Background/Objectives: Japan, the world's first super-aged society, has confronted rapid population aging and increasing healthcare demands earlier than any other country. In this context, dysphagia rehabilitation has become a critical issue affecting quality of life and survival. With nearly 30% of the population aged ≥65 years, Japan has developed a distinctive dysphagia rehabilitation model characterized by interprofessional collaboration and dental involvement. This narrative review describes its historical evolution and structural characteristics. Methods: This narrative review employed a structured literature search of PubMed and Ichushi-Web, supplemented by manual searches of policy documents and professional guidelines. Publications from 1980 to January 2026 were included if they addressed dysphagia rehabilitation systems or dental involvement in Japan. Both English- and Japanese-language sources were analyzed using thematic synthesis. Results: Japan's dysphagia rehabilitation model evolved alongside population aging and is embedded within the universal health insurance and long-term care insurance systems. A prominent characteristic is the sustained involvement of dental professionals, who contributed to the foundational development of the field and remain actively involved across care settings, particularly within community- and home-based care. The system is further supported by certification frameworks, a triadic model integrating rehabilitation, nutrition, and oral health, and institutionalized interprofessional education. Conclusions: Previous studies have examined specific aspects of dysphagia care in Japan, but few have examined the overall structure of the system. This review maps the fundamental structure of Japan's dysphagia rehabilitation model within its historical and policy context, offering insights relevant to dysphagia care in other aging societies.
To determine the incidence of dysphagia and define the associated co-morbidities in infants born very preterm (VP) or very low birth weight (VLBW). This is a retrospective cohort study evaluating 158 VP or VLBW infants born over two years. Forty infants diagnosed with dysphagia confirmed by flexible endoscopic evaluation of swallowing were compared to 118 infants with no dysphagia. The incidence of dysphagia was 25%. After adjusting for gestational age and birth weight, dysphagia was associated with morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and intracranial hemorrhage. Regression analyses indicated that dysphagia was associated with higher central line days and longer hospital length of stay. Feeds were thickened in 38 infants (95%) before discharge and 3 infants (7.5%) needed gastrostomy tube. Dysphagia is an important morbidity affecting a quarter of the infants born VP or VLBW. Significant associations with other major morbidities were noted.
Background: Post-stroke dysphagia is a frequent complication associated with aspiration, malnutrition, and prolonged dependence on enteral feeding. Systemic inflammation and impaired nutritional status may adversely affect neuromuscular recovery; however, their relative and combined associations with swallowing recovery and transition from enteral to oral feeding remain insufficiently characterized. Objective: This study aimed to examine the independent associations of inflammatory and nutritional indices with swallowing function recovery and to evaluate their relationship with enteral-to-oral feeding transition in patients with post-stroke dysphagia. Methods: In this retrospective observational study, patients with dysphagia following ischemic stroke were evaluated before (T0) and after (T1) routine dysphagia rehabilitation. Inflammatory indices including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), as well as the prognostic nutritional index (PNI), were calculated at both time points. Changes in indices (Δ = T1 - T0) were analyzed in relation to changes in swallowing function assessed by the Functional Oral Intake Scale (FOIS) and the Penetration-Aspiration Scale (PAS). Results: Changes in PNI were independently associated with greater improvement in functional oral intake (ΔFOIS) and reductions in aspiration severity for both liquid and soft consistencies (ΔPAS; all p < 0.01). In contrast, changes in inflammatory indices (ΔSIRI, ΔSII, ΔPLR, and ΔPIV) were consistently associated with less favorable swallowing outcomes. In multivariable logistic regression analysis, baseline stroke severity (NIHSS) was the only independent determinant of transition from enteral to oral feeding (OR = 0.72, p = 0.002). The model demonstrated good discrimination (AUC = 0.81). Conclusions: Changes in nutritional status, as reflected by ΔPNI over time, were the biomarker most consistently associated with functional swallowing recovery and reduced aspiration severity in patients with post-stroke dysphagia. While inflammatory burden was associated with less favorable swallowing physiology, transition from enteral to oral feeding appeared to be primarily driven by neurological severity rather than inflammatory or nutritional indices alone. These findings may support the clinical value of monitoring nutritional reserve alongside inflammatory burden during dysphagia rehabilitation.
