Abstract
Purpose
Marfan syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on swallowing and QoL. This study examined perceptions of swallowing difficulties and QoL among persons with MFS.
Method
A total of 356 participants (1% response rate) with a self-reported diagnosis of MFS provided medication regime and completed a Quality-of-Life Index and a modified version of the SWAL-QOL used to assess 8 QOL concepts related to swallowing: burden, duration, desire, food choice, fear, mental health, social concerns, and fatigue.
Results
Dysphagia symptoms were reported by 62% (N = 356) of the participants. Analyses assessing correlations between responses to SWAL-QOL questions, QoL scores, and reported medications were conducted. Further, responses on the SWAL-QOL predicted QoL satisfaction, even after controlling for medications. Findings revealed that greater swallowing difficulty affects QoL satisfaction and overall QoL, but not QoL importance. Further, specific medications were associated with differences in swallowing difficulty as well as QoL satisfaction.
Conclusions
The findings of the current study suggest that individuals with MFS may experience specific swallowing difficulties which impact QoL. Specific classes of drugs may also be associated with reported swallowing QoL and QoL satisfaction in MFS. These findings have implications for clinicians who work with individuals with MFS.
Similar content being viewed by others
References
Goldfinger, J. Z., Preiss, L. R., Devereux, R. B., Roman, M. J., Hendershot, T. P., Kroner, B. L., & Eagle, K. A. (2017). Marfan syndrome and quality of life in the GenTAC registry. Journal of the American college of Cardiology, 69(23), 2821–2830.
Nelson, A. M., Walega, D. R., & McCarthy, R. J. (2015). The incidence and severity of physical pain symptoms in Marfan syndrome. A survey of 993 patients. Clinical Journal of Pain, 31, 1080–1086.
Rand-Hendriksen, S., Sørensen, I., Holmström, H., Andersson, S., & Finset, A. (2007). Fatigue, cognitive functioning and psychological distress in Marfan syndrome, a pilot study. Psychology, Health & Medicine, 12(3), 305–313. https://doi.org/10.1080/13548500600580824
Behr, C. A., Denning, N., Kallis, M. P., Maloney, C., Soffer, S. Z., Romano-Adesman, A., & Hong, A. R. (2019). The incidence of Marfan syndrome and cardiac anomalies in patients presenting with pectus deformities. Journal of Pediatric Surgery, 54, 1926–1928.
Fusar-Poli, P., Klersy, C., Stramesi, F., Callegari, A., Arbustini, E., & Politi, P. (2008). Determinants of quality of life in Marfan syndrome. Psychosomatics, 49, 243–248.
Aubart, M., Gross, M., Hanna, N., Zabot, M., Sznajder, M., Detaint, D., Gouya, L., Jondeau, G., Boileau, C., & Stheneur, C. (2015). The clinical presentation of Marfan syndrome is modulated by expression of wild-type FBN1 allele. Human Molecular Genetics, 24(10), 2764–2770.
Du, Q., Zhang, D., Zhuang, Y., Xia, O., Wen, T., & Jia, H. (2021). The molecular genetics of Marfan syndrome. International Journal of Medical Sciences, 18(13), 2752–2766.
Growth, K. A., Hove, H., Kyhl, K., Folkestad, L., Gaustadnes, M., Vejlstrup, N., Stochholm, K., Ostergaard, J. R., Andersen, N. H., & Gravholt, C. H. (2015). Prevalence, incidence, and age at diagnosis in Marfan syndrome. Orphanet Journal of Rare Diseases, 10(153), 1–10.
Otremski, H., Widmann, R. F., Di Maio, M. F., & Ovadia, D. (2020). The correlation between spinal and chest wall deformities and pulmonary function in Marfan syndrome. Journal of Children’s Orthopaedics, 14, 343–348.
Peters, K. F., Apse, K. A., Blackford, A., McHugh, B., Michalic, D., & Biesecker, B. B. (2005). Social and behavioral research in clinical genetics. Living with Marfan syndrome: Coping with stigma. Clinical Genetics, 68, 6–14.
Ratiu, I., Virden, T. B., Baylow, H., Flint, M., & Esfandiarei, M. (2018). Executive function and quality of life in individuals with Marfan syndrome. Quality of Life Research, 27, 2057–2065.
