Objective: To systematically assess frequency and characteristics of swallowing dysfunction in multiple system atrophy (MSA) patients during endoscopy and compare findings to a cohort of patients with Parkinson’s disease (PD).

Background: Dysphagia is a major clinical concern in MSA, since it is closely related to long-term survival. However, to date no systematic endoscopic evaluation of swallowing dysfunction has been performed in a sufficiently sized MSA cohort. Only few studies reported swallowing findings based on videofluoroscopic examination.

Method: Patients at two German hospitals underwent flexible endoscopic evaluation of swallowing (FEES) following a standardised MSA-FEES protocol. Each patient obtained at least 11 standardized test boli of different consistencies. Nature and severity of swallowing dysfunction were scored with endoscopic rating scales. Findings in MSA were compared to a PD cohort.

Results: 57 consecutive MSA-patients (median age 64[IQR 59 – 71] years, 35 women) underwent MSA-FEES task-assessments and results were compared to 57 PD-patients (age 67[60 – 73] years; 28 women). MSA-patients had a shorter disease duration (4 [3-5] years vs. 7 [5-10] years; p<0.0001) and greater disease severity (Hoehn&Yahr stages 4[3-4] vs. 3[2-4]; p<0.0001).
The dysphagia pattern in MSA was similar to PD, but swallowing dysfunction occurred more frequently. Dysphagia was present in 83% in MSA and 46% in PD-patients (p<0.05). Dysphagia severity scores were higher in MSA compared to PD (1.2±0.7 vs. 0.5±0.3; p<0.01). The most frequent swallowing dysfunction in MSA was piecemeal deglutition (42% of all swallows), followed by late swallow initiation at the epiglottis or piriform sinuses (44% of liquid swallows) and relevant pharyngeal residue (33% of solid swallows). 15.7% of MSA-patients aspirated. Endoscopic dysphagia severity in MSA correlated positively with disease duration but not Hoehn&Yahr stages.

Conclusion: Swallowing dysfunction is highly prevalent in MSA patients when systematically assessed by a specific MSA-FEES protocol. Endoscopic characteristics of swallowing dysfunctions in MSA are similar to PD but more prevalent despite the longer disease duration in the PD cohort. In MSA, endoscopic dysphagia severity correlated with longer disease duration. We suggest MSA patients to be routinely examined by FEES to enable early detection of dysphagia and initiation of management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/endoscopic-characteristics-of-swallowing-dysfunctions-in-multiple-system-atrophy/