School-aged children with neurodisability and oropharyngeal dysphagia who need mealtime assistance have an increased risk of premature death. Speech & Language Therapists (SLTs) provide assessment and recommendations to optimise mealtime nutrition and hydration, but little is known about current clinical practice including mealtime recommendation provision and carer adherence support strategies. Before developing any intervention, the context needs to be known. This survey aimed to explore the practice of UK SLTs working with school-aged children with neurodisability and oropharyngeal dysphagia that require mealtime assistance. This included describing workforce and service delivery; assessment practices; mealtime recommendations targeted for example, carer use certain pace, specific utensil; current approaches used to provide mealtime recommendations including the people worked with, delivery modality and adherence support techniques. An online ethically approved survey was developed using research literature, with SLT stakeholder consultation and piloted prior to dissemination. The survey comprised 36 questions focusing on demographic and caseload information, typical assessment and intervention practice. Questions were multiple choice and free text responses with an upload option for intervention implementation documents. The survey was disseminated using professional networks and social media (summer 2021). Descriptive statistics were used with qualitative analysis for free text and submitted documents. SLT participants consented and completed demographic and assessment practice questions (n = 139) with 102 continuing to the final question. Participants worked across all UK regions, with different employers (NHS, education, independent) and in acute, school and community settings and frequently shared care. Some SLTs had no access to instrumental assessment; videofluoroscopy (n = 5, 4%) or FEES (n = 88, 63%), and there was limited published assessment use. Participants (n = 122) commonly used 17 different mealtime recommendations, most frequently targeting carers to change pace, environment, food consistency (n = 120-121, 98%-99%, sometimes-often). Qualitative analysis identified two practice styles: 'collaborative creation' or 'informative prescription'. 37 SLTs provided 59 intervention documents, (n = 39, 66%) were accessible information mealtime mats. There were 28 unique mat templates with 19 different names. Formats and recommendation target frequency differed for example, drink texture (n = 27, 96%), pace (n = 14, 50%). This work provides contextual information on UK SLT practice with school-aged children with neurodisability and oropharyngeal dysphagia who require mealtime assistance. Further work is required to support research into practice implementation (e.g., assessments), alongside exploration and evaluation of meal mat use and potential SLT consultation styles. These findings contribute to a project creating a resource to improve SLT-family-carer working. What is already known on this subject SLTs working with children with oropharyngeal dysphagia are typically specialists that work across various settings each week. They, and other health care professionals, report limited use of published assessments but recommend a range of changes which carers need to make within a mealtime (e.g., communicate with their child, make change to food textures, etc.,). What this study adds to existing knowledge SLTs have variable time allocated to working with children with oropharyngeal dysphagia while working with diverse children with different diagnoses and needs. SLTs frequently share care with other SLTs have limited use of published assessment tools and frequently provide a range of mealtime recommendations requiring carers to change the mealtime. SLTs frequently use an accessible 'mealtime mat' to provide written recommendations but these are highly variable in name, format and content between services. SLTs had two styles when working with family-carers. They always provide personalised recommendations following assessment, focussing on information provision, but only one style uses fully person-centred practice. What are the potential or actual clinical implication of this work? SLTs would benefit from workforce support to implement evidence-based practices into their practice when working with children with neurodisability and oropharyngeal dysphagia. SLTs could consider using published assessment(s) to enable good shared-care communication. Consideration of which mealtime mats is most effective is needed. SLTs may wish to reflect on their personal style-personalised or truly person-centred.
Stroke persists as a paramount global health priority, maintaining persistently elevated incidence and mortality metrics across epidemiological registries. Post-stroke dysphagia, serving as a critical determinant of functional prognosis, imposes multidimensional burdens spanning aspiration pneumonia risk, nutritional compromise, and psychosocial well-being. This neurogenic deglutition disorder has consequently catalyzed clinical innovation in rehabilitation modalities, with scalp acupuncture emerging as a promising neuromodulatory intervention. We conducted a systematic search of 8 databases for randomized controlled trials (RCTs) assessing scalp acupuncture treatment for post-stroke dysphagia. The primary outcomes included clinical efficacy, while the secondary outcomes comprised the Kubota Water Swallowing Test (WST), standardized swallowing assessment (SSA), videofluoroscopic dysphagia scale (VDS), and adverse events. Rigorous evaluation of potential biases within the selected studies was performed by the Cochrane Handbook (version 5.1.0) for systematic reviews of interventions. Heterogeneity among studies was addressed through sensitivity analysis. Based on data derived from 20 RCTs involving 1278 participants, the meta-analysis revealed significant clinical effective rate in the application of scalp acupuncture for post-stroke dysphagia [odds ratio = 4.45, 95% confidence interval (CI) (3.04, 6.51), P < .01], improvement in the Kubota WST [mean differences (MD) = -0.82, 95% CI (-1.04, -0.59), P < .00001], SSA [MD = -4.01, 95% CI (-4.59, -3.42), P < .00001], VDS [MD = -5.75, 95% CI (-8.33, -3.17), P < .0001], in comparison with the conventional rehabilitation protocols. Only one study reported adverse events. Current evidence suggests that scalp acupuncture therapy may be an effective measure for post-stroke dysphagia.
Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
Background/Objectives: Providing an appropriate diet to older adults with dysphagia can prevent aspiration, choking, and nutritional deficiencies and help preserve their quality of life. Therefore, assessments for determining the appropriateness of food types are required. This multicenter study aimed to determine the reliability and validity of the Meal Rounds Observation Form (MROF), which was developed to identify food forms that can be safely consumed by older adults with dysphagia. Methods: We analyzed 532 food-texture observations obtained from 155 participants (114 men and 41 women). The reliability and validity of the MROF were compared with those of videofluoroscopic (VF) or videoendoscopic (VE) examinations of swallowing. Results: The food-form categories were water (108 pairs), 0j (54 pairs), 0t (118 pairs), 1j (20 pairs), 2-1 (28 pairs), 2-2 (37 pairs), 3 (68 pairs), 4 (67 pairs), and normal food (32 pairs) based on JDD 2021 codes. The AUC was lowest for the water (0.568) category and highest for food forms requiring chewing, such as those of the 4 and normal food (0.678) categories. The sensitivity and specificity of the Gugging Swallowing Screen were 60.1% and 69.1%, respectively (p < 0.001). The agreement between the Gugging Swallowing Screen and the MROF evaluation for food types requiring mastication was 73.2%. Logistic regression analysis revealed asymmetric movement of the corners of the mouth and coughing as important indicators when evaluating food types requiring mastication. Conclusions: The MROF is useful for determining food intake safety when VF or VE tests cannot be performed in medical and nursing care settings and can guide clinical decision-making. However, caution is required in applying it clinically because of its relatively low specificity.
Vicious Cycle of Delirium and Oropharyngeal Dysphagia.
Post-extubation dysphagia (PED) is a prevalent and debilitating complication in intensive care unit (ICU) patients, yet the longitudinal heterogeneity of swallowing recovery remains poorly understood. This study was aimed to characterize distinct recovery trajectories of swallowing function in ICU patients with PED and to identify the clinical predictors associated with each pattern. This longitudinal observational study utilized convenience sampling to enroll ICU patients from a tertiary hospital. Swallowing function was evaluated using the Standard Swallowing Assessment (SSA) at seven time points post-extubation, at 4-6, 24, 48, and 72 h and 7, 14, and 28 days. Latent recovery trajectories were identified using growth mixture modeling (GMM), and independent predictors of group membership were determined by multivariate logistic regression. Of 495 intubated patients, 248 (54.98%) developed PED and were included; 209 completed all follow-up assessments. Three distinct trajectories emerged: Group HS (high level, slow improvement; 10.0%), Group HR (high level, rapid improvement; 22.5%), and Group LE (low level, early recovery; 67.5%). For both Group HR and Group HS, membership was predicted by older age, neurological diagnosis, higher peak inspiratory pressure, longer intubation duration, and early pharyngeal pain. In addition, membership in Group HR was uniquely associated with an APACHE II score of 10-14 and exposure to fiberoptic bronchoscopy. Post-extubation swallowing recovery follows distinct trajectories shaped by physiological, procedural, and disease-related factors. Early trajectory identification allows for personalized, stage-specific interventions to optimize functional outcomes and mitigate long-term morbidity.
