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North & South America

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Colombia

Local distributor

Colombia

Sistemas Medicos, LTDA.

Apartado Aereo 24456
Calle 58 No. 35A61
Bogota
(Colombia)

ph. +571-221-9837
Fax +571-222-5310
Perù

Local distributor

Perù

REIMED, SCRL

Pasaje Villaran 192-194 U-12
Urb. Los Sauces Surquillo
Lima 15076
(Peru)

ph. 511-448-1087
Fax 511-448-3447
Uruguay

Local distributor

Uruguay

Lifenir S.A.

Justicia 2069
C 11800 Montevideo
(Uruguay)

ph. +5982-400-3020
Fax +5982-4007320
Venezuela

Local distributor

Venezuela

SUFOMECA

Torre Polar Oeste
Plaza Venezuela
Floor 7, Room 7C
Caracas
PO Box 1050
(Venezuela)

ph. +582-12-793-3222
Fax +582-12-781-1923

Europe

Europa

Albania

Local distributor

Albania

RX PHARMA Sh.P.K.

Rr Komuna e Parisit
Pallatet Kike - Kulla 2
Tirana
(Albania)

ph. +355 42251091
Bosnia-Herzegowina

Local distributor

Bosnia-Herzegowina

MARK Srl

Via S. Michele 334
34170 Gorizia
(Italy)

Montenegro

ph. +39 481217111
Fax +39 48120719
Bulgaria

Local distributor

Bulgaria

EWOPHARMA AG

73 Persenk Street
App. 27 - Floor 8
1164 Sofia
(Bulgaria)

ph. +359 29624478
Fax +359 28683968
Croatia

Local distributor

Croatia

MARK Srl

Via S. Michele 334
34170 Gorizia
(Italy)

Montenegro

ph. +39 481217111
Fax +39 48120719
Greece

Local distributor

Greece

LERIVA IMAGING S.A.

33 Pigis Avenue &
6 Anapiron Polemou Street
151 27 Melissia
Athens (Greece)

ph. +30 210-6199886
Fax +30 210 61 78 733
Kosovo

Local distributor

Kosovo

RX PHARMA Sh.P.K.

Rr Komuna e Parisit
Pallatet Kike - Kulla 2
Tirana
(Albania)

ph. +355 42251091
Montenegro

Local distributor

Montenegro

MARK Srl

Via S. Michele 334
34170 Gorizia
(Italy)

Montenegro

ph. +39 481217111
Fax +39 48120719
Romania

Local distributor

Romania

EWOPHARMA A.G. ROMANIA

B-dul Primaverii 19 -21
Sc. B - Et.1 - Sect. 1
011972 - Bucharest
(Romania)

ph. +40 212601344
Fax +40 212029327
Serbia

Local distributor

Serbia

MARK Srl

Via S. Michele 334
34170 Gorizia
(Italy)

Montenegro

ph. +39 481217111
Fax +39 48120719
Slovenia

Local distributor

Slovenia

MARK Srl

Via S. Michele 334
34170 Gorizia
(Italy)

Montenegro

ph. +39 481217111
Fax +39 48120719
Hungary

Local distributor

Ungheria

EWOPHARMA REPRESENTATION OFFICE

Budakeszi ut 73/F
H-1021 Budapest
(Hungary)

ph. +36 12004650
Fax +36 13980316

Eastern Europe, Middle East & Africa

Eastern Europe, Middle East & Africa

Ethiopia

Local distributor

Ethiopia

Caroga Pharma PVT. Ltd

P.O.Box 12627
Addis Abeba
(Ethiopia)

ph. +251 11 4654944 / 11 4161090
Fax +251 11 4654595
Ghana

Local distributor

Ghana

Cyndex Pharmacy

P.O.Box DS 1165 Dansoman
Accra
(Ghana)

ph. +233 21553370
Fax +233-244366622 / 21850072
Israel

Local distributor

Israel

DEXCEL

Or-Akiva 30600
30600000 Israel
(Israel)

ph. +972-4-6364015
Fax +972-4-6364004
Jordan

Local distributor

Jordan

THE ARAB DRUG STORE

Khaleel Al Salem street
Amman
(Jordan)

ph. +962 6 5502995
Fax +962 6 5502984
Kenya

Local distributor

Kenya

Nairobi X-Rays Supplies Ltd.

P.O. Box 41669
Nairobi
(Kenya)

ph. +254 20446265-6-7-8
Fax +254 20 4448515/17
Lebanon

Local distributor

Lebanon

Unione Pharmaceutic. d'Orient

Rue du Musée Imm. Stephan QtrBadaro
Beyrouth
(Lebanon)

ph. +961 1 396085-6
Fax +961 1 396047
Mauritius

Local distributor

Mauritius

The Mauritius Pharmacy

4, Louis Pasteur Str Forest Side
(Mauritius)

ph. +230 6762435
Fax +230 675 1387
Saudi Arabia

Local distributor

Saudi Arabia

SARABEEL COMMERCIAL EST.

Medical Division
P.O. BOX 14795
21434 Jeddah
(Saudi Arabia)

ph. +966 12657 2246

Yousef Ahmed Algosaibi Trading Est.

