| 1. |
- Ask, Per, et al.
(författare)
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A simple device measuring differences in level in the oesophagus
- 1978
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 85:3-4, s. 296-297
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- A device for measuring the difference in level between the pressure transducer and a point of measurment is described. It can be used in oesophageal manometry with waterfilled catheters to measure and compensate for superimposed hydrostatic pressure. The practical application of the method is illustrated.
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| 2. |
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| 3. |
- Ask, Per, 1950-, et al.
(författare)
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Clinical evaluation of different fluid-filled systems for oesophageal manometry
- 1979
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Ingår i: Scandinavian Journal of Gastroenterology. - 0036-5521 .- 1502-7708. ; 14:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- In a clinical study of oesophageal manometry with fluid-filled catheters, both a non-perfused system and a perfused system with a syringe pump have been compared to a system with a low-compliance perfusion pump, which served as a reference. Significantly lower values of motility amplitudes, motility derivatives, and partly of LES pressures, and a time delay of up to 0.5 sec of the amplitude maximum were obtained with the non-perfused system and the system with a syringe pump in comparison to the low-compliance system. Since the oesophageal function can be erroneously evaluated by use of a non-perfused system or a perfused system with a syringe pump, such systems cannot be recommended for clinical use.
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| 4. |
- Ask, Per, et al.
(författare)
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Combined pH and pressure measurement device for oesophageal investigations.
- 1981
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Ingår i: Medical and Biological Engineering and Computing. - 0140-0118 .- 1741-0444. ; 19:4, s. 443-446
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Tidskriftsartikel (refereegranskat)abstract
- A combined pH- and pressure-measurement device for oesophageal investigations has been designed using monocrystalline antimony pH electrodes and perfused polyvinyl catheters. The combined device facilitates pressure measurements simultaneously with pH recording, both distal and proximal to the pH electrode. The device is easier to pass through the nose to the oesophagus than the conventional glass pH electrode. pH and pressure measurements in the oesophagus are therefore simplified and valuable information about the function of the region of the lower oesophageal sphincter is added owing to the simultaneous recording of the two parameters.
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| 5. |
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| 6. |
- Ask, Per, et al.
(författare)
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Effect of time interval between swallows on esophageal peristalsis.
- 1980
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Ingår i: American Journal of Physiology. - 0002-9513 .- 2163-5773. ; 238:6, s. G485-90
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Tidskriftsartikel (refereegranskat)abstract
- Esophageal peristaltic pressure amplitude, peristaltic incidence, speed of peristalsis, and wave duration were investigated as a function of swallow interval. In the distal half of the esophagus, the amplitude decreased at swallow intervals of 8 s and shorter. At intervals of 8 and 4 s, dropouts of contractions that were obtained were most frequent in the distal esophagus and for the 4-s interval. At continuous swallows no contractions were obtained below the upper esophageal sphincter until the end of the swallow sequence, after which a peristaltic wave of high amplitude propagated along the esophagus. The peristaltic speed increased toward a level 5 cm above the lower esophageal sphincter. The peristaltic wave duration was approximately the same in different parts of the esophagus and at different swallow intervals. The findings indicate an impairment of esophageal transport function by short swallow intervals.
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| 7. |
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| 8. |
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| 9. |
- Ask, Per, et al.
(författare)
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Evaluation of a new method for abdominal compression for use in oesophageal investigation.
- 1982
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Ingår i: Scandinavian Journal of Gastroenterology. - 0036-5521 .- 1502-7708. ; 17:2, s. 269-272
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Tidskriftsartikel (refereegranskat)abstract
- The use of conventional extra-abdominal compression with a constant cuff pressure was shown to give various pressures intra-abdominally in different subjects. A feedback system was therefore used, in which the extra-abdominal pressure is controlled by the intra-abdominal pressure. For an intra-abdominal pressure increase of 15 mm Hg the external cuff pressure in 20 subjects varied from 21 to 98 mm Hg. There was, however, an almost linear relationship between increased intra-abdominal pressure and cuff pressure. The extra-abdominal pressure required to obtain a certain intra-abdominal pressure also varied with the size of the cuff. To obtain relevant and comparable results in studies of hiatal incompetence and gastro-oesophageal reflux, the feedback system is recommended and the size of the intra-abdominal cuff should be stated.
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| 10. |
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| 11. |
- Ask, Per, et al.
