Pere Clavé

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Don Ross

University College Cork

Cristiana Facchini

Università di Bologna

Vittorio Gallese

Università degli Studi di Parma (Italy)

Graham Martin

University of Leicester

Fabio Cuzzolin

Oxford Brookes University

Susanne Klingenstein

Harvard University

Li Sheng

University of Delaware

Olga Louchakova-Schwartz

University of California, Davis

Carlo Semenza

Università degli Studi di Padova

Matthew Rouse

Biola University

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Papers by Pere Clavé

Approaching oropharyngeal dysphagia

Revista Española de Enfermedades Digestivas, 2004

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Advances in a multimodal approach for dysphagia analysis based on automatic voice analysis

by Marcos Faundez-Zanuy and Pere Clavé

In: Bassis, S., Esposito, A., Morabito, F., Pasero, E. (eds) Advances in Neural Networks. WIRN 2015. Smart Innovation, Systems and Technologies, vol 54. Springer, Cham, 2016

Parkinson's disease (PD) is the second most frequent neurodegenerative disease with prevalence am... more Parkinson's disease (PD) is the second most frequent neurodegenerative disease with prevalence among general population reaching 0.1-1 %, and an annual incidence between 1.3-2.0/10000 inhabitants. The most obvious symptoms are movement-related such as tremor, rigidity, slowness of movement and walking difficulties and frequently these are the symptoms that lead to the PD diagnoses but also they could have In this sense voice analysis is a safe, non-invasive, and reliable screening procedure for PD patients with dysphagia, which could detect patients at high risk of clinically significant aspiration. In this paper we will present a part of an ongoing project that will evaluate automatic speech analysis based on linear and non-linear features. These can be reliable predictors/indicators of swallowing and balance impairments in PD. An important advantage of voice analysis is its low intrusiveness and easy implementation in clinical practice. Thus, if a significant correlation between these simple analyses and the gold standard videofluoroscopic analysis will imply simpler and less stressing diagnostic test for the patients as well as the use of cheaper analysis systems.

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Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy

Nutrients, 2021

Background: Special needs schools (SNS) educate children and young people with major neurological... more Background: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. Methods: A cross-sectional observational study was conducted at SNS L’Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). Results: A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II–III of EDACS, and 31.3...

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Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia

Nutrients

Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therap... more Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener® (FCT)] on four phenotypes of OD patients: G1) 36 older; G2) 31 head/neck cancer (HNC); G3) 30 Parkinson’s disease; and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5/20 mL boluses, at four levels of shear-viscosity (<50, 250, 1000 and 2000 mPa·s). The effect of α-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 ± 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 2...

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COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic

Clinical Nutrition

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EXPRESS: European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

European Stroke Journal

Post-stroke dysphagia (PSD) is present in more than 50 % of acute stroke patients, increases the ... more Post-stroke dysphagia (PSD) is present in more than 50 % of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke ...

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Effect of Aging, Gender and Sensory Stimulation of TRPV1 Receptors with Capsaicin on Spontaneous Swallowing Frequency in Patients with Oropharyngeal Dysphagia: A Proof-of-Concept Study

Diagnostics

Spontaneous swallowing contributes to airway protection and depends on the activation of brainste... more Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) divided into three groups: GI—18–39 yr, GII—40–59 yr, and GIII—>60 yr. OD was assessed by the Volume–Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10−5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min; p =...

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Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art