Vanem, T. T., Rand-Hendriksen, S., Brunborg, C., Geiran, O. R., & Roe, C. (2020). Health-related quality of life in Marfan syndrome: A 10-year follow-up. Health and Quality of Life Outcomes, 18(376), 1–8.
Castori, M., Morlino, S., Pascolini, G., Blundo, C., & Grammatico, P. (2015). Gastrointestinal and nutritional issues in joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility Type. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 169, 54–75.
Fankhauser, G. T., Stone, W. M., Fowl, R. J., Oonnell, M. E., Bower, T. C., Meyer, F. B., & Money, S. R. (2015). Surgical and medical management of extracranial carotid artery aneurysms. Journal of Vascular Surgery, 61, 389–393.
Hoganson, N. E., Cernaianu, A. C., Cilley, J. H., & DelRossi, A. J. (1990). Aneurysm of the left sinus of Valsalva. An unusual presentation. Texas Heart Institute Journal, 17, 245–248.
Khan, A., Humayun, M., Haider, I., & Ayub, M. (2016). Lujan–Fryns Syndrome (LFS): A unique combination of hypernasality, marfanoid body habitus, and neuropsychiatric issues, presenting as acute-onset dysphagia. Clinical Medicine Insights: Case Reports, 9, 115–118. https://doi.org/10.4137/CCRep.S41083
Dranseika, V., Erdil, T., Schweiger, M., Balmer, C., Pretre, R., & Dave, H. (2020). Dysphagia and an aberrant subclavian artery: More than just a coincidence. Interactive CardioVascular and Thoracic Surgery, 31, 228–231.
Colton, R. H., Casper, J. K., & Leonard, R. (2011). Understanding voice problems. A physiological perspective for diagnosis and treatment (4th ed.). Lippincott Williams & Wilkins.
Teixido, M. T., & Leonett, J. P. (1990). Recurrent laryngeal nerve paralysis associated with thoracic aortic aneurysm. Otolaryngology - Head and Neck Surgery, 102(2), 140–144.
Yuan, S. M. (2014). Cardiovascular dysphagia—Anatomical and clinical implications. Folia Morphologica, 73(2), 113–121.
Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech - Language Pathology, 12(4), 400.
Werner, C., Rbah, R., & Böhm, M. (2006). Cardiovascular dysphagia. Clinical Research in Cardiology, 95, 54–56.
Iacovou, E., Vlastarakos, P. V., & Nikolopoulos, T. P. (2014). Laryngeal involvement in connective tissue disorders. Is it important for patient management? Indian Journal of Otolaryngology Head & Neck Surgery, 66, S22–S29.
Verdonschot, R., & Baijens, L. W. J. (2013). Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. Journal of Psychosomatic Research, 75(5), 451–455.
Verdonschot, R. J. C. G., Baijens, L., Vanbelle, S., Florie, M., Kremer, B., & Leue, C. (2015). The relationship between fiberoptic endoscopic evaluation of swallowing outcome and symptoms of anxiety and depression in dysphagic patients. The Laryngoscope, 126, E199–E207.
Loosen, S. H., Kandler, J., Luedde, T., Kostev, K., & Roderburg, C. (2021). Achalasia is associated with a higher incidence of depression in outpatients in Germany. PLoS ONE, 16(4), e0250503.
Barbe, A. G. (2018). Medication-induced xerostomia and hyposalivation in the elderly: Culprits, complications, and management. Drugs & Aging, 35, 877–885.
Nolan, N. M. (2001). Medication-induced taste disturbances. Nutrition in Clinical Care, 4(1), 43–52.
Bowen, J. M., & Connolly, H. M. (2014). Of Marfan’s Syndrome, mice, and medications—Editorial. The New England Journal of Medicine, 371(22), 2127–2128.
Jobski, K., Hofmann, F., Herget-Rosenthal, S., & Dörks, M. (2020). Drug interactions with oral anticoagulants in German nursing home residents: Comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case–control studies. Clinical Research in Cardiology, 109, 465–475.