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by autonomic failure and motor impairment, with dysphagia emerging early and representing a key feature for differential diagnosis from Parkinson's disease (PD). Safe and efficient swallowing relies on precise coordination between oropharyngeal events and breathing, yet this interaction has not been systematically investigated in MSA. To quantify the temporal relationships between oropharyngeal phases and breathing during water and jelly swallows, we retrospectively analyzed the electrokinesiographic study of swallowing (EKSS) from 38 patients with the parkinsonian variant of MSA (MSA-P), 16 patients with the cerebellar variant of MSA (MSA-C), 21 patients with PD, and 15 healthy controls. MSA patients exhibited widespread oropharyngeal dysfunction across both bolus consistencies, with MSA-C showing the most severe abnormalities. Both MSA phenotypes indeed displayed multiple EKSS alterations consistent with disrupted swallowing-breathing coordination, including paradoxical sequencing and prolonged inter-events intervals. The MSA-C group showed additional impairment in the control of the upper esophageal sphincter. In contrast, PD patients had milder EKSS abnormalities, predominantly involving oral phase parameters. The post-swallowing inspiration index reliably discriminated MSA from PD across all bolus types, being significantly higher in MSA patients and indicating more pronounced swallowing-breathing desynchronization. These findings provide a detailed neurophysiological characterization of oropharyngeal swallowing in MSA and PD, highlighting disease- and phenotype-specific patterns: predominant impairment of the pharyngeal phase and its coordination with breathing in MSA, particularly in MSA-C, and mainly oral phase involvement in PD.
Anaplastic thyroid carcinoma is a rapidly progressive thyroid malignancy associated with extensive local invasion and limited survival. We describe the case of a 60-year-old man who developed new-onset dysphagia and voice changes in the setting of a thyroid mass. Initial cytology and core sampling were consistent with papillary thyroid carcinoma, yet the patient's accelerating compressive symptoms led to expedited total thyroidectomy. Surgical pathology ultimately demonstrated conventional papillary carcinoma with discrete foci of undifferentiated carcinoma within the same specimen. This case highlights that rapidly progressive compressive symptoms in a patient with cytology-proven conventional papillary thyroid carcinoma may indicate an occult, unsampled anaplastic component, even in the absence of high-risk features on preoperative evaluation. The presence of both differentiated and undifferentiated components broadens the differential considerations regarding tumor evolution and highlights the need for close clinicopathologic correlation. Prompt recognition of alarming symptoms and early multidisciplinary coordination were central to management, particularly to mitigate the risk of airway compromise and to guide timely postoperative systemic therapy.
Unilateral vocal fold paralysis secondary to peripheral nerve injury presents limited treatment options and inconsistent outcomes. This protocol describes an electroacupuncture-based cerebral electric field therapy designed to target neuroanatomically relevant pathways through combined scalp, posterior cervical, and anterior neck electroacupuncture. The procedure includes standardized point selection, stimulation parameters, and treatment sequencing, followed by objective functional assessment using laryngoscopy and videofluoroscopic swallowing study. In a representative case, the application of this protocol was associated with observable improvements in voice quality and swallowing function. Patients with unilateral vocal fold paralysis frequently experience hoarseness, dysphagia, aspiration, and reduced laryngeal sensation, leading to substantial functional limitations and decreased quality of life. This protocol demonstrates the feasibility of electroacupuncture-based cerebral electric field therapy as a structured intervention for unilateral vocal fold paralysis and provides a reproducible framework for future clinical exploration. Additional investigation may help clarify its potential role as a supportive therapeutic option. Future controlled studies may further evaluate its clinical effectiveness and applicability.
