINOM. 2017. 304 s.
31. Oknina L.B., Sharova E.V., Zajcev O.S. Vejvlet-sinhronnost' vyzvannyh otvetov mozga pri proslushivanii realistichnyh stimulov v prognoze vosstanovleniya soznaniya. Fiziologiya cheloveka/Human Physiology. 2017. T. 43. № 6. S. 15–23.
32. Edmiaston J., Connor L.T., Loehr L., Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J. Crit. Care. 2010 Jul.  V. 19(4). P. 357–64. DOI: 10.4037/ajcc2009961. Epub 2009 Oct 29.
33. Truhmanov A.S. Gastroezofageal'naya reflyuksnaya bolezn': klinicheskie varianty, prognoz, lechenie: Diss. … dokt. med. nauk. M. 2008. 41 s.
34. Yanova O.B., Valitova E.R. Rol' vodno-perfuzionnoj manometrii v diagnostike zabolevanij pishchevoda. XI s"ezd NOGR. Tezisy dokl. M.: CNII gastroenterologii. 2011. S. 243.
35. Kajbysheva V.O., Nikonov E.L., Bordin D.S., Morozov S.V., Valitova E.R., Isakov V.A., Smirnov A.A., Fyodorov E.D., Shapoval'yanc S.G. Manometriya pishchevoda vysokogo razresheniya: Metodicheskie rekomendacii. Dokazatel'naya gastroenterologiya. 2018. V. 7(2). P. 3–55.
36. Kahrilas P.J., Bredenoord A.J., Fox M., Gyawali C.P., Roman S., Smout A.J., Pandolfino J.E. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders. v3.0. Neurogastroenterol Motil. 2015. V. 27(2). P. 160–174. https://doi.org/10.1111/nmo.1247
37. Diniz P.B., Vanin G., Xavier R., Parente M.A. Reduced incidence of aspiration with spoon-thick consistency in stroke patients. Nutr. Clin. Pract. 2009. Jun–Jul. V. 24(3). P. 414–8. DOI: 10.1177/0884533608329440.
38. Truhmanov A.S., Kajbysheva V.O. rN-impedansometriya pishchevoda: Posobie dlya vrachej. Pod red. akad. RAMN, prof. V.T. Ivashkina. M.: ID «MEDPRAKTIKA-M». 2013. 32 s.
39. Keller H.H., Laurie C.B., McLeod J., Ridgeway N. Development and reliability of the Mealtime Social Interaction Measure for Long-Term Care (MSILTC). J. Appl. Gerontol. 2013. Sep. V. 32(6). P. 687–707. DOI: 10.1177/0733464811433841. Epub 2012 Mar 22.
40. Lever T., Cox K.T., Holbert D., et al. The effect of an effortful swallow on the normal adult esophagus. Dysphagia. 2007. V. 22. P. 312–325.
41. Nekl C.G., Lintzenich C.R., Leng X., et al. Effects of effortful swallow on esophageal function in healthy adults. Neurogastroenterol Motil. 2012.  V. 24. P. 252–256; e107–e108.
42. O’Rourke A., Morgan L., Coss-Adame E. et al. The effect of voluntary pharnygeal swallowing maneuvers on esophageal swallowing physiology. Dysphagia. 2014. V. 29. P. 262–268.