(författare)
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Frequency content of esophageal peristaltic pressure.
- 1979
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Ingår i: American Journal of Physiology. - 0002-9513 .- 2163-5773. ; 236:3, s. E296-300
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Tidskriftsartikel (refereegranskat)abstract
- Fourier analysis of esophageal peristaltic pressure waves was performed by computer fast Fourier transform. The highest power spectral density was obtained in the frequency range below 1 Hz. The Fourier analysis showed spectral components up to about 12 Hz in the upper esophageal sphincter (UES). The significance of different frequency components was investigated by low-pass filtering at different cut-off frequencies. A reduction in the amplitude of UES contractions was obtained at a cut-off frequency of 4 Hz, whereas the cut-off frequency of 8 Hz did not show any distortion. For perfused manometry systems, only a low-compliance perfusion pump will have sufficient bandwidth for accurate recording of esophageal peristaltic pressures.
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| 12. |
- Ask, Per, et al.
(författare)
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Mechanisms affecting lower oesophageal sphincter opening and oesophageal retention : A combined X-ray and manometry study
- 1978
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Ingår i: Scandinavian Journal of Gastroenterology. - 0036-5521 .- 1502-7708. ; 13:7, s. 857-861
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Tidskriftsartikel (refereegranskat)abstract
- Using simultaneous manometry and cineradiography, oesophageal evacuation was studied while contrast medium was infused via a catheter. The distal half of the oesophagus could be filled with contrast medium without triggering peristalsis. The hydrostatic pressure necessary to open the lower oesophageal sphincter (LES) was of approximately the same magnitude as the pressure gradient between oesophagus and LES. No significant relaxation of the LES could be observed at the initiation of swallowing. The LES may be looked upon not only as a sphincter preventing reflux but also as a gate which must be forced open by food.
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| 13. |
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| 14. |
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| 15. |
- Ask, Per, et al.
(författare)
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On the use of monocrystalline antimony pH electrodes in gastro-oesophageal functional disorders.
- 1982
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Ingår i: Medical and Biological Engineering and Computing. - 0140-0118 .- 1741-0444. ; 20:3, s. 383-389
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Tidskriftsartikel (refereegranskat)abstract
- Monocrystalline antimony electrodes have been shown to be suitable for thein vivo determination of pH in blood, tissue and in the upper gastro-intestinal canal. Thanks to their small dimensions it has been possible to mount them into conventional manometry catheters for oesophageal investigation. The monocrystalline antimony pH electrode has several advantages over the conventional pH glass electrode; better accuracy, shorter rise time, smaller dimensions. The monocrystalline antimony electrode has been used for long-term registration of gastro-oesophageal reflux, for the oesophageal acid clearing test and for identification of the pH gradient zone between the gastric and oesophageal mucosa. Its use in combination with pressure sensors has added a new dimension to the diagnosis of functional disorders in the gastro-oesophageal region.
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| 16. |
- Ask, Per, et al.
(författare)
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Static and dynamic characteristics of fluid-filled esophageal manometry systems
- 1977
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Ingår i: American Journal of Physiology. - 0002-9513. ; 233:5, s. E389-E396
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Tidskriftsartikel (refereegranskat)abstract
- Esophageal manometric systems with water-filled catheters have been characterized by the use of model experiments. The examined parameters have been: catheter dimension, catheter compliance, catheter resistance, pump type, pump compliance, and perfusion flow. Accurate static pressure measurements have been obtained for perfused systems independently of the investigated parameters. The dynamic characteristics vary with catheter diameter and perfusion flow. For catheters with low diameter, a narrow bandwidth is obtained for the investigated perfusion flows. The results have been expressed in terms of an electric model of the measurement system. Perfusion pumps with low compliance are recommended to improve the dynamic properties of the measurement system.
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| 17. |
- Cederbrant, Karin, et al.
