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Prevalence of dysphagia in patients with multiple sclerosis: A systematic review and meta-analysis

      Highlights

      • Dysphagia is a major disorder in patients with MS, yet its prevalence is unknown.
      • 54 of 997 reviewed records made it to the meta-analysis, encompassing 11266 MS cases.
      • The overall prevalence of dysphagia across all the included studies was 44.8%.

      Abstract

      Background

      Dysphagia is a major disorder observed in patients with multiple sclerosis (MS), yet different prevalence rates are reported for it. Therefore, we designed this study to estimate the pooled prevalence of dysphagia in patients with MS.

      Method

      We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, reviews studies, and conference abstracts which were published up to May 2022. Articles that were relevant to our topic and could provide information regarding the prevalence of dysphagia among MS patients were included; however, articles with self-report screening strategies were excluded.

      Results

      The literature search found 997 articles. After eliminating duplicates, 672 articles remained. Two conference abstracts were included for final analysis. A total of 11,266 MS cases and 5047 MS patients with dysphagia were included in the meta-analysis. The overall prevalence of dysphagia across all 54 studies was 44.8 % (95 % CI: [40.4 %–49.2 %]), with a high level of heterogeneity between countries (Q=; I2 = 94.96 %; p < 0.001).

      Conclusion

      The results of this systematic review shows that the prevalence of dysphagia in MS patients is 45% which is greatly higher compared to the general population.

      Keywords

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      References

        • Abraham S.
        • Scheinberg L.C.
        • Smith C.R.
        • Larocca N.G.
        Neurologic impairment and disability status in outpatients with multiple sclerosis reporting dysphagia symptomatology.
        Neurorehabil Neural Repair. 1997; 11: 7-13
        • Alali D.
        • Ballard K.
        • Bogaardt H.
        The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires.
        Mult Scler Relat Disord. 2018; 25: 227-231
        • Alfonsi E.
        • Bergamaschi R.
        • Cosentino G.
        • Ponzio M.
        • Montomoli C.
        • Restivo D.A.
        • et al.
        Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis.
        Clin Neurophysiol. 2013; 124: 1638-1645
        • Almerie A.
        • Ip V.
        • Ahmed F.
        • Kang J.Y.
        Gastrointestinal symptoms in patients with degenerative neurological disorders: Multiple sclerosis and Parkinson's disease.
        QJM. 2011; 104: 353
        • Araya S.C.
        • Flores C.J.
        • Lara G.F.
        • Quezada J.G.
        • Nogales G.J.
        • Aracena C.R.
        • et al.
        Relapsing remitting multiples sclerosis (RR-MS) IN Chile. Evolution of dysphagia and dysarthria in 84 patients.
        Mult Scler J. 2012; 18: 1862
      1. Barcikova A, Prochazkova L, Cingelova M, Martinkova J. Dysphagia in patients with multiple sclerosis. Multiple Sclerosis. 2007;13:S121--S.