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IntroductionUnderweight is common in Parkinson's disease (PD), particularly in advanced stages, and is linked to malnutrition and poorer outcomes. Understanding dietary habits and nutritional status may help identify vulnerable patients.ObjectiveTo examine dietary habits and their associations with clinical characteristics in underweight versus normal-to-overweight individuals with PD.MethodsThis cross-sectional study included 70 patients with PD attending a tertiary movement disorders centre. Demographic and clinical data were obtained through interviews and medical records. Disease severity was assessed using the Hoehn & Yahr scale and the Unified Parkinson's Disease Rating Scale (UPDRS Part III and IV). Nutritional status was screened using the Mini Nutritional Assessment-Short Form (MNA-SF). Dietary habits were evaluated using a culturally adapted Thai PD dietary questionnaire, and a dietitian estimated daily caloric and fluid intake. Participants were categorized by body mass index as underweight (<18.5) or normal-to-overweight (≥18.5). Group comparisons and logistic regression analyses were performed.ResultsUnderweight patients more often consumed soft or liquid diets and had a higher prevalence of dysphagia. They reported less varied diets with lower meat and vegetable intake, although caloric and fluid intake were similar between groups. Underweight participants had lower MNA-SF scores (p < 0.001) and greater motor complications, including higher UPDRS Part IV scores (p = 0.015). Female gender (OR 18.51), dysphagia (OR 5.97), and dyskinesia (OR 2.03) were independently associated with underweight status.ConclusionUnderweight in PD is associated with female gender, dysphagia, and dyskinesia. Early nutritional screening and management of dysphagia and motor complications may improve outcomes. Parkinson's disease (PD) patients often lose weight, particularly as the disease progresses. Being underweight can increase the risk of malnutrition, infections, and poorer quality of life. This study aimed to examine differences in eating habits, food choices, and health problems between underweight PD patients and those with normal-to-overweight PD groups. Seventy PD patients participated in this study. Information on health status, disease severity, and nutritional condition was collected through interviews and medical records. Patients completed a questionnaire on their eating habits, food preferences, and fluid intake over the past week. A dietitian estimated their daily calorie and water intake. Based on body weight, patients were divided into two groups: underweight and normal-to-overweight. Compared with the normal-to-overweight group, underweight patients showed distinct differences in both eating habits and health status. They were more likely to experience dysphagia and to consume soft or liquid foods. They consumed less red meat and vegetables and more milk, and they ate certain foods, such as desserts, less often. Although their total calorie and fluid intake were similar to those of the other group, the underweight group had poorer overall nutritional status. The findings suggest that underweight status in PD is associated with female gender, dysphagia, and dyskinesia. However, this study identifies associations rather than establishing cause-and-effect relationships. Early screening for eating issues, careful medication adjustment, and personalised nutritional support may help improve nutritional status, health outcomes, and quality of life in PD patients at risk of being underweight.
Tremella fuciformis polysaccharides (TP), a natural polysaccharide with dual medicinal and edible values, possesses excellent gelling properties, water-holding capacity, and biological activities, rendering it a promising thickening agent for dysphagia-friendly foods. However, its poor solubility and tendency to agglomerate severely limit its practical applications. To overcome this limitation, the present study developed two optimized processing techniques: fluffy tablets prepared by heating at 95 °C (named TPS1, where S stands for fluffy tablets) and tablets treated with a single cycle of high-pressure homogenization at 3 MPa (TPHP1). Their dissolution times were 211.29 ± 4.32 s and 169.07 ± 7.55 s, respectively. Both methods significantly enhanced the instant solubility and thickening capacity of TP. Notably, this study is the first to classify instant TP products under the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Structural characterization results indicate that high-pressure homogenization treatment significantly reduced the number-average molecular weight of TP from 5087.33 kDa to 1538.90 kDa, while broadening the molecular weight distribution range. Meanwhile, the porous structure formed by TPHP1 provided a structural basis for the enhanced instant solubility of TP. Antioxidant activity testing showed that the IC50 values of TPHP1 for scavenging DPPH radicals, ABTS radicals, and hydroxyl radicals were 1.58 ± 0.279 mg/mL, 0.87 ± 0.079 mg/mL, and 1.02 ± 0.065 mg/mL, respectively, all superior to those of TPS1 (1.73 ± 0.045 mg/mL, 1.49 ± 0.064 mg/mL, and 1.41 ± 0.074 mg/mL, respectively). Rheological property analysis and application evaluations indicated that TPS1 could stably meet IDDSI Levels 1-3 at concentrations of 4-12 mg/mL. TPHP1 achieved the same stability at concentrations of 8-12 mg/mL. Sensory evaluation results indicate that TPS1 exhibits excellent oral cohesiveness, propulsive force, and lubrication adaptability in practical food matrices such as milk and turtle peptides. TPHP1, on the other hand, excels in lubrication and propulsive force, making it suitable for meeting the sensory requirements of low-viscosity beverages. Research indicates that TPS1 possesses high polysaccharide retention and structural stability, making it suitable for general-purpose medium-viscosity dysphagia foods. TPHP1 offers superior instant solubility, enhanced antioxidant activity, and outstanding shear stability, positioning it as ideal for low-viscosity functional beverages. This study provides theoretical foundations and practical support for the high-value application of TP in functional foods and dysphagia diets, offering new solutions for dietary management in special populations.