(författare)
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In vitro Lymphocyte Proliferation as Compared to Patch Test Using Gold, Palladium and Nickel
- 1997
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Ingår i: International Archives of Allergy and Immunology. - : S. Karger AG. - 1018-2438 .- 1423-0097. ; 112:3, s. 212-217
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Tidskriftsartikel (refereegranskat)abstract
- Background: A conventional lymphocyte transformation test (LTT) was compared to the commercially available MELISA® (memory lymphocyte immuno-stimulation assay), a lymphoproliferative assay that has been suggested to be a valuable instrument for the diagnosis of metal allergy. Sensitivity and specificity of the two assays were calculated using a patch test as a reference method.Methods: 34 patients were patch-tested for gold sodium thiosulfate, palladium chloride and nickel sulfate, and the lymphocyte proliferation to these metals was tested in vitro using mononuclear cells from peripheral blood.Results: No significant differences regarding sensitivity and specificity were found between MELISA and conventional LTT. The sensitivity varied between 55 and 95% and the specificity between 17 and 79%.Conclusions: The low specificity of the two in vitro assays suggests that they are not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.
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| 18. |
- Danbolt, Christina, 1946-, et al.
(författare)
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Validation and characterization of the computerized laryngeal analyzer (CLA) technique
- 1999
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Ingår i: Dysphagia (New York. Print). - 0179-051X .- 1432-0460. ; 14:4, s. 191-195
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the response characteristics of the Computerized Laryngeal Analyzer (CLA) and the validity of the noninvasive CLA method to detect swallowing-induced laryngeal elevation correctly. Two healthy adults and two experimental models were used in the study. The CLA technique identified all swallowing events but was unable to discriminate between swallowing and other movements of the tongue or the neck. The computer program produced a derivated response to a square wave signal. Stepwise bending increments of the sensor displayed a linear amplitude response. The degree of laryngeal elevation could not be estimated with the CLA technique, and it was not possible to draw any reliable conclusions from the recordings as to whether the larynx was moving upward or downward.
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| 19. |
- Franzen, Thomas, et al.
(författare)
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Is the severity of gastroesophageal reflux dependent on hiatus hernia size?
- 2014
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Co. Limited. - 1007-9327 .- 2219-2840. ; 20:6, s. 1582-1584
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Tidskriftsartikel (refereegranskat)abstract
- AIM:To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia.METHODS:Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain.RESULTS:The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups.CONCLUSION:Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.
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| 20. |
- Franzen, Thomas, et al.
(författare)
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Oral neuromuscular training relieves hernia-related dysphagia and GERD symptoms as effectively in obese as in non-obese patients
- 2018
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Ingår i: Acta Oto-Laryngologica. - : TAYLOR & FRANCIS LTD. - 0001-6489 .- 1651-2251. ; 138:11, s. 1004-1008
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many physicians insist patients lose weight before their hiatal hernia (HH) condition and related symptoms including intermittent esophageal dysphagia (IED) and gastroesophageal reflux disease (GERD) can be treated, but it is not proven that body mass index (BMI) has an impact on exercise-based treatment of HH-related symptoms. Aims/Objectives: To investigate whether BMI has significance on IQoro (R) neuromuscular training (IQNT) effectiveness in treating HH-related symptoms. Material and Methods: Eighty-six patients with sliding HH and enduring IED and GERD symptoms, despite proton pump inhibitor medication, were consecutively referred for 6 months IQNT comprising 11/2 minutes daily. They were grouped by BMI which was recorded before and after IQNT, as were their symptoms of IED, reflux, heartburn, chest pain, globus sensation, non-productive cough, hoarseness, and misdirected swallowing. They were also assessed on food swallowing ability, water swallowing capacity and lip force both before and after treatment. Results: After IQNT, all BMI groups showed significant improvement (p amp;lt; .001) of all assessments and symptoms; and heartburn, cough and misdirected swallowing were significantly more reduced in the severely obese. Conclusions and significance: IQNT can treat HH-related IED and GERD symptoms as successfully in moderately or severely obese patients as in those with normal bodyweight.
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| 21. |
- Franzén, Thomas, 1955-, et al.
(författare)
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Prospective evaluation of laparoscopic and open 360o fundoplication in mild and severe gastro-oesophageal reflux disease
- 2002
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 168:10, s. 539-545
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To investigate the relationship between five-year control of reflux and early postoperative oesophageal function after total fundoplication done either laparoscopically or through a laparotomy in severe and mild reflux disease.DESIGN:Prospective open study.SETTING:University hospital, Sweden.PATIENTS:In the group with severe disease 9 patients had a laparotomy and 7 laparoscopy. The corresponding figures for the group with mild disease were 21 and 34 respectively.RESULTS:The increase in lower oesophageal sphincter pressure 6 months after operation in patients with recurrent disease was significantly less than that for patients with good reflux control (p < 0.01). In patients who had laparotomy, including 30% (9/30) with severe reflux disease, good long-term reflux control was found in 93% (27/29). In patients operated on laparoscopically including 17% (7/41) with severe reflux disease good long-term reflux control was found in 90% (35/39).CONCLUSION:The mechanism of recurrence differed between patients with severe disease who had a laparotomy and patients with mild disease operated on laparoscopically. Early postoperative manometry was prognostic for recurrence. Long-term reflux control seems to be similar after laparotomy and laparoscopy. Further randomised studies are needed.
