Influence of barium (Steele et al., 2022)

Purpose: Prior studies suggest there may be differences in videofluoroscopic measures of swallowing across different barium concentrations. Whether different barium products of identical concentration result in similar swallowing physiology remains unknown. This is important, as barium intended for videofluoroscopy (i.e., Bracco Varibar) is not available globally. Our aim was to identify differences in healthy swallowing across five different barium stimuli.
Method: Twenty healthy adults (10 women), aged 22–54 years, underwent videofluoroscopy including comfortable sips of thin liquid barium: two sips of 20% weight-to-volume (w/v) barium prepared with E-Z-HD powder, and two sips each of 20%w/v and 40%w/v barium prepared with Liquid Polibar Plus and E-Z-Paque powder. Recordings were analyzed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Measures of timing, kinematics and residue were obtained. Chi-square, Friedman’s, and Wilcoxon signed-ranks test were used to identify differences across stimuli. 
Results: Significant differences were seen across barium stimuli for upper esophageal sphincter (UES) opening duration, UES diameter, pharyngeal area at maximum constriction, and residue. In all cases, smaller values were seen with the 20%w/v E-Z-HD stimulus; however, this stimulus had questionable opacity for visualization. Patterns of residue severity were not explained by barium concentration.
Conclusions: This study confirms that some measures of swallowing are influenced by barium product and/or concentration. Measures are not necessarily similar across different barium products at the same concentration. This study illustrates the importance of using standard and appropriate stimuli in videofluoroscopy, and for clinicians to report not only the product but also the concentration of stimuli used.

Supplemental Material S1. Videofluoroscopy task orders. 

Supplemental Material S2. Descriptive statistics for quantitative videofluoroscopic measures by barium stimulus.

Steele, C. M., Barrett, E., & Peladeau-Pigeon, M. (2022). Which videofluoroscopy parameters are susceptible to the influence of differences in barium product and concentration? American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2022_AJSLP-22-00017

目的：先前研究指出，在不同钡浓度下，视频荧光吞咽测量可能存在差异。然而，相同浓度的不同钡产品是否会导致相似的吞咽生理学尚不得而知。这一点至关重要，因为用于视频荧光透视的钡剂（例如，Bracco Varibar）在全球范围内并不普遍可用。本研究旨在识别五种不同钡刺激下健康吞咽的差异。

方法：二十名健康成人（其中女性10名），年龄在22至54岁之间，接受了包括舒适地啜饮稀薄钡剂的视频荧光透视检查：两次啜饮由E-Z-HD粉末制备的20%重量/体积（w/v）钡剂，以及两次啜饮由Liquid Polibar Plus和E-Z-Paque粉末制备的20%w/v和40%w/v钡剂。记录根据吞咽生理学分析：事件、运动学和时序方法进行分析。获得了时间、运动学和残留量的测量值。使用卡方检验、Friedman检验和Wilcoxon符号秩检验来识别不同刺激之间的差异。

结果：在钡刺激下，上食管括约肌（UES）开放持续时间、UES直径、最大收缩时的咽部面积和残留量均存在显著差异。在所有情况下，20%w/v的E-Z-HD刺激均显示出较小的值；然而，该刺激的透视清晰度存在疑问。残留严重程度的模式不能由钡浓度来解释。

结论：本研究证实，某些吞咽测量值受钡产品及/或浓度的影响。在不同钡产品相同浓度下，测量值并不一定相似。本研究阐述了在视频荧光透视中使用标准且适当刺激的重要性，以及临床医生报告产品的同时，也应报告所使用的刺激浓度。

补充材料S1：视频荧光透视任务清单。

补充材料S2：按钡刺激的定量视频荧光透视测量值的描述性统计。

Steele, C. M., Barrett, E., & Peladeau-Pigeon, M. (2022). 哪些视频荧光透视参数易受钡产品及浓度差异的影响？美国言语-语言病理学杂志。在线预发布。https://doi.org/10.1044/2022_AJSLP-22-00017