Journal of the American Medical Directors Association, 2017

Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization and defin... more Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization and defined as the difficulty or inability to move a bolus safely and effectively from the oral cavity to the esophagus, and can include aspirations, choking, and residue. OD is pandemic among different phenotypes of older people, affecting between 27% and 91% of the population 70 years or older. Although OD can be diagnosed by well-defined clinical methods and complementary explorations, in the clinical setting OD is seldom systematically screened and treated, and awareness among the medical/geriatric community is scarce. The etiology of OD in this population includes many concomitant risk factors with neurogenic and neurodegenerative processes, muscular weakness, and sarcopenia. The pathophysiology includes mechanical deficits in the swallow response (mainly delayed laryngeal vestibule closure time and weak tongue thrust), reduced pharyngeal sensitivity, and sensory/motor central nervous system impairments. Recently, OD has been recognized as a geriatric syndrome due to its high prevalence and its relationship with many comorbidities and their poor outcomes, including malnutrition, respiratory infections and aspiration pneumonia, functional disability and frailty, institutionalization and increased readmissions, and mortality. There is an evidence-based and effective treatment for OD in the elderly mainly oriented to compensating swallow impairments through adaptation of fluid viscosity and solid food textures to avoid aspiration and choking, and improving nutritional status and oral health to avoid respiratory infections. This has been defined as the minimal effective treatment to be provided to this population. New treatments aiming at recovering the swallowing function are under research with promising results, and the near future will provide us with methods to stimulate the swallow response with pharmacological or physical stimuli.

Erratum for Ann. N.Y. Acad. Sci. 1300: 261-277

Annals of the New York Academy of Sciences, 2014

Pharmacological and molecular characterization of muscular cholecystokinin receptors in the human lower esophageal sphincter

Neurogastroenterology and Motility

1. Neurol Res. 2000 Jun;22(4):379-85. Pharmacological and molecular characterization of glutamate... more

Dysphagia: current reality and scope of the problem

Nature reviews. Gastroenterology & hepatology, Jan 7, 2015

Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. A... more Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a n...

α,β-meATP mimics the effects of the purinergic neurotransmitter in the human and rat colon

European Journal of Pharmacology, 2014

The purine receptor involved in inhibitory responses in the gastrointestinal tract has been recen... more The purine receptor involved in inhibitory responses in the gastrointestinal tract has been recently identified. P2Y1 receptor activation mediates the fast component of the inhibitory junction potential (IJPf) and the non-nitrergic relaxation. The aim of the present work has been to investigate which purinergic agonist better mimics endogenous responses. We used different agonist and antagonist of P2 receptors. Contractility and microelectrode experiments were used to compare the effects of exogenously added purines and electrical field stimulation (EFS)-induced nerve mediated effects in rat and human colonic strips. In rat colon, the IJPf and EFS-induced inhibition of contractions were concentration-dependently inhibited by the P2Y1 antagonist MRS2500 but not by iso-PPADS or NF023 (P2X antagonists) up to 1 μM. In samples from human colon, EFS-induced inhibition of contractions was inhibited by either MRS2500 or apamin (1 μM) but not by iso-PPADS. In both species, α,β-meATP, a stable analog of ATP, caused inhibition of spontaneous contractions. α,β-meATP effect was concentration-dependent (EC50: 2.7 μM rat, 4.4 μM human) and was antagonized by either MRS2500 or apamin but unaffected by P2X antagonists. ATP, ADP, β-NAD and ADP-ribose inhibited spontaneous contractions but did not show the same sensitivity profile to purine receptor antagonists as EFS-induced inhibition of contractions. The effect of α,β-meATP is due to P2Y1 receptor activation leading the opening of sKca channels. Accordingly, α,β-meATP mimics the endogenous purinergic mediator. In contrast, exogenously added putative neurotransmitters do not exactly mimic the endogenous mediator. Quick degradation by ecto-nuclease or different distribution of receptors (junctionally vs extrajunctionally) might explain these results.

Esophageal pH monitoring: Are you sure that the electrode is properly placed?