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| 22. |
- Franzén, Thomas, 1955-, et al.
(författare)
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Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication
- 1999
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 86:7, s. 956-960
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Tidskriftsartikel (refereegranskat)abstract
- Background:This was a prospective study of symptoms, and short-term and long-term reflux competence after partial fundoplication.Methods:Some 101 patients were operated consecutively with posterior partial (270°) fundoplication. Indications for surgery were reflux disease without erosive oesophagitis in 25 patients, moderate oesophagitis in 43, severe oesophagitis in 25 and paraoesophageal hernia in eight. Symptom score, manometry and pH tests were performed before operation, 6 months after operation and after 6–14 years.Results:All patients (n = 101) were free from heartburn and regurgitation at early follow-up. There was evidence of clinical recurrence at late follow-up (n = 87) in two of 22 patients without oesophagitis before operation, two of 39 with moderate oesophagitis before operation and three of 19 patients with severe oesophagitis before operation; 92 per cent had good reflux control at late follow-up.ConclusionPosterior partial fundoplication shows excellent reflux control at early follow-up. Ten years later fewer than 10 per cent of patients have recurrence, which is more common in patients who had severe oesophagitis before operation.
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| 23. |
- Franzén, Thomas, 1955-, et al.
(författare)
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Reliability of 24-hour oesophageal pH monitoring under standardized conditions
- 2002
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:1, s. 6-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Twenty-four-hour pH monitoring is an investigation technique that can give both false-positive and false-negative results, depending on patient factors such as diet and different activities. The aim was to study the reproducibility of 24-h oesophageal pH monitoring under as standardized conditions as possible in patients with symptoms of gastro-oesophageal reflux disease.METHODS:Antimony pH electrodes were used in 22 adult patients who were investigated twice, 6 weeks apart, under identical conditions. They were hospitalized and were served a standardized diet which had been tested to contain no lower than pH 5.0. Neither coffee nor smoking was allowed. The patients had to refrain from proton-pump inhibitors for 10 days and H2 blockers for 2 days prior to the investigation. The paired t test was used.RESULTS:There was no significant difference in total reflux time, upright or supine reflux time, or longest reflux periods between the two test occasions. However, there were discordant results in six patients who had normal total reflux time on one test occasion but pathological results on the other.CONCLUSION:Since the biological variability of gastro-oesophageal reflux is not negligible from time to time, a normal 24-h oesophageal pH test should be assessed with caution.
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| 24. |
- Hägg, Mary, et al.
(författare)
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Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms
- 2015
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 135:7, s. 635-639
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Forskningsöversikt (refereegranskat)abstract
- Conclusion: Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro(R) screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia. Objectives: The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia. Methods: A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0-3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM). Results: Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79%, and cough in 86%. Significant improvement was found for all symptoms after oral IQS training (p < 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.
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| 25. |
- Hägg, Mary, et al.
(författare)
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Effect of IQoro (R) training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke
- 2016
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 136:7, s. 742-748
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion All patients with dysphagia after stroke have impaired postural control. IQoro (R) screen (IQS) training gives a significant and lasting improvement of postural control running parallel with significant improvement of oropharyngeal motor dysfunction (OPMD). Objectives The present investigation aimed at studying the frequency of impaired postural control in patients with stroke-related dysphagia and if IQS training has any effect on impaired postural control in parallel with effect on OPMD. Method A prospective clinical study was carried out with 26 adult patients with stroke-related dysphagia. The training effect was compared between patients consecutively investigated at two different time periods, the first period with 15 patients included in the study more than half a year after stroke, the second period with 11 patients included within 1 month after stroke. Postural control tests and different oropharyngeal motor tests were performed before and after 3 months of oropharyngeal sensorimotor training with an IQS, and at a late follow-up (median 59 weeks after end of training). Result All patients had impaired postural control at baseline. Significant improvement in postural control and OPMD was observed after the completion of IQS training in both intervention groups. The improvements were still present at the late follow-up.
