Nicaretta Denise Hack, Rosso Ana Lucia, Mattos James Pitágoras de, Maliska Carmelindo, Costa Milton M B
Movement Disorders Sector, Wards 24 and 25, Hospital Geral da Santa Casa de Misericórdia, Rio de Janeiro, RJ, Brazil.
Arq Gastroenterol. 2013 Jan-Mar;50(1):42-9. doi: 10.1590/s0004-28032013000100009.
Dysphagia and sialorrhea in patients with Parkinson's disease are both automatically accepted as dependent on this neurological disease.
The aim were to establish if these two complaints are a consequence or associated manifestations of Parkinson's disease.
Two Parkinson's diseases groups from the same outpatients' population were studied. Patients in the first group, with dysphagia, were studied by videofluoroscopy. The second, with sialorrhea, were studied by the scintigraphic method,
Videofluoroscopic examination of the oral, pharyngeal and esophageal phases of swallowing showed that 94% of Parkinson's diseases patients present, structural causes, not related to Parkinson's diseases, able to produce or intensify the observed disphagia. The scintigraphic examination of Parkinson's diseases patients with sialorrhea showed that there is no increase of serous saliva production. Nevertheless, showed a significantly higher velocity of saliva excretion in the Parkinson's diseases patients.
Dysphagia can be due to the muscular rigidity often present in the Parkinson's diseases patient, or more usually by non Parkinson's disease associated causes. In Parkinson's diseases patients, sialorrhea is produced by saliva retention. Nevertheless, sialorrhea can produce discomfort in swallowing, although without a formal complaint of dysphagia. In this case, subclinical dysphagia must be considered. Sialorrhea is indicative of dysphagia or at least of subclinical dysphagia. As final conclusion, Parkinson's diseases can be an isolated cause of dysphagia and/or sialorrhea, but frequently, a factor unrelated to Parkinson's diseases is the main cause of or at least aggravates the dysphagia.
帕金森病患者的吞咽困难和流涎都被自动认为与这种神经疾病有关。
目的是确定这两种症状是帕金森病的结果还是相关表现。
对来自同一门诊人群的两组帕金森病患者进行了研究。第一组有吞咽困难的患者通过视频荧光透视检查进行研究。第二组有流涎症状的患者通过闪烁扫描法进行研究。
对吞咽的口腔、咽部和食管阶段进行的视频荧光透视检查显示，94%的帕金森病患者存在与帕金森病无关的结构性原因，这些原因能够导致或加重观察到的吞咽困难。对有流涎症状的帕金森病患者进行的闪烁扫描检查显示，浆液性唾液分泌没有增加。然而，帕金森病患者的唾液排泄速度明显更高。
吞咽困难可能是由于帕金森病患者常出现的肌肉僵硬，或者更常见的是由与帕金森病无关的原因引起。在帕金森病患者中，流涎是由唾液潴留引起的。然而，流涎会在吞咽时产生不适，尽管没有正式的吞咽困难主诉。在这种情况下，必须考虑亚临床吞咽困难。流涎表明存在吞咽困难或至少是亚临床吞咽困难。作为最终结论，帕金森病可能是吞咽困难和/或流涎的孤立原因，但通常情况下，与帕金森病无关的因素是吞咽困难的主要原因或至少会加重吞咽困难。
