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Gastrojejunostomy Inserted Through Peg (Peg-J) in Prevention of Aspiration Pneumonia. Clinical Nutrition Complication in Dysphagic Patients

100%
Ławiński M., Gradowski Ł., Bzikowska A., Goszczyńska A., Jachnis A., Forysiński K.
Polish Journal of Surgery
|
2015
|
vol. 86
|
issue 5
223-229
EN
Percutaneous endoscopic gastrostomy (PEG) is the most commonly used method of access to the gastrointestinal tract in long‑term home enteral nutrition (HEN) in patients with neurogenic deglutition and stenosis of the upper gastrointestinal tract caused by tumour. One of the most common complications of HEN is pneumonia resulting from aspiration of saliva or food. The risk of aspiration and the potential consequent sudden death is further increased by concomitant delayed gastric emptying and gastroesophageal reflux disease. The aim of the study was to evaluate the efficacy of changing percutaneous endoscopic gastrostomy to a gastrojejunostomy inserted through the PEG (PEG-J) in the prevention of aspiration pneumonia. Materiał and methods. The study involved 158 patients receiving HEN by percutaneous endoscopic gastrostomy (PEG), aged 19 to 90 years. Indications for enteral nutrition in the study subjects included: neurogenic dysphagia - 95 patients (60%), and obstruction of the upper gastrointestinal tract due to cancer - 63 patients (40%). Results. The pulmonary and gastrointestinal complications were observed in 28 patients receiving gastric nutrition through PEG within one to nine months following the start of the feeding. In 20 patients, because of the symptoms of aspiration pneumonia with accompanying gastroesophageal reflux and delayed gastric emptying, PEG was changed to PEG-J as an alternative. There were no reports on food reflux and aspiration pneumonia in patients whose PEG has been replaced by PEG-J. Conclusions. The use of PEG-J appears to prevent the occurrence of aspiration pneumonia in patients receiving home enteral nutrition in the long‑term
2
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The role of an oral formulation of hyaluonic acid and chondroitin sulphate in the treatment of patients with laryngopharyngeal reflux

86%
Chmielecka-Rutkowska J., Tomasik B., Pietruszewska W.
Otolaryngologia Polska
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2019
|
vol. 73(6)
38-49
EN
Introduction: Proton pump inhibitors (PPIs) have become an important breakthrough in the treatment of gastroesophageal reflux disease (GERD). However, in patients with laryngopharyngeal reflux (LPR) – one of the extraesophageal variants of the disease – the efficacy of PPI is incomplete or limited and alleviation of symptoms requires additional medications. As of today, the importance of hyaluronic acid (HA) and chondroitin sulphate (CS) and their role in mucosal damage healing, most particularly within the larynx, is being highlighted. Objective: The objective of the study was to assess the outcomes of treatment in LPR patients receiving a combination of hyaluronic acid and chondroitin sulfate (HA + CS) on a bioadhesive carrier. Material and methods: A total of 51 patients (18 males and 33 females) aged 25–75 years and presenting with LPR symptoms further confirmed in a laryngovideoscopic examination, were included in the study. Patients were qualified for the study on the basis of reflux symptom index (RSI) of above 13 and reflux finding score (RFS) of above 7. Patients were recommended to use the HA + CS combination product for 14 days and were evaluated after this time. Results: Symptoms suggestive of significant or severe problem (RSI of 4 or 5) before the treatment included: throat clearing (48 patients; 90.19%), hoarseness (29 patients; 56.86%) and cough after eating/cough while lying down (37 patients; 72.50%). After the treatment, patients reported a moderate impact of the above symptoms on their everyday functioning (P < 0.001). Symptoms such as pharyngeal mucus presence, acute cough, sensation of foreign body in the throat, while declared as moderate at baseline (score of 3) resolved to mild (score of 1) following the supportive treatment (P < 0.001). Total RSI after the treatment was assessed as borderline for LPR diagnosis (median 13, range 12–15). Although patients were not completely freed of their reflux symptoms, a significant reduction in symptoms was achieved in the entire study group. Prior to the treatment, the most common morphological changes within the larynx included redness/congestion, vocal fold edema and posterior commissure hypertrophy. These changes were observed in all patients. After the treatment, the RFS fell below the LPR diagnostic threshold (median 6, range 5–7). Compared to baseline values (median 9, range 8–10), significant improvement of laryngeal changes was observed in nearly the entire study group (N = 50; 98.04%) (P < 0.001). Conclusions: The combination product consisting of hyaluronic acid and chondroitin sulfate on a bioadhesive acts locally to significantly reduce laryngopharyngeal reflux symptoms, particularly in patients with chronic cough, throat clearing, and hoarseness. In addition, by lining the laryngeal mucosa with a protective layer, the product facilitates better hydration as well as faster healing and regeneration of the mucosal membrane, thus leading to a reduction or resolution of morphological changes within the larynx.
3
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The role of an oral formulation of hyaluonic acid and chondroitin sulphate in the treatment of patients with laryngopharyngeal reflux