Long COVID affects multiple organ systems, yet the incidence and risk factors for post-COVID-19 laryngeal dysfunction remain underexplored. This study evaluated the incidence of laryngeal dysfunction following COVID-19. A retrospective cohort study was performed using the TriNetX Global Collaborative EHR Network (> 180 million records). Adults without prior laryngeal dysfunction or major comorbidities were stratified by COVID-19 exposure and compared with uninfected controls. Outcomes included chronic cough, dysphagia, voice disorders, vocal fold paralysis, and laryngeal spasm, assessed up to 5 years post-infection. After propensity score matching, odds ratios (OR) and risk differences (RD) with 95% confidence intervals (CI) were calculated. COVID-19 was associated with significantly increased odds of chronic cough (peak OR 7.12; RD 0.33%, p < 0.0001), dysphagia (peak OR 2.71; RD 0.36%, p < 0.0001), voice disorders (peak OR 3.25; RD 0.12%, p < 0.0001), vocal fold paralysis (peak OR 2.17; RD 0.01%, p < 0.0001), and laryngeal spasm (peak OR 2.79; RD 0.003%, p < 0.0001). Incidence peaked at 1-2 years for most outcomes and at 2-3 years for laryngeal spasm. Hospitalization and mechanical ventilation were associated with increased rates of dysphagia (HR 2.63; HR 5.26), voice disorders (HR 1.15; HR 4.45), and vocal cord paralysis (HR 2.09; HR 9.35), but reduced rates of chronic cough (HR 0.68; HR 0.45). Vaccinated patients showed higher rates of chronic cough (HR 1.36) and voice disorders (HR 1.22). COVID-19 is associated with increased incidence of new-onset laryngeal dysfunction, most commonly peaking 1-2 years after infection and influenced by hospitalization, mechanical ventilation, and vaccination status.
Pseudoachalasia is an uncommon cause of dysphagia, often due to malignancy at the gastroesophageal junction (GEJ). It is crucial to distinguish idiopathic achalasia from pseudoachalasia due to tumor infiltrations of the lower esophageal sphincter. The aim of this case is to highlight the importance of clinicopathological features that distinguish pseudoachalasia from achalasia and the most appropriate diagnostic workup as well as the management challenges in low-resource settings. We present the case of a 76-year-old man with a 40-year smoking history presented with a one-month history of progressive dysphagia, first to solids and then to liquids, associated with epigastric discomfort, regurgitation, early satiety, and 10 kg unintentional weight loss over 4 months. Given the patient's advanced age, alarming GI symptoms, and smoking history, a malignant upper gastrointestinal pathology was highly suspected. Esophagogastroduodenoscopy (EGD) revealed an infiltrative thickened mass at the gastric cardia with reduced distensibility and irregular ulceration on retroflexion, which resulted in subtle difficulty when passing the scope across the GE junction. Computed Tomography (CT) showed circumferential irregular gastric wall thickening involving the gastric cardia, fundus, and body with regional lymphadenopathy, loss of fat plane to the pancreas concerning for invasion, and multiple small hypodense liver lesions. Histopathological examination confirmed the presence of discohesive pleomorphic cells with invasion into the lamina propria with no lymphovascular or perineural invasion was observed in the examined sections, consistent with diffuse-type gastric adenocarcinoma. Diffuse-type gastric adenocarcinoma can present with pseudoachalasia due to GEJ involvement. In older patients with rapid-onset dysphagia and systemic red flags, prompt EGD and cross-sectional imaging are essential. Early recognition is critical but challenging in low-resource settings. Treatment of pseudoachalasia depends on the underlying cause and stage of the disease.
Patients with head and neck cancer (HNC) face a high risk of malnutrition and sarcopenia, often exacerbated by the toxicities of chemoradiotherapy, such as dysphagia, xerostomia, and mucositis. These Nutritional Impact Symptoms significantly compromise oral intake and negatively affect quality of life. This paper presents a conceptual framework designed to support clinicians in optimizing oral intake through personalized nutritional management. Central to this approach is the integration of systematic screening using MUST, the Malnutrition Universal Screening Tool (MUST), and the Nutritional Risk Screening 2002 (NRS-2002). Furthermore, functional assessment of swallowing via instrumental studies (VFSS/FEES) is essential for tailoring dietary textures according to the International Dysphagia Diet Standardization Initiative framework. Key nutritional strategies include high-energy and high-protein oral fortification, the use of oral nutritional supplements, and specific dietary adjustments addressing pain management and sensory alterations. A multidisciplinary approach involving nutritionists, speech-language pathologists, and oncologists is paramount to transition from reactive symptom management to proactive "adaptive nutrition," ultimately improving clinical outcomes and patient survival.
