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Intervention Review

Treatment for swallowing difficulties (dysphagia) in chronic muscle disease

  1. Marguerite Hill1,*,
  2. Thomas Hughes2,
  3. Chris Milford3

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 19 APR 2004

Assessed as up-to-date: 30 AUG 2007

DOI: 10.1002/14651858.CD004303.pub2


How to Cite

Hill M, Hughes T, Milford C. Treatment for swallowing difficulties (dysphagia) in chronic muscle disease. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004303. DOI: 10.1002/14651858.CD004303.pub2.

Author Information

  1. 1

    Morriston Hospital, Department of Neurology, Swansea, UK

  2. 2

    Rookwood Hospital, Neurology and Rehabilitation, Cardiff, UK

  3. 3

    Radcliffe Infirmary, ENT, Oxford, UK

*Marguerite Hill, Department of Neurology, Morriston Hospital, Swansea, SA6 6NL, UK. marguerite.hill@swansea-tr.wales.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 APR 2004

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This is not the most recent version of the article. View current version (08 AUG 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The management of dysphagia (difficulty in swallowing), a common complication of long-term progressive muscle disease in children and adults, is currently unclear.

Objectives

Our objective was to determine the most appropriate intervention for dysphagia in people with chronic, untreatable, non-inflammatory muscle disease.

Search methods

We searched the Cochrane Neuromuscular Disease Group Trials Register (August 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2008), MEDLINE (from January 1966 to August 2007), EMBASE (from January 1980 to August 2007), AMED (from January 1985 to August 2007), LILACS (from January 1982 to August 2007) and CINAHL (from January 1982 to August 2007) and contacted authors of published studies and other experts.

Selection criteria

We included randomised and quasi-randomised controlled trials of adults and children with chronic untreatable non-inflammatory muscle disease. The interventions under review included dietary modification, swallowing manoeuvres, a range of surgical interventions and enteral feeding. Our primary outcome was stabilisation of previously documented progressive weight loss not attributable to any other cause or weight gain of at least 5 kg in adults or increase in weight to at least the 10th centile in children, maintained for at least six months following the intervention. Secondary outcomes were: reduction in laryngeal penetration of bolus and/or aspiration observed on videofluoroscopy (modified barium swallow), reduction in chest infections attributable to aspiration over a six-month period, improvement in quality of life using a validated rating scale, the proportion of subjects who refused the intervention, the proportion of carers who refused the intervention, and serious adverse events related to the intervention within the first twelve months after intervention.

Data collection and analysis

We identified no randomised controlled trials. We identified seven case series reporting the results of surgical intervention for moderate to severe dysphagia, and one reporting on the outcome of feeding advice and enteral feeding in children with a congenital myopathy.

Main results

No studies were found that fulfilled the inclusion criteria. Therefore it was not possible to determine the benefit or otherwise of surgical interventions such as cricopharyngeal myotomy or upper oesophageal dilatation for oculopharyngeal muscular dystrophy or other chronic progressive muscle diseases. The effect of dietary advice or enteral feeding for children with congenital myopathy has not been compared with no intervention or an alternative intervention.

Authors' conclusions

There are no trials that have adequately evaluated treatments in the management of dysphagia for chronic muscle disease. It is therefore not possible to decide on the most appropriate treatment for a given individual based on current evidence.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Treatment for swallowing difficulties (dysphagia) in long-term, progressive muscle disease

People with long-lasting, progressive muscle disease often develop swallowing difficulties (dysphagia), normally as a result of muscle weakness. This can lead to weight loss or inability to gain weight, breathing problems due to food inhalation into the airways or social problems resulting from embarrassment about coughing or spluttering while eating. The main treatment options for dysphagia are dietary manipulation (altering the consistency of food and adding supplements), adopting safe swallowing techniques, surgical interventions and feeding through the stomach (enteral feeding). No randomised controlled trials of the effectiveness of treatments for dysphagia in muscle disease were identified. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

慢性肌病吞嚥困難的治療

吞嚥困難是進展性肌病變常見的長期併發症之一,其治療方式目前仍然未定。

目標

目標是決定對於非發炎性,無法治癒的慢性肌病的吞嚥困難最好的治療方式。

搜尋策略

搜尋的範圍包括:Neuromuscular Disease Group trials register, Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2003), MEDLINE (from January 1966 to Week 2June 2003), EMBASE (from January 1980 to Week 2 June 2003), AMED (from January1985 to Week 2 June 2003), LILACS (from January 1982 to June 21 2003) and CINAHL (from January 1982 to Week 2 June 2003) 和研究的作者及其他的專家聯繫。

選擇標準

我們收錄所有針對不論是成人或是孩童的慢性、非治癒性、非發炎性肌病之隨機對照試驗。介入方式包含飲食改變,吞嚥運動,手術及腸道灌食。初級成果指標分成治療前的體重下降穩定下來,或是成人體重增加5公斤以上,小孩體重增加10%,並且維持六個月以上。次級成果指標包含藉由螢光透視法(videofluoroscopy)證實減少食糜掉入喉部,減少六個月內吸入性肺炎發生率,提高生活品質評分,拒絕接受治療的病人或者照顧者的比例,發生於治療後的前十二個月嚴重副作用。

資料收集與分析

在這樣的搜尋條件下,並沒有找到任何隨機對照試驗。我們找到七篇關於手術介入中等到嚴重程度吞嚥困難的系列病例報告(case series),一篇孩童遺傳性肌病使用腸道灌食的病例報告。

主要結論

並沒有找到符合搜尋條件的文章,所以沒有證據支持任何治療方式和不做治療相比,有比較大的好處。不管是手術介入,例如咽肌切開術(cricopharyngeal myotomy)或上食道擴張術(upper oesophageal dilatation)治療眼咽肌失養症或其他進展性肌病,或是對於孩童遺傳性肌病的飲食調整或腸道灌食。

作者結論

並沒有足夠證據的文章研究關於慢性肌病的治療方式。現在要根據研究結果選擇對於病人最好的治療結果是不可行的。

翻譯人

本摘要由新光醫院王瑄翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

需要蒐集更多的資料來證明何種治療方式對於進展性慢性肌病長期併發症吞嚥困難是最有效的。慢性進展性肌病的病人,長時間後常產生吞嚥困難,主要是因為肌肉無力的關係。吞嚥困難的結果可能造成體重下降,或是小孩子體重無法成長,或是未吞下的食物被吸入呼吸道,甚至是吃飯時引發咳嗽等觀感的問題。主要的治療方法是改變食物的軟硬質地並添加營養元素,訓練安全的吞嚥技巧,手術及腸道灌食。沒有隨機對照試驗的結果可供參考,需要更多的研究的蒐集資料。