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| 26. |
- Hägg, Mary, et al.
(författare)
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Effect of oral IQoro(R) and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia : A comparison study
- 2015
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 135:9, s. 962-968
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion: Training with either a palatal plate (PP) or an oral IQoro(R) screen (IQS) in patients with longstanding facial dysfunction and dysphagia after stroke can significantly improve facial activity (FA) in all four facial quadrants as well as swallowing capacity (SC). Improvements remained at late follow-up. The training modalities did not significantly differ in ameliorating facial dysfunction and dysphagia in these patients. However, IQS training has practical and economic advantages over PP training. Objectives: This study compared PP and oral IQS training in terms of (i) effect on four-quadrant facial dysfunction and dysphagia after a first-ever stroke, and (ii) whether the training effect persisted at late follow-up. Methods: Patients were included during two periods; 13 patients in 2005-2008 trained with a PP, while 18 patients in 2009-2012 trained with an IQS. Four-quadrant facial dysfunction was assessed with an FA test and swallowing dysfunction with a SC test: before and after a 3-month training period and at late follow-up. FA and SC significantly improved (p < 0.001) in both groups. FA test scores after training and at late follow-up did not differ significantly between the groups, irrespective of whether the interval between stroke incidence and the start of training was long or short.
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| 27. |
- Hägg, Mary, et al.
(författare)
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Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training
- 2015
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327 .- 2219-2840. ; 21:24, s. 7558-7562
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. METHODS: A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (>= 15 N), velopharyngeal closure test (>= 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7 (0-3) vs 0.5 (0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71 (30-100) vs 22 (0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N (12-80 N) vs 54 N (27-116), P < 0.001] and velopharyngeal closure test values [28 s (5-74 s) vs 34 s (13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mmHg at rest (range: 0-0 mmHG) to 65 mmHg (range: 20-100 mmHg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.
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| 28. |
- Hägg, Mary, et al.
(författare)
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Four-quadrant facial function in dysphagic patients after stroke and in healthy controls
- 2014
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Ingår i: Neurology Research International. - : Hindawi Limited. - 2090-1852 .- 2090-1860. ; 2014, s. 672685-
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to examine any motility disturbance in any quadrant of the face other than the quadrant innervated by the lower facial nerve contralateral to the cortical lesion after stroke. Thirty-one stroke-afflicted patients with subjective dysphagia, consecutively referred to a swallowing centre, were investigated with a facial activity test (FAT) in all four facial quadrants and with a swallowing capacity test (SCT). Fifteen healthy adult participants served as FAT controls. Sixteen patients were judged to have a central facial palsy (FP) according to the referring physician, but all 31 patients had a pathological FAT in the lower quadrant contralateral to the cortical lesion. Simultaneous pathology in all four quadrants was observed in 52% of stroke-afflicted patients with dysphagia; some pathology in the left or right upper quadrant was observed in 74%. Dysfunction in multiple facial quadrants was independent of the time interval between stroke and study inclusion. All patients except two had a pathological SCT. All the controls had normal activity in all facial quadrants. In summary the majority of poststroke patients with dysphagia have subclinical orofacial motor dysfunction in three or four facial quadrants as assessed with a FAT. However, whether subclinical orofacial motor dysfunction can be present in stroke-afflicted patients without dysphagia is unknown.
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| 29. |
- Hägg, Mary K D, et al.
(författare)
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Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke
- 2015
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Ingår i: NeuroRehabilitation. - : IOS Press. - 1878-6448 .- 1053-8135. ; 36:1, s. 101-106
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown.OBJECTIVE: This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia.METHODS: Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment).RESULTS: Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke.CONCLUSIONS: Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment.
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| 30. |
- Hägg, Mary, et al.
