Document Detail


Videofluorography swallow study of patients with systemic sclerosis.
MedLine Citation:
PMID:  19562267     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: This study was undertaken to evaluate the role of the videofluorographic (VFG) swallow study in patients with systemic sclerosis. MATERIALS AND METHODS: Over a 23-month period, 45 women (mean age 58 years, range 27-76 years) with a known diagnosis of systemic sclerosis and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and oesophageal phases of swallowing with videofluorography. All examinations were performed with a remote-controlled digital C-arm device with 16-in image intensifier, 0.6- to 1.2-mm focal spot range and maximum tube voltage of 150 kVp in fluorography and 120 kVp in fluoroscopy. Cineradiographic sequences were acquired for the swallow study with 12 images per second and matrix 512 x 512 after the ingestion of boluses of high-density (250% weight/volume) barium. The evaluation of oesophageal peristalsis was documented with digital cineradiographic sequences with six images per second in the upright and supine positions during the swallowing of barium (60% weight/volume), and the water siphon test was performed with the patient in the supine position to evaluate the presence of gastro-oesophageal reflux disease (GORD). All patients subsequently underwent laryngoscopy, endoscopy and pH monitoring, and the data thus obtained were processed and compared. RESULTS: The VFG swallow study identified alterations of epiglottal tilting associated with intraswallowing laryngeal penetration in 26 patients (57.8%), pooling of contrast agent in the valleculae and pyriform sinuses in 23 (51.1%) and radiographic signs of nonspecific hypertrophy of the lingual and/or palatine tonsils in 18 (40%). The study of the oesophageal phase revealed the presence of altered peristalsis in all patients, and in particular, 36 patients (80%) showed signs of atony. Altered oesophageal clearing mechanisms were evident in all 45 patients, sliding hiatus hernia in 43 (93%) and GORD in 44 (97%). CONCLUSIONS: Our study demonstrated that in patients with systemic sclerosis, there is no primary alteration of the oral or pharyngeal phase of swallowing. In addition, alterations of epiglottal tilting associated with laryngeal penetration of contrast agent were found to be secondary to chronic GORD. Indeed, in 40% of patients, radiographic signs were found that indicated nonspecific hypertrophy of the lingual tonsil and/or palatine tonsils and nonspecific signs of chronic pharyngeal inflammation, and GORD was identified in 93% of patients, which in 40% of cases extended to the proximal third of the oesophagus. The data obtained were confirmed in 85% of cases with pH monitoring and in all cases with laryngoscopy.
Authors:
S Russo; G Lo Re; M Galia; A Reginelli; V Lo Greco; T D'Agostino; G La Tona; F Coppolino; R Grassi; M Midiri; R Lagalla
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Publication Detail:
Type:  Journal Article     Date:  2009-06-26
Journal Detail:
Title:  La Radiologia medica     Volume:  114     ISSN:  1826-6983     ISO Abbreviation:  Radiol Med     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-10-02     Completed Date:  2009-12-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0177625     Medline TA:  Radiol Med     Country:  Italy    
Other Details:
Languages:  eng; ita     Pagination:  948-59     Citation Subset:  IM    
Affiliation:
Dipartimento Biotecnologie Mediche e Medicine Legale, Università degli Studi di Palermo, Via M. Cefalu' 11, S. Flavia Palermo, 90017 Palermo, Italy. dott.s.russo@alice.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Barium Sulfate / diagnostic use
Cineradiography / methods*
Contrast Media
Deglutition Disorders / etiology*,  radiography*
Female
Fluoroscopy / methods
Humans
Middle Aged
Scleroderma, Systemic / complications*
Videotape Recording
Chemical
Reg. No./Substance:
0/Contrast Media; 7727-43-7/Barium Sulfate

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