Osawa, H., Kita, H., Ohnishi, H., Mutoh, H., Ishino, Y., Satoh, K., & Sugano, K. (2005). Histamine-2 receptor expression in gastric mucosa before and after Helicobacter pylori cure. Alimentary Pharmacology & Therapeutics, 21(2), 92–98.
Wallace, J. L., & Del Soldato, P. (2003). The therapeutic potential of NO-NSAIDs. A review article. Fundamental & Clinical Pharmacology, 17, 11–20.
Jaspersen, D. (2000). Drug-induced oesophageal disorders pathogenesis, incidence, prevention and management. Drug Safety, 22(3), 237–249.
O’Neill, J. L., & Remington, T. L. (2003). Drug-induced esophageal injuries and dysphagia. The Annals of Pharmacotherapy, 37, 1675–1684.
Boyce, H. W. (1998). Drug-induced esophageal damage: Diseases of medical progress. Gastrointestinal Endoscopy, 47(6), 547–550.
Ferrans, C. E., & Powers, M. J. (1985). Quality of Life Index: Development and psychometric properties. Advanced Nursing Science, 8, 15–24.
McHorney, C. A., Robbins, J., Lomax, K., Rosenbek, J. C., Chignell, K., Kramer, A. E., & Bricker, D. E. (2002). The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia, 17(2), 97–114.
Eslick, G. D., & Talley, N. J. (2008). Dysphagia. Epidemiology, risk factors and impact on quality of life—A population-based study. Alimentary Pharmacology & Therapeutics, 27, 971–979.
Plowman-Prine, E. K., Sapienza, C. M., Okun, M. S., Pollock, S. L., Jacobson, C., Wu, S. S., & Rosenbek, J. C. (2009). The relationship between quality of life and swallowing in Parkinson’s disease. Movement Disorders, 24(9), 1352–1358.
Walker, R. W., Dunn, J. R., & Gray, W. K. (2011). Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson’s disease. Dysphagia, 26, 92–96.
Brodsky, M. B., McNeil, M. R., Martin-Harris, B., Palmer, C. V., Grayhack, J. P., & Verdolini Abbott, K. (2012). Effects of divided attention on swallowing in healthy participants. Dysphagia, 27, 307–317.
Brodsky, M. B., Verdolini Abbott, K., McNeil, M. R., Palmer, C. V., Grayhack, J. P., & Martin-Harris, B. (2012). Effects of divided attention on swallowing in persons with idiopathic Parkinson’s disease. Dysphagia, 27, 390–400.
Lee, V. C., Rhew, D. C., Dylan, M., Badamgarav, E., Braunstein, G. D., et al. (2004). Meta-analysis: Angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction. Annals of Internal Medicine, 141(9), 693–704.
Umemura, S., Arima, H., Arima, S., Asayama, K., Dohi, Y., Hirooka, Y., Horio, T., et al. (2019). The Japanese Society of hypertension guidelines for the management of hypertension. Hypertension Research, 42, 1235–1481.
Miarons, M., Tomsen, N., Nascimento, W., Espín, A., López-Faixó, D., Clavé, P., & Rofes, L. (2018). Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia. Neurogastroenterology & Motility, 30(e13397), 1–10. https://doi.org/10.1111/nmo.13397
Acknowledgements
The authors would like to thank The National Marfan Foundation (USA) and Genetic Aortic Disease Association (GADA Canada) for their assistance with patient recruitment for this study.
Funding
The author declares that Hope E Baylow receives a full-time salary from The University of Scranton. The author declares that Mitra Esfandiarei and Ileana Ratiu each receive a full-time salary from Midwestern University. The author declares there is no funding associated with this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author declares that neither Hope E Baylow, Mitra Esfandiarei, nor Ileana Ratiu have a conflict of interest. The author declares that neither Hope E Baylow, Mitra Esfandiarei, nor Ileana Ratiu have no relevant non-financial interests to disclose.
Research involving animal rights
The author declares that animals were not used in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baylow, H.E., Esfandiarei, M. & Ratiu, I. Swallowing and quality of life in individuals with Marfan syndrome: a cross-sectional study. Qual Life Res 31, 3365–3375 (2022). https://doi.org/10.1007/s11136-022-03192-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-022-03192-1