(författare)
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Longstanding Effect and Outcome Differences of Palatal Plate and Oral Screen Training on Stroke-Related Dysphagia
- 2013
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Ingår i: The Open Rehabilitation Journal. - 1874-9437. ; :6, s. 35-42
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Tidskriftsartikel (refereegranskat)abstract
- Aim:This study aimed at evaluating (1) if the oral training effect on stroke related dysphagia differs between two different oral appliances, a palatal plate (PP) and an oral screen (OS), and (2) if the training effect remains at a late follow-up.Methods:We included patients with stroke-related dysphagia at two different time periods: the first group of 12 patients studied in 1997- 2 002 had to train with a PP, the other one of 14 patients studied in 2003-2008 had to train with an OS. All patients were evaluated by a swallowing capacity test (SCT), and by a self-assessed visual analogue scale (VAS) of water swallowing capacity at entry of the study, after 13 weeks of training, and at a late follow-up.Results:At end of treatment the SCT had normalized in 33% of PP patients and in 71% of OS patients. There was a significant SCT improvement difference between the PP and OS groups in the period from baseline to late follow-up (p <0.002) in favor of the OS group. VAS as tested at baseline and at end of treatment did not differ significantly between the two groups. Training with PP and with OS produced remaining improvement of SCT and of VAS as assessed at a late follow-up.Conclusion:The outcome of OS training on SCT in patients with stroke-related dysphagia seems to be superior to PP training. The improvement as assessed with VAS did not differ between the two groups. Training with PP or OS gives a longstanding improvement of SCT and VAS.
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| 31. |
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| 32. |
- Mjönes, Anna-Britta, 1947-, et al.
(författare)
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Hoarseness and misdirected swallowing before and after antirefluxsurgery
- 2005
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 125:1, s. 82-85
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion Patients with hiatus hernia can be relieved from H, MSL and MSN by hiatus hernia repair. Objective It has been hypothesized that respiratory symptoms in patients with gastro-oesophageal reflux disease (GORD) may, in some cases, be due to misdirected swallowing as a consequence of defective opening of the upper oesophageal sphincter. The aim of this study was to investigate whether patients with hiatus hernia are relieved from symptoms of misdirected swallowing to the larynx (MSL) and nose (MSN), as well as hoarseness (H), as a result of hiatus hernia repair. Material and methods A questionnaire concerning symptoms of H, MSL and MSN was administered to 90 patients under investigation for hiatus hernia repair before and after surgery. Results Before surgery, MSL occurred in 30% of patients, MSN in 30% and H in 25%. These symptoms were significantly interrelated (p<0.008). After antireflux surgery, all symptoms were significantly reduced (p<0.001). Symptom reduction was not related to the weight of the patients.
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| 33. |
- Mjönes, Anna-Britta, et al.
(författare)
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Hoarseness and misdirected swallowing in patients with hiatal hernia
- 2007
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 264:12, s. 1437-1439
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to elucidate whether misdirected swallowing is an extra-laryngeal cause of hoarseness and investigate whether the prevalence of misdirected swallowing and hoarseness in patients with hiatal hernias differ from those with and without pathological gastroesophageal reflux (GER). One hundred and ninety eight patients with hiatal hernias diagnosed via esophageal manometry and pH-reflux test and 262 subjects in the general population who did not have a hiatal hernia at endoscopy, filled in a questionnaire about symptoms on hoarseness, misdirected swallowing, and heartburn. Hoarseness (35%), misdirected swallowing to the larynx (MSL; 35%), misdirected swallowing to the nose (MSN; 22%) and heartburn (85%) were significantly more common in patients with hiatal hernia than in controls (13, 5, 1, and 6%, respectively, P<0.001). MSL and MSN in the patient group were significantly interrelated (P<0.0001). Hoarseness and MSL were not significantly associated (P<0.076). Hoarseness and MSL were as common in the hernia group with normal GER, as in the group with pathological GER. There is a predisposition for hoarseness and MSL in patients with hiatal hernias, but the cause-and-effect relationship is unclear. Hoarseness does not seem to be caused by pathological GER.