Gastroenterology, 2001

OBJECTIVE: A crucial methodological aspect of ambulatory 24-h esophageal pH monitoring is electro... more OBJECTIVE: A crucial methodological aspect of ambulatory 24-h esophageal pH monitoring is electrode placement. Lower esophageal sphincter (LES) location is recommended for standard electrode positioning. The aim of the present study was to evaluate prospectively whether LES manometric location and intragastric pH acid confirmation suffice to guarantee that the pH electrode is properly placed. METHODS: We evaluated data from 402 consecutive patients undergoing esophageal pH monitoring. LES location was determined by manometry, and the pH electrode was introduced until a pH recording Ͻ3 was obtained. Subsequently, it was positioned 5 cm above the proximal LES border. Thereafter, adequate catheter placement and absence of bends or loops were checked by fluoroscopy. Patients with bent or rolled catheters were instructed to have breakfast immediately, and catheter placement was checked again by fluoroscopy. RESULTS: When checked by fluoroscopy, the catheter was properly placed in 383 patients (95.3%). In the other 19 (4.7%), it was not located in the distal part of the esophagus owing to bending or rolling: 14 in the esophagus and five in the pharynx. After breakfast, 14 of the 19 malpositioned catheters were properly positioned whereas five remained bent or rolled. Those bent in the esophagus were more prone to unbending (12 of 14) than those bent or rolled in the pharynx (two of five). CONCLUSIONS: After LES location by manometry and demonstration of acid pH during the pH step-up technique, the pH electrode was properly placed in more than 95% of cases. Nevertheless, it cannot be completely guaranteed that the pH catheter will not bend or roll, and the pH electrode will not be malpositioned. Eating immediately after electrode placement resolves this problem in the majority (75%) of cases. Therefore, we recommend that patients undergoing esophageal pH-metric studies be instructed to eat as soon as possible after electrode placement to minimize these possible pitfalls.

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Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly

European Respiratory Journal, 2013

Objectives: To explore whether oropharyngeal dysphagia is a risk factor for community-acquired pn... more Objectives: To explore whether oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly and to assess the physiology of deglutition of patients with pneumonia. Methods: Case-control study: 36 elderly patients (>70 years) hospitalized with pneumonia were matched by age and sex with two independently-living controls. All subjects were given the volume-viscosity swallow test to identify signs of oropharyngeal dysphagia. Pathophysiological study: All cases and 10 healthy elderly were examined with videofluoroscopy. Results: Case-control study: Prevalence of oropharyngeal dysphagia was 91.7% in cases and 40.3% in controls (p<0.001). Adjusting for functionality and co-morbidities, dysphagia showed an independent effect on pneumonia (OR=11.9, 95%CI:3.03-46.9). Pathophysiological study: Among cases, 16.7% showed safe swallow, 30.6% high penetrations, 36.1% severe penetrations and 16.7% silent aspirations during videofluoroscopy, while in the healthy elderly these percentages were 80.0%, 20.0%, 0% and 0%, respectively (p<0.001). A delay in the laryngeal vestibule closure (0.414±0.029s vs 0.200±0.059s, p<0.01) was the main mechanism of impaired airway protection. Conclusions: In elderly subjects, oropharyngeal dysphagia is strongly associated with community-acquired pneumonia independently of functionality and comorbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia.

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PP071-SUN Influence of Gastrointestinal Peptides and Gastrointestinal Motility on Anorexia of Ageing in Frail Elderly Persons

Clinical Nutrition Supplements, 2012

Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration

Clinical Nutrition, 2008

Videofluoroscopy showed patients had prolonged swallow response (≥1064 ms); 52.1% had safe swallo... more

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The gaseous mediator, hydrogen sulphide, inhibits in vitro motor patterns in the human, rat and mouse colon and jejunum

Neurogastroenterology and Motility, 2008

Hydrogen sulphide (H2S) has been recently proposed as a transmitter in the brain and peripheral t... more Hydrogen sulphide (H2S) has been recently proposed as a transmitter in the brain and peripheral tissues. Its role in the gastrointestinal tract is still unknown despite some data which suggest an involvement mediating smooth muscle relaxation. The aim of this study was to investigate the effect of this gas on intestinal segments from mouse jejunum and colon, and muscular strips from the human and rat colon. In isolated segments of mouse colon and jejunum, bath applied sodium hydrogen sulphide (NaHS) (a H2S donor) caused a concentration-dependent inhibition of spontaneous motor complexes (MCs) (IC50 121 μmol L−1 in the colon and 150 μmol L−1 in the jejunum). This inhibitory effect of NaHS on MCs was (i) unaffected by tetrodotoxin (TTX), capsaicin, pyridoxal-phosphate-6-azophenyl-2′,4′-disulfonate and N-nitro-l-arginine suggesting a non-neural effect and (ii) significantly reduced by apamin 3 μmol L−1. NaHS concentration-dependently inhibited the spontaneous motility in strips from hu...

