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. 2022 Aug;37(4):868-878.
doi: 10.1007/s00455-021-10346-9. Epub 2021 Jul 23.

Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study

Laura Mariani  1 , Giovanni Ruoppolo  2 , Armando Cilfone  2 , Chiara Cocchi  2 , Jacopo Preziosi Standoli  2 , Lucia Longo  2 , Marco Ceccanti  3 , Antonio Greco  2 , Maurizio Inghilleri  3
Affiliations

Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study

Laura Mariani et al. Dysphagia. 2022 Aug.

Abstract

Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients.Level of Evidence Level IV.

Keywords: Amyotrophic lateral sclerosis; Deglutition; Deglutition disorders; Dysphagia; FEES; Nutrition; Progression rate.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors are responsible for the accuracy of the statements provided in the manuscript.

Figures

Fig. 1
Fig. 1
Survival plot related to occurrence of dysphagia in patients during observation period. Censored observations are not reported
Fig. 2
Fig. 2
Cumulative Hazard plot related to occurrence of dysphagia in patients during observation period. Censored observations are not reported
Fig. 3
Fig. 3
Survival plot related to occurrence of PEG indication in patients during observation period. Censored observations are not reported
Fig. 4
Fig. 4
Cumulative Hazard plot related to occurrence of PEG indication in patients during observation period. Censored observations are not reported
See this image and copyright information in PMC

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