        • Barzegar M.
        • Mirmosayeb O.
        • Rezaei M.
        • Bjrklund G.
        • Nehzat N.
        • Afshari-Safavi A.
        • et al.
        Prevalence and risk factors of dysphagia in patients with multiple sclerosis.
        Dysphagia. 2021;
        • Beckmann Y.
        • Erkoyun H.
        • Incesu T.K.
        • Gokce S.
        • Ertekin C.
        Polygraphic evaluation of dysphagia in multiple sclerosis.
        Mult Scler J. 2016; 22: 864
        • Maden T.
        • Usgu G.
        • Tuncer A.
        Myotonometric comparison of sternocleidomastoideus and masseter muscles in multiple sclerosis patients with swallowing problem and healthy individuals.
        Mult Scler Relat Disord. 2022; 57103387
        • Beckmann Y.
        • Grgr N.
        • Akir A.
        • Arıcı Ş.
        • İncesu T.K.
        • Seil Y.
        • et al.
        Electrophysiological evaluation of dysphagia in the mild or moderate patients with multiple sclerosis: A concept of subclinical dysphagia.
        Dysphagia. 2015; 30: 296-303
        • Bergamaschi R.
        • Crivelli P.
        • Rezzani C.
        • Patti F.
        • Solaro C.
        • Rossi P.
        • et al.
        The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.
        J Neurol Sci. 2008; 269: 49-53
        • Bergamaschi R.
        • Rezzani C.
        • Minguzzi S.
        • Amato M.P.
        • Patti F.
        • Marrosu M.G.
        • et al.
        Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.
        Funct Neurol. 2009; 24: 159-162
        • Calcagno P.
        • Ruoppolo G.
        • Grasso M.G.
        Dysphagia in multiple sclerosis - Prevalence and prognostic factors.
        Acta Neurol Scand. 2002; 105: 40-43
        • Chauvet G.
        • Fernandez B.
        • Camdessanche J.P.
        • Giraux P.
        Screening and typology of dysphagia in multiple sclerosis.
        Ann Phys Rehabil Med. 2013; : 56
        • Constantinou A.
        • Pantzaris M.
        • Ntzani E.
        • Tziakouri C.
        • Walshe M.
        Oropharyngeal and oesophageal dysphagia in MS: pathophysiology, severity and risk factors.
        Mult Scler J. 2015; 21: 517
        • Conte W.
        • Patel S.
        • Allen D.
        • Reder A.
        Comparing the DYMUS dysphagia screening questionnaire with the video fluoroscopic swallow study in MS: a pilot study.
        Mult Scler J. 2019; 25: 410
        • Barzegar M.
        • Mirmosayeb O.
        • Rezaei M.
        • Bjørklund G.
        • Nehzat N.
        • Afshari-Safavi A.
        • et al.
        Prevalence and risk factors of dysphagia in patients with multiple sclerosis.
        Dysphagia. 2022; 37: 21-27
        • Mirmosayyeb O.
        • Shaygannejad V.
        • Bagherieh S.
        • Hosseinabadi A.M.
        • Ghajarzadeh M.
        Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis.
        Neurol Sci. 2022; 43: 233-241
        • Ezabadi S.G.
        • Sahraian M.A.
        • Maroufi H.
        • Shahrbaf M.A.
        • Eskandarieh S.
        Global assessment of characteristics of multiple sclerosis registries; A systematic review.
        Mult Scler Relat Disord. 2022; 63103928
        • Lo C.-K.-L.
        • Mertz D.
        • Loeb M.
        Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments.
        BMC Med Res Method. 2014; 14: 45
        • Bonifai
        Orofacial symptoms in patients with multiple sclerosis.
        Acta Stomatol Croat. 2019; 53: 286
        • Covello F.
        • Ruoppolo G.
        • Carissimo C.
        • Zumbo G.
        • Ferrara C.
        • Polimeni A.
        • et al.
        Multiple sclerosis: impact on oral hygiene, dysphagia, and quality of life.
        Int J Environ Res Public Health. 2020; 17
        • Danesh-Sani S.A.
        • Rahimdoost A.
        • Soltani M.
        • Ghiyasi M.
        • Haghdoost N.
        • Sabzali-Zanjankhah S.
        Clinical assessment of orofacial manifestations in 500 patients with multiple sclerosis.
        J Oral Maxillofac Surg. 2013; 71: 290-294
        • Erakovic J.L.
        • Radulovic L.B.
        • Idrizovic Z.A.
        • Roganovic M.B.
        Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro.
        Neurosciences. 2021; 26: 331-338
        • Eren F.
        • Ozkan B.
        • Demir A.
        The relationship between dysphagia, respiratory functions and anthropometry in patients with multiple sclerosis.
        Mult Scler Relat Disord. 2021; 55
        • Fathi S.
        • Fathy N.
        • Sheikhany A.
        • Labib D.
        • Ezzat W.
        • Abulfotouh S.
        • et al.
        Depicting neurogenic dysphagia in a sample of Egyptian multiple sclerosis patients.
        Mult Scler Relat Disord. 2018; 26: 237-238
        • Fernandes A.M.F.
        • Duprat A.C.
        • Eckley C.A.
        • da Silva L.
        • Ferreira R.B.
        • Tilbery C.P.
        Oropharyngeal dysphagia in patients with multiple sclerosis: Do the disease classification scales reflect dysphagia severity?.
        Braz J Otorhinolaryngol. 2013; 79: 460-465
        • Goncalves M.L.L.
        • Franca C.M.
        • Fragoso Y.D.
        • Deana A.M.
        • de Almeida L.M.
        • Bussadori S.K.
        Orofacial evaluation in patients with multiple sclerosis using nordic orofacial test-screening.
        Clin Oral Invest. 2017; 21: 1681-1685
        • Guan X.L.
        • Wang H.
        • Huang H.S.
        • Meng L.
        Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis.
        Neurol Sci. 2015; 36: 671-681
      2. Hartelius L, Svensson P. Speech and swallowing symptoms associated with Parkinson's disease and multiple sclerosis: a survey. Folia Phoniatr Logop. 1994;46(1):9--17 , pmid = 8162135.