Seventh Floor Sesmo Building
Dhahran Street
(PO Box 5540)
31432 Dammam
(Saudi Arabia)

ph. +966 382 69 490
Fax +966 382 72 528
South Africa

Local distributor

South Africa

AXIM - Head Office Midrand

121 Gazelle Avenue
Corporate Park South
Midrand Johannesburg 2000
(South Africa)

ph. +27 113140140
Fax +27 113140141
Uganda

Local distributor

Uganda

Kampala X-Rays Suppliers

Plot 181 Bombo Rd (KuBbiri)
P.O. Box 9519
Kampala
(Uganda)

ph. +256 41 534313
Fax +256 41 349919
Ukraine

Local distributor

Ukraine

DELTA MEDlCAL

43 Chernovola
Vishnevoe - 08132
(Ukraine)

ph. +38 445933355

Asia Pacific

Asia Pacific

Australia

Local distributor

Australia

REGIONAL HEALTH CARE GROUP

3-11 Primrose Avenue Rosebery
NSW 2018 - Sydney
(Australia)

ph. +61 296624144
Fax +61 296626040
India

Local distributor

India

Imaging Products (India ) Ltd

Mumbai
(India)

ph. +91 9819725471
Fax +91 2228320208
Indonesia

Local distributor

Indonesia

PT DIPA PHARMALAB INTERSAINS

Jl. Panjang No. 10
Kebon Jeruk
Jakarta 11530
(Indonesia)

ph.  +62 215348644
Fax +62 2153676066
New Zealand

Local distributor

New Zealand

REGIONAL HEALTH LIMITED

19C Orbit Drive
Mairangi Bay
(New Zealand)

ph. +64 94140040
Fax +64 94140041
Pakistan

Local distributor

Pakistan

S. EJAZUDDIN & CO LTD

PO Box 5629 - Zia Plaza
Altaf Hussain Road
74000 Karachi
(Pakistan)

ph. +92 21212032
Fax +92 212629716
Philippines

Local distributor

Philippines

NEW MARKETLINK INTERNATIONAL CORP

Tao Corporate Centre 2291
Don Chino Roches Ave
Ext Makati City Metro
Manila (Philippines)

ph. (632) 836-5838
Singapore

Local distributor

Singapore

LF ASIA PHARMACEUTICAL DIVISION

Healthcare Distribution Centre
24 Penjuru Road (off Penjuru Close)
#03-04 CWT Commodity Hub
(Singapore 609128)

ph. +65 65097629
Taiwan

Local distributor

Taiwan

SUPER FORTUNE ENTERPRISE CO LTD

5 F-1 - 42 Sec.1 Ming
Sheng E. Road Jehovah Building
101 Taipei
(Taiwan)

ph. +886 225673456
Fax +886 225319231
Thailand

Local distributor

Thailand

Interpharmacare Co., Ltd.

90 Moo 13 Soi Mahacha
Bangpleeyai
Bangplee
Samutprakarn 10540
(Thailand)

ph. + 66 2 675 9140-2
Fax + 66 2 325 0265
Vietnam

Local distributor

Vietnam

HOANG GIA INVESCO, JSC

No 74-76 Hoa Bang Str
Cau Giay
Dist Ha Noi Hanoi
(Viet Nam)

ph. +43 7846952

About Dysphagia

WHAT IS DYSPHAGIA?

Dysphagia is the medical term for “difficulty swallowing.” The problem occurs when there is difficulty in the passage of solids or liquids from the mouth to the stomach and can occur at various stages in the swallowing process:

  • Oral phase – sucking, chewing, and moving food or liquid to the throat
  • Pharyngeal phase – squeezing food down the throat during the swallowing reflex
  • Esophageal phase – relaxing and tightening the openings at the top and bottom of the esophagus while it propels food into the stomach

SIGNS & SYMPTOMS

General signs may include:

  • Coughing during or following eating or drinking
  • Wet sounding voice during or after eating or drinking
  • Slow or extra effort needed to chew or swallow
  • Food or liquid leaking from or getting stuck in the mouth
  • Recurring pneumonia or chest congestion following meals
  • Weight loss or dehydration due to poor food intake
Glowing

The most common symptom of esophageal dysphagia is the inability to swallow food, described by the patient as food being “stuck” above the stomach.

CAUSES
Dysphagia can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions. Generally, there are two types of problems that may cause difficulty swallowing:

The muscles and nerves that help move substances down the esophagus are not working properly. This may be caused by:

  • Stroke, brain or spinal injury
  • Nervous system problems including multiple sclerosis, muscular dystrophy, or Parkinson's disease
  • Swelling from an immune system problem
  • Esophageal spasms
  • Scleroderma

Another cause is a blockage in the throat or esophagus, from:

  • Esophagitis
  • Gastroespohageal reflux disease (GERD)
  • Diverticula
  • Esophageal tumors
  • Food or objects stuck in the throat

The two types of dysphagia and their causes are:

  • Esophageal dysphagia: Some functional causes are: achalasia; myasthenia gravis; and bulbar or pseudