This is not the most recent version of the article. View current version (8 AUG 2014)
Treatment for swallowing difficulties (dysphagia) in chronic muscle disease
Editorial Group: Cochrane Neuromuscular Disease Group
Published Online: 19 APR 2004
Assessed as up-to-date: 30 AUG 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 19 APR 2004
This is not the most recent version of the article. View current version (08 AUG 2014)
The management of dysphagia (difficulty in swallowing), a common complication of long-term progressive muscle disease in children and adults, is currently unclear.
Our objective was to determine the most appropriate intervention for dysphagia in people with chronic, untreatable, non-inflammatory muscle disease.
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.
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.
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.
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
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.
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。
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。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。