A scintigraphic study of oral, pharyngeal, and esophageal transit in patients with stroke

Although stroke affects mainly the oral and pharyngeal phases of swallowing, it may also impair esophageal contractions. Our hypothesis is that stroke may affect esophageal transit. The oral, pharyngeal, and esophageal transit was studied by the scintigraphic method in 26 patients (age range=26-83 years), eight of whom had mild dysphagia but all were able to feed orally and who had suffered an acute first-ever ischemic stroke 10-56 days (median = 43 days) before transit evaluation. The control group included 15 healthy volunteers (age range=27-86 years). All subjects swallowed a 5-ml liquid bolus and a 5-ml paste bolus labeled with technetium-99m phytate while sitting in front of the collimator of a gamma camara. The oral, pharyngeal, and proximal, middle, and distal esophageal transit was measured for 20 s. Three patients did not swallow the bolus during the scintigraphic evaluation. There was no difference between patients and controls with respect to oral and pharyngeal transit or clearance of liquid. For paste, the pharyngeal transit time was shorter for patients (0.48+/-0.17 s) than for controls (0.61+/-0.18 s, p=0.027). Also for the paste bolus, the residue in the mouth was greater in patients (18.4+/-13.6%) than in controls (10.2+/-4.9%, p=0.031). The liquid transit duration in the distal esophagus was shorter in patients with stroke (1.74+/-0.84 s) than in controls (2.68+/-1.65 s, p=0.028). There was no difference between patients and controls in esophageal residue. In conclusion, patients with stroke and able to feed orally may have alterations in the esophageal transit of a liquid bolus.