        • Jafari Z.
        • Shahbodaghi M.R.
        • Maroufizadeh S.
        • Moghadasi A.N.
        Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis.
        Iran J Neurol. 2018; 17: 99-104
        • Johansson K.
        • Schalling E.
        • Hartelius L.
        Self-reported changes in cognition, communication and swallowing in multiple sclerosis: data from the Swedish multiple sclerosis registry and from a national survey.
        Folia Phoniatr Logop. 2021; 73: 50-62
        • Klugman T.M.
        • Ross E.
        Perceptions of the impact of speech, language, swallowing, and hearing difficulties on quality of life of a group of South African persons with multiple sclerosis.
        Folia Phoniatr Logop. 2002; 54: 201-221
      3. Levinthal DJ, Rahman A, Nusrat S, O'Leary M, Heyman R, Bielefeldt K. Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis. Mult Scler Int. 2013;2013:319201 , pmid = 24163768.

        • Marti L.
        • Coret F.
        • Minguez M.
        • Vera A.
        • Casanova B.
        • Benages A.
        Oropharyngeal dysphagia in patients with multiple sclerosis (MS): Clinical and videofluoroscopy study (VFS).
        Gastroenterology. 2005; 128 (A636–A)
        • Martoiu M.M.
        • Panea C.A.
        • Petrescu S.
        Dysphagia and quality of life in multiple sclerosis patients.
        Eur J Neurol. 2021; 28: 912
        • Milewska M.
        • Grabarczyk K.
        • Dabrowska-Bender M.
        • Jamroz B.
        • Dziewulska D.
        • Staniszewska A.
        • et al.
        The prevalence and types of oral- and pharyngeal-stage dysphagia in patients with demyelinating diseases based on subjective assessment by the study subjects.
        Mult Scler Relat Disord. 2020; 37
        • Munn Z.
        • Barker T.H.
        • Moola S.
        • Tufanaru C.
        • Stern C.
        • McArthur A.
        • et al.
        Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.
        JBI Evidence Synthesis. 2020; 18
        • Pajouh S.D.
        • Na M.
        Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.
        Mult Scler Relat Disord. 2017; 17: 240-243
        • Peres D.S.
        • Diniz D.S.
        • Silva P.P.
        • Ribeiro T.G.
        • Mendonca A.R.
        • Alves S.S.
        • et al.
        Evaluation of the swallowing in 31 patients with Multiple Sclerosis by speech therapist.
        J Neurol Sci. 2005; 238 (S247–S)
        • Poorjavad M.
        • Derakhshandeh F.
        • Etemadifar M.
        • Soleymani B.
        • Minagar A.
        • Maghzi A.H.
        Oropharyngeal dysphagia in multiple sclerosis.
        Mult Scler J. 2010; 16: 362-365
        • Printza A.
        • Boziki M.
        • Bakirtzis C.
        • Nikolaidis I.
        • Kalaitzi M.
        • Triaridis S.
        • et al.
        The modified DYMUS questionnaire is a reliable, valid and easy-to-use tool in the assessment of dysphagia in multiple sclerosis.
        Eur J Neurol. 2020; 27: 1231-1237
        • Printza A.
        • Triaridis S.
        • Kalaitzi M.
        • Nikolaidis I.
        • Bakirtzis C.
        • Constantinidis J.
        • et al.
        Dysphagia prevalence, attitudes, and related quality of life in patients with multiple sclerosis.
        Dysphagia. 2020; 35: 677-684
        • Ruhaak L.
        • Geytenbeek J.
        • Bruggeman C.
        • Bogaardt H.
        • de Groot V.
        Validation of DYMUS-NL for swallowing function in MS.
        Mult Scler J. 2018; 24: 848-849
        • Sadeghi Z.
        • Afshar M.R.
        • Ebadi A.
        • Baghban K.
        • Qureshi Z.S.
        Swallowing disorder in multiple sclerosis: modified version of the screening tool.
        Arch Rehab. 2020; 21: 236-255
        • Sadeghi Z.
        • Ghoreishi Z.S.
        • Flowers H.
        • Mohammadkhani P.
        • Ashtari F.
        • Noroozi M.
        Depression, anxiety, and stress relative to swallowing impairment in persons with multiple sclerosis.
        Dysphagia. 2021; 36 (pmid = 33783621): 902-909
        • Sales D.S.
        • Alvarenga R.M.
        • Vasconcelos C.C.
        • Silva R.G.
        • Thuler L.C.
        Translation, cross-cultural adaptation and validation of the Portuguese version of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.
        Springerplus. 2013; 2 (pmid = 23961403): 332
        • Sales D.S.
        • Alvarenga R.P.A.
        Accuracy of the brazilian version of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.
        Dysphagia. 2019; 34: 962
      4. Santos VAD, Vieira ACC, Silva HJD. Electrical activity of the masseter and supra hyoid muscles during swallowing of patients with multiple sclerosis. CoDAS. 2019;31(6):e20180207 , shorttitle = Atividade el \' e trica dos m \' u sculos masseter e supra-hi \' o ideo durante a degluti \c c \∼ a o do paciente com esclerose m \' u ltipla.

