Cheng Ivy, Hamad Adeel, Sasegbon Ayodele, Hamdy Shaheen
Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Neuropsychiatr Dis Treat. 2022 Oct 14;18:2251-2263. doi: 10.2147/NDT.S371624. eCollection 2022.
Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.
吞咽困难是指吞咽困难和/或吞咽紊乱，是与各种神经系统疾病相关的常见问题，如中风、运动神经元疾病和神经退行性疾病。传统上，吞咽困难的治疗方法要么是代偿性的，包括改变食团质地或进食姿势，要么是康复性的，包括行为练习和感觉刺激。尽管这些治疗方法在临床实践中被广泛采用，但由于主要是非对照研究支持的证据水平较低，最近的观点对这些治疗方法的临床疗效提出了质疑。因此，随着技术和科学研究方法的进步，近年来新型吞咽困难治疗方法的开发激增，强大的随机对照临床试验也越来越多。在这篇综述中，我们将回顾过去二十年中几种新引入的吞咽困难治疗方法的临床证据，包括康复练习、生物反馈、药物治疗、神经调节治疗和软机器人技术。尽管最近吞咽困难治疗疗效的证据质量有所提高，但一些关键问题，包括治疗方案的异质性、长期治疗效果、一些神经调节治疗的潜在机制，以及这些技术在非中风性吞咽困难中的效果，仍有待在未来的临床试验中解决。
