Pressure flow analysis in the assessment of preswallow pharyngeal bolus presence in dysphagia

Objectives: Preswallow pharyngeal bolus presence is evident in patients with oropharyngeal dysphagia. Pressure flow analysis (PFA) using high resolution manometry with impedance (HRMI) with AIMplot software is a method for objective interpretation of pharyngeal and upper esophageal sphincter (UES) pressures and bolus flow patterns during swallowing. This study aimed to observe alterations in PFA metrics in the event of preswallow pharyngeal bolus presence as seen on videofluoroscopy (VFSS). Methods: Swallows from 40 broad dysphagia patients and 8 controls were recorded with a HRMI catheter during simultaneous VFSS. Evidence of bolus presence and level reached prior to pharyngeal swallow onset was recorded. AIMPlot software derived automated PFA functional metrics. Results: Patients with bolus movement to the pyriform sinuses had a higher SRI, indicating greater swallow dysfunction. Amongst individual metrics, TNadImp to PeakP was shorter and flow interval longer in patient groups compared to controls. A higher pharyngeal mean impedance and UES mean impedance differentiated the two patient groups. Conclusions: This pilot study identifies specific altered PFA metrics in patients demonstrating preswallow pharyngeal bolus presence to the pyriform sinuses. PFA metrics may be used to guide diagnosis and treatment of patients with oropharyngeal dysphagia and track changes in swallow function over time.Lara Ferris, Taher Omari, Margot Selleslagh, Eddy Dejaeger, Jan Tack, Dirk Vanbeckevoort and Nathalie Romme

Automatische Impedantie Manometrie (AIM): objectieve diagnostiek van oro-faryngale dysfagie

Dit overzichtsartikel wil het klinisch potentieel aantonen van Automatische Impedantie Manometrie (AIM) als nieuwe, nietradiologische techniek voor screening en diagnostiek van faryngale dysfagie, zijnde slikstoornissen in de mond, keelholte en bovenste slokdarm. Deze AIM-techniek maakt gebruik van een katheter met druksensoren en impedantie-elektroden om slikken kwantitatief te beschrijven. Een geïntegreerde – eerder dan afzonderlijke – analyse van de gemeten druk- en impedantiepatronen die ontstaan bij het doorslikken van een voedselbolus, kan een zinvolle aanvulling zijn op de dynamische beeldvormingsonderzoeken die vandaag de dag als gouden standaard worden gezien. Belangrijke voordelen zijn het objectieve karakter van de techniek en de geautomatiseerde berekening van diverse slikparameters. Een globale maat voor de slikfunctie kan worden bekomen (Slik Risico Index, SRI) en houdt verband met (de ernst van) het aspiratierisico van de patiënt en de aanwezigheid van bolusresidu. Zo kan een accurate detectie van aspiratie met een sensitiviteit van 0,88 en specificiteit van 0,96 niet via radiologisch onderzoek bereikt worden. Verschillende slikparameters zijn ook voldoende gevoelig om veranderingen in voedselconsistentie te detecteren en om de effecten van slikmanoeuvres objectief te beschrijven. Recent werd ook aangetoond dat deze AIM-analyse snel en betrouwbaar kan worden uitgevoerd door clinici met variërende ervaring en opleiding. Bovendien worden in verschillende patiëntengroepen andere patronen van afwijkende slikparameters aangetroffen. Of deze observatie aanleiding kan geven tot specifieke slikdiagnoses en dus meer gerichte behandelingen is momenteel onderwerp van onderzoek

Are Estuarine Fish Opportunistic Feeders? The Case of a Low Anthropized Nursery Ground (the Canche Estuary, France)

International audienceStomach contents of the main fish species (i.e. sprat Sprattus sprattus, sea-bass Dicentrarchus labrax, common goby Pomatoschistus microps and flounder Platichthys flesus) in the Canche nursery ground (France) were examined from May 2006 to March 2007 according to food availability (i.e. macrozoobenthos and zooplankton) to analyse diet composition, trophic competition and prey selection. Overall, 44 prey fish species were identified from the 684 stomach contents examined. Fish diet was characterized by a wide diversity of prey, a relatively high feeding activity (vacuity index ranged between 16.9 and 29.0 % according to species) and spatiotemporal changes, except for D. labrax which did not vary between periods or estuarine zones. Copepods Temora longicornis and Euterpina acutifrons were the most important items in the diet of S. sprattus; for D. labrax, the dominant prey was the amphipod Gammarus sp., while Platichthys flesus and Pomatoschistus microps showed a more similar trophic niche (similarity percentage=39 %) with diets consisting of nematodes and amphipods. Spatiotemporal sharing of trophic resources by fish and high food resources in the Canche estuary was examined, and very limited diet overlap was observed, indicating that competition for food resources was limited. Differences between the available preys and fish diets demonstrated that fish do not select the most abundant food resources. S. sprattus showed a selection for Tachidius sp. and cladocerans; D. labrax for Gammarus sp., Hediste diversicolor and to a lesser extent nematodes and Corophium sp.; Pomatoschistus microps for nematodes and Gammarus sp.; and Platichthys flesus for nematodes, Gammarus sp., H. diversicolor and Corophium sp. It was concluded that the studied fish exhibit a specialist rather than opportunistic feeding strategy

Environmental factors structuring fish composition and assemblages in a small macrotidal estuary (eastern English Channel).

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Macrozoobenthic resources use by teleosts in the Gironde estuary

International audienceStomach contents of the main benthodemersal teleost species of the Gironde estuary (France) were examined in order to analyse diet composition, spatial variation and interspecific trophic overlap. The studied species are spotted seabass Dicentrarchus punctatus (Moronidae), common sole Solea solea (Soleidae), flounder Platlchthys flesus (Pleuronectidae), common goby Pomatoschistus mlcrops and sand goby Pomatoschistus minutus (Gobiidae). The macrozoobenthos was simultaneously sampled in order to explore the trophic use of estuarine habitats by teleosts. Except gobies, teleosts show a high feeding activity and diets are characterized by a wide diversity of prey and a spatial variation. Ragworm (Hediste diversicolor, Nereididae), brown shrimp (Crangon crangon, Crangonidae) and mudshrimp (Corophium volutator, Corophiidae) are the most common prey items. Spatial sharing of macrozoobenthic resources by teleosts occurs and trophic overlap is limited, indicating that competition for trophic resources is minimized, especially in the intertidal area where resources are abundant. Differences between the availability of potential preys and teleost diet show that most teleosts do not feed on the most abundant resources in the habitat but on preys with the highest individual biomass value (and possibly the highest energy content) despite their scarcity. This possibly indicates high mobility, habitat connectivity and low fidelity for estuarine habitats. Only the common sole predominantly fed on local prey, which conversely might indicate a narrow range of movement and reduced feeding area for this species

Influence of environmental conditions on macrofauna assemblages in intertidal zone.

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Inter-season and interannual variations in fish and macrocrustacean community structure on a eastern English Channel sandy beach: influence of environmental factors

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