Objective: This study aimed to establish benchmark values for the "optimal"achievable safety outcomes in low-risk patients undergoing sleeve gastrectomy (SG) in China using a standardized benchmarking methodology. Methods: This retrospective case series study was based on the greater China bariatric and metabolic surgery database. According to predefined inclusion and exclusion criteria,1 029 low-risk patients who underwent SG between January 2018 and December 2023 across 12 participating centers were included. The cohort comprised 773 females(75.12%) and 256 males (24.88%),with an age of (31.6±7.8) years (range:18 to 63 years),preoperative body mass index of (37.2±4.8)kg/m² (range:25.0 to 50.0 kg/m2). Twenty-two perioperative safety indicators (within 90 days post-surgery) were collected and analyzed. The benchmark value for each indicator was defined as the 75th percentile of the median values from all participating centers. Results: The cumulative complication rates (Clavien-Dindo classification system≥grade I) for low-risk patients were 1.26% within 7 days, 4.86% within 30 days, and 6.90% within 90 days postoperatively. The most common complications within 90 days included dysphagia (2.24%),wound infection (1.65%),and acid reflux (1.17%). The cumulative complication rate demonstrated a gradual increase over time,reaching 12.73% within 4 years after surgery. A significant negative correlation was observed between the cumulative total surgical volume of the centers and the 90-day cumulative complication rate (R=-0.61, P<0.05). The benchmark values were as follows: operative time was 106 minutes,intraoperative conversion-to-laparotomy rate was 0.12%, and cumulative complication rates during hospitalization,within 30 days,and within 90 days were 1.11%,12.37%,and 13.14%, respectively. Specifically,benchmark rates for wound infection were 0.08% during hospitalization, 2.11% within 30 days, and 2.11% within 90 days. Benchmark rates for dysphagia/gastric stenosis were 0 during hospitalization, 1.08% within 30 days,and 1.99% within 90 days. Conclusion: This is the first study to define benchmark values for achievable safety outcomes in low-risk patients undergoing SG in China,providing a critical reference for quality control and benchmarking in Chinese bariatric and metabolic surgery. 目的： 通过基准研究方法确定我国接受胃袖状切除术（SG）且符合低风险手术患者的“最佳”安全性结局。 方法： 本研究为回顾性病例系列研究。基于大中华减重与代谢手术数据库，根据纳入和排除标准，回顾性纳入2018年1月至2023年12月我国12家中心收治的1 029例接受胃袖状切除术（SG）的低风险患者。女性773例（75.12%），男性256例（24.88%），年龄（31.6±7.8）岁（范围：18~63岁），术前体重指数（37.2±4.8）kg/m2（范围：25.0~50.0 kg/m2）。收集并分析22项围手术期（包含术后90 d内）安全性指标并逐一定义基准值。基准值的定义采用所有中心每项指标中位数的第75个百分位数。 结果： 低风险患者术后7 d内并发症（Clavien-Dindo并发症分级系统≥Ⅰ级）累积发生率为1.26%，术后30 d和术后90 d并发症累积发生率分别为4.86%和6.90%。其中吞咽困难（2.24%）、伤口感染（1.65%）和反酸（1.17%）为术后90 d内最常见的并发症。并发症累积发生率随时间推移逐渐增加，术后4年内累积发生率为12.73%。中心累积总手术量与90 d内并发症累积发生率呈显著负相关性（R=-0.61，P<0.05）。手术时间基准值为106 min，术中中转开腹率基准值为0.12%，住院期间、术后30 d内、术后90 d内并发症发生率基准值分别为1.11%、12.37%、13.14%，其中伤口感染基准值分别为0.08%、2.11%和2.11%，吞咽困难/胃囊狭窄基准值分别为0、1.08%和1.99%。 结论： 本研究首次定义了我国行SG的低风险患者人群的最佳可实现安全性结果，为我国减重与代谢外科手术质量控制基准研究提供了重要参考。.