        • Solaro C.
        • Cuccaro A.
        • Gamberini G.
        • Patti F.
        • D'Amico E.
        • Bergamaschi R.
        • et al.
        Prevalence of dysphagia in a consecutive cohort of subjects with MS using fibre-optic endoscopy.
        Neurol Sci. 2020; 41: 1075-1079
        • Solaro C.
        • Rezzani C.
        • Trabucco E.
        • Amato M.P.
        • Zipoli V.
        • Portaccio E.
        • et al.
        Prevalence of patient-reported dysphagia in multiple sclerosis patients: An Italian multicenter study (using the DYMUS questionnaire).
        J Neurol Sci. 2013; 331: 94-97
        • Tahir E.
        • Kavaz E.
        • Kemal O.
        • Sen S.
        • Terzi M.
        Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis.
        Mult Scler Relat Disord. 2020; 45
        • Tarameshlu M.
        • Azimi A.R.
        • Ghelichi L.
        • Ansari N.N.
        Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis.
        Med J Islam Repub Iran. 2017; 31: 882-885
        • Tenekeci E.G.
        • Kara B.
        • Etiz A.
        • Demirkaya Ş.
        • Demir N.
        • Aikel C.
        Validity and reliability of the Turkish version of the questionnaire for the assessment of Dysphagia in multiple sclerosis.
        Noropsikiyatri Arsivi. 2018; 55: 243-247
        • Thomas F.J.
        • Wiles C.M.
        Dysphagia and nutritional status in multiple sclerosis.
        J Neurol. 1999; 246: 677-682
        • Villain M.
        • Heinzlef O.
        DYMUS questionnaire for dysphagia in multiple sclerosis: French validation and clinical considerations.
        Mult Scler J. 2013; 19: 356
        • Wiesner W.
        • Wetzel S.G.
        • Kappos L.
        • Hoshi M.M.
        • Witte U.
        • Radue E.W.
        • et al.
        Swallowing abnormalities in multiple sclerosis: correlation between videofluoroscopy and subjective symptoms.
        Eur Radiol. 2002; 12: 789-792
        • Zenginler Y.
        • Tarakci E.
        • Civi T.
        • Kurtuncu M.
        Evaluation of oropharyngeal dysphagia in patients with multiple sclerosis.
        Mult Scler J. 2017; 23: 906-907
        • Zwanzger M.
        • Grieshofer P.
        • Marsden J.
        • Austin A.
        • Peichel M.
        • Koller H.
        • et al.
        Dysphagia in multiple sclerosis - A cross sectional correlational study (#2).
        Mult Scler. 2012; 18: S53-S54
        • Aghaz A.
        • Alidad A.
        • Hemmati E.
        • Jadidi H.
        • Ghelichi L.
        Prevalence of dysphagia in multiple sclerosis and its related factors: systematic review and meta-analysis.
        Iran J Neurol. 2018; 17: 180-188