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| 34. |
- Mjönes, Anna-Britta, 1947-
(författare)
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Svalgproblem och hiatushernia : reflektioner över symptom och fynd
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Denna licentiatavhandling består av tre delarbeten. Dessa tre arbeten handlar omsymtom som inte alltid kommer i fråga när det gäller gastroesofageal reflux.I det första arbetet var syftet att undersöka huruvida patienter medmagmunsbråck (hiatushernia) blev förbättrade med avseende på symtom somfelsväljning till larynx (MSL) och till näsan (MSN), samt heshet (H), som ettresultat av hiatusherniaoperation. Nittio patienter, som undersöktes före ochefter hiatusherniaoperation, fyllde i frågeformulär om H, MSL och MSN. Hos30% av patienterna förekom MSL och lika många hade MSN. Heshet fanns hos25% av patienterna före operation. Dessa symtom hade ett signifikant inbördessamband (p<0.008). Alla symtom minskade efter antirefluxkirurgi (p<0.001).Förbättringen var oberoende av patienternas vikt.I det andra arbetet studerades huruvida felsväljning var en extralaryngeal orsaktill heshet och om det var någon skillnad i prevalensen för felsväljning ochheshet mellan patienter med hiatushernia med gastroesofageal refluxsjukdom(GERD) och patienter med hiatushernia utan patologisk gastroesofageal reflux(GER). Patientmaterialet bestod av 198 patienter, som befunnits ha hiatusherniavid undersökning med esofagusmanometri och pH-refluxtest och somkontrollgrupp 262 personer ur normalbefolkningen, vilka inte visade sig hahiatushernia vid endoskopi. Dessa grupper svarade på ett frågeformulärangående symtom på heshet, felsväljning och halsbränna. Jämförelsen mellanpatientgrupp och kontrollgrupp visade H hos 35% respektive 13%, MSL hos35% respektive 5%, MSN hos 22% respektive 1% och halsbränna hos 85%respektive 6% (p<0.001). Båda symtomen MSL och MSN var vanliga(p<0.0001). H och MSL hade inget inbördes förhållande. H och MSL var likavanligt i gruppen med GERD som i gruppen med GER. Slutsatsen blev att detfinns en predisponering för H och MSL hos patienter med hiatushernia, menorsakssambandet är oklart. Heshet verkar inte vara orsakat av GERD.
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| 35. |
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| 36. |
- Tibbling Grahn, Lita, et al.
(författare)
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Gastric bile monitoring : An in vivo and in vitro study of bilitec reliability
- 2002
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:11, s. 1334-1337
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Tidskriftsartikel (refereegranskat)abstract
- Background: It has been claimed that the combination of bile and hydrochloride acid (HCl) has a noxious effect on intestinal mucosa. The aim was to study the reliability of the Bilitec 2001 method in monitoring the presence of bile in repeated tests and at different pH and water dilutions. Methods: 24-h esophageal pH and gastric Bilitec monitoring were performed twice with an interval of 6 weeks in 23 patients with symptomatic gastroesophageal reflux (GER). In vitro tests of pH and Bilitec recordings were performed with different mixtures of bile, HCl and water. Results: Gastric bile was present in 37% of the recording time, 28% during day time and 47% during nights. No significant difference was found between the two test occasions. The maximum bile concentration in the stomach was significantly lower in patients with severe pathological GER than in those with normal GER. When concentrated bile was diluted with the same volume of HCl, the pH level fell below 4. The maximum absorption limit with Bilitec in concentrated bile was gradually reduced with decreasing pH. The Bilitec technique recorded the presence of bile even at a pH of 1.4, but not if the bile was diluted with water at a ratio of 1:100 or more. Conclusions: Bilitec gastric recordings show the same clinical result when repeated under standardized conditions. The Bilitec technique is not reliable for monitoring the amount and concentration of bile in the stomach. Bile reflux cannot be monitored with the pH recording technique.
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| 37. |
- Tibbling Grahn, Lita
(författare)
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Longitudinal oesophageal muscle and pharyngo-oesophageal dyshagia - a deductive study.
- 2000
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Ingår i: Acta Oto-Laryngologica. - 0001-6489 .- 1651-2251. ; 543, s. 239-240
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Tidskriftsartikel (refereegranskat)abstract
- The hypothesis has been raised that a dysfunction of the longitudinal oesophageal muscle is the common denominator for pharyngeal and oesophageal dysphagia in patients with hiatal hernia, and that contraction of the: longitudinal muscle is a contributing factor for the opening of the upper oesophageal sphincter and for the stiffening: of the oesophageal wall when swallowing. Different studies were used to test the implications of this hypothesis. It was concluded that dysfunction of the longitudinal oesophageal muscle, caused by slipping of the distal end through the hiatal canal, can explain oesophageal dysphagia and inadequate opening of the upper oesophageal sphincter.
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| 38. |
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| 39. |
- Tibbling, Lita, et al.