86%
Chmielecka-Rutkowska J., Tomasik B., Pietruszewska W.
Polish Journal of Otolaryngology
|
2019
|
vol. 73
|
issue 6
38-49
EN
Introduction: Proton pump inhibitors (PPIs) have become an important breakthrough in the treatment of gastroesophageal reflux disease (GERD). However, in patients with laryngopharyngeal reflux (LPR) – one of the extraesophageal variants of the disease – the efficacy of PPI is incomplete or limited and alleviation of symptoms requires additional medications. As of today, the importance of hyaluronic acid (HA) and chondroitin sulphate (CS) and their role in mucosal damage healing, most particularly within the larynx, is being highlighted. Objective: The objective of the study was to assess the outcomes of treatment in LPR patients receiving a combination of hyaluronic acid and chondroitin sulfate (HA + CS) on a bioadhesive carrier. Material and methods: A total of 51 patients (18 males and 33 females) aged 25–75 years and presenting with LPR symptoms further confirmed in a laryngovideoscopic examination, were included in the study. Patients were qualified for the study on the basis of reflux symptom index (RSI) of above 13 and reflux finding score (RFS) of above 7. Patients were recommended to use the HA + CS combination product for 14 days and were evaluated after this time. Results: Symptoms suggestive of significant or severe problem (RSI of 4 or 5) before the treatment included: throat clearing (48 patients; 90.19%), hoarseness (29 patients; 56.86%) and cough after eating/cough while lying down (37 patients; 72.50%). After the treatment, patients reported a moderate impact of the above symptoms on their everyday functioning (P < 0.001). Symptoms such as pharyngeal mucus presence, acute cough, sensation of foreign body in the throat, while declared as moderate at baseline (score of 3) resolved to mild (score of 1) following the supportive treatment (P < 0.001). Total RSI after the treatment was assessed as borderline for LPR diagnosis (median 13, range 12–15). Although patients were not completely freed of their reflux symptoms, a significant reduction in symptoms was achieved in the entire study group. Prior to the treatment, the most common morphological changes within the larynx included redness/congestion, vocal fold edema and posterior commissure hypertrophy. These changes were observed in all patients. After the treatment, the RFS fell below the LPR diagnostic threshold (median 6, range 5–7). Compared to baseline values (median 9, range 8–10), significant improvement of laryngeal changes was observed in nearly the entire study group (N = 50; 98.04%) (P < 0.001). Conclusions: The combination product consisting of hyaluronic acid and chondroitin sulfate on a bioadhesive acts locally to significantly reduce laryngopharyngeal reflux symptoms, particularly in patients with chronic cough, throat clearing, and hoarseness. In addition, by lining the laryngeal mucosa with a protective layer, the product facilitates better hydration as well as faster healing and regeneration of the mucosal membrane, thus leading to a reduction or resolution of morphological changes within the larynx.
4
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Difficult management of chronic cough

86%
Dąbrowska M., Arcimowicz M.
|
EN
Chronic cough affects about 4–10% of adults and has a negative impact on the patients’ quality of life. Chronic cough may be a symptom of many different diseases and its management should be based on treating the underlying cause. The most common cough cause in adults is chronic bronchitis due to smoking. Next, in non-smoking adults upper airway cough syndrome, gastroesophageal reflux and asthma account for the majority of cough reasons. Despite thorough diagnostics and management in 5–10% adults management of chronic cough is unsuccessful. In difficult-to-treat cough neuromodulators and speech therapy may be effective.
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