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Different responsiveness of excitatory and inhibitory enteric motor neurons in the human esophagus to electrical field stimulation and to nicotine

AJP: Gastrointestinal and Liver Physiology, 2004

To compare electrical field stimulation (EFS) with nicotine in the stimulation of excitatory and ... more To compare electrical field stimulation (EFS) with nicotine in the stimulation of excitatory and inhibitory enteric motoneurons (EMN) in the human esophagus, circular lower esophageal sphincter (LES), and circular and longitudinal esophageal body (EB) strips from 20 humans were studied in organ baths. Responses to EFS or nicotine (100 μM) were compared in basal conditions, after NG-nitro-l-arginine (l-NNA; 100 μM), and after l-NNA and apamin (1 μM). LES strips developed myogenic tone enhanced by TTX (5 μM) or l-NNA. EFS-LES relaxation was abolished by TTX, unaffected by hexamethonium (100 μM), and enhanced by atropine (3 μM). Nicotine-LES relaxation was higher than EFS relaxation, reduced by TTX or atropine, and blocked by hexamethonium. After l-NNA, EFS elicited a strong cholinergic contraction in circular LES and EB, and nicotine elicited a small relaxation in LES and no contractile effect in EB. After l-NNA and apamin, EFS elicited a strong cholinergic contraction in LES and EB, ...

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Oral health in older patients with oropharyngeal dysphagia

Age and Ageing, 2014

Background: oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential ri... more Background: oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). Aim: to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. Patients and methods: fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S); (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis); and (iii) the presence of dental caries. Results: 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent; 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. Conclusions: older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.

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The Volume-Viscosity Swallow Test for Clinical Screening of Dysphagia and Aspiration

Stepping Stones to Living Well with Dysphagia, 2012

Background: Oropharyngeal dysphagia (OD) is a major complaint among many patients with neurologic... more Background: Oropharyngeal dysphagia (OD) is a major complaint among many patients with neurological diseases and in the elderly, but is often underdiagnosed. The volumeviscosity swallow test (V-VST) is a bedside method to screen patients for dysphagia. Methods: The V-VST was designed to identify clinical signs of impaired efficacy (labial seal, oral and pharyngeal residue, and piecemeal deglutition) and impaired safety of swallow (voice changes, cough and decrease in oxygen saturation ≥3%). It starts with nectar viscosity and increasing bolus volume, then liquid and finally pudding viscosity in a progression of increasing difficulty to protect patients from aspiration. Results: The V-VST allows quick, safe and accurate screening for OD in hospitalized and independently living patients with multiple etiologies. The V-VST presents a sensitivity of 88.2% and a specificity of 64.7% to detect clinical signs of impaired safety of swallow (aspiration or penetration). The test takes 5-10 min to complete. Discussion and Conclusion: The V-VST is an excellent tool to screen patients for OD. It combines good psychometric properties, a detailed and easy protocol designed to protect safety of patients, and valid end points to evaluate safety and efficacy of swallowing and detect silent aspirations.

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Approaching oropharyngeal dysphagia

Revista Española de Enfermedades Digestivas, 2004

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Advances in a multimodal approach for dysphagia analysis based on automatic voice analysis

by Marcos Faundez-Zanuy and Pere Clavé

In: Bassis, S., Esposito, A., Morabito, F., Pasero, E. (eds) Advances in Neural Networks. WIRN 2015. Smart Innovation, Systems and Technologies, vol 54. Springer, Cham, 2016

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Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy

Nutrients, 2021

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Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia

Nutrients

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COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic

Clinical Nutrition

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EXPRESS: European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

European Stroke Journal