(författare)
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Effect of spasmolytic drugs on esophageal foreign bodies : A multicenter placebo controlled double-blind study of glucagon and diazepam
- 1995
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Ingår i: Dysphagia (New York. Print). - 0179-051X .- 1432-0460. ; 10:2, s. 126-7
-
Tidskriftsartikel (refereegranskat)abstract
- Muscle spasm has been proposed as the cause for esophageal food impaction. The aim was therefore to treat esophageal foreign bodies with spasmolytic drugs influencing both striated and smooth muscles of the esophagus. A multicenter, placebo-controlled, double-blind study of glucagon and diazepam was undertaken in 43 patients. The foreign body disimpacted in 9 of 24 patients given active substances and in 6 of 19 patients given placebo; there was no significant difference between these two groups. Almost all disimpactions occurred several hours after injection of the drugs. The hypothesis of muscle spasm as an important cause of esophageal obstruction was rejected. Medical therapies for food disimpaction other than spasmolytic drugs have to be investigated.
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| 40. |
- Tibbling, Lita, et al.
(författare)
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Electromyography of human oesophageal smooth muscle.
- 1986
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Ingår i: Scandinavian Journal of Gastroenterology. - Oslo : Scandinavian University Press. - 0036-5521 .- 1502-7708. ; 21:5, s. 559-567
-
Tidskriftsartikel (refereegranskat)abstract
- The aim was to study whether electromyography (EMG) activity is synchronous with oesophageal motor activity as assessed by manometry from the same oesophageal site. Patients with different motor disorders of the oesophagus and control subjects were investigated. EMG recordings were made by means of a suction capsule with silver/silver chloride spike electrodes. Slow EMG waves synchronous with respiration were recorded from the lower oesophageal sphincter and intermittently from the body of the oesophagus. Edrophonium increased spike discharges; atropine diminished or abolished spike discharges after swallowing. Swallowing caused a burst of spiking activity which began immediately after deglutition. Continuous sips of water produced constant EMG activity but no peristaltic contractions as seen by manometry. In a patient with scleroderma and aperistalsis, swallowing elicited vigorous electrical activity. The different EMG findings without simultaneous contractions at manometry are interpreted as a response to a swallow by the longitudinal muscle of the oesophagus.
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| 41. |
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| 42. |
- Tibbling, Lita, et al.
(författare)
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Factors influencing lower esophageal sphincter relaxation after deglutition
- 2011
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Co. Limited. - 1007-9327 .- 2219-2840. ; 17:23, s. 2844-2847
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To study the relationship between upper esophageal sphincter (UES) relaxation, peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects. METHODS: Ten non-dysphagic adult subjects had a high-resolution manometry probe passed transnasally and positioned to cover the UES, the esophageal body and the LES. Ten water swallows in each subject were analyzed for time lag between UES relaxation and LES relaxation, LES pressure at time of UES relaxation, duration of LES relaxation, the distance between the transition level (TL) and the LES, time in seconds that the peristaltic wave was before (negative value) or after the TL when the LES became relaxed, and the maximal peristaltic pressure in the body of the esophagus. RESULTS:Relaxation of the LES occurred on average 3.5 s after the bolus had passed the UES and in most cases when the peristaltic wave front had reached the TL. The LES remained relaxed until the peristaltic wave faded away above the LES. CONCLUSION: LES relaxation seemed to be caused by the peristaltic wave pushing the bolus from behind against the LES gate.
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| 43. |
- Tibbling, Lita, et al.
(författare)
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Globus jugularis and dysphagia in patients with hiatus hernia
- 2010
-
Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 267:2, s. 251-254
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the article was to study if there is any relationship between globus sensation in the jugular fossa (GJ), intermittent esophageal dysphagia (IED), and the presence of a hiatus hernia, and if GJ can be relieved after hiatus hernia repair. 167 patients with a hiatus hernia (Group A) and 61 other patients with hiatus hernia and gastroesophageal reflux disease who were surgically treated with Nissen fundoplication (Group B), filled in a symptom questionnaire on GJ and IED. GJ was found in 66% and IED in 68% of patients in group A. In group B, 49% had GJ and 64% IED before surgery. At surgical follow-up 16% (P < 0.005) and 43% (P < 0.05) had GJ and IED, respectively. The combination of GJ and IED was found in 28% of IED patients before operation and in 31% at surgical follow-up. The high frequency of GJ in patients with hiatus hernia and the significant relief of GJ after hiatus hernia repair imply that GJ most likely is a referred sensation from the esophagus. IED and GJ are two parallel phenomena in patients with hiatus hernia, but do not seem to have any causal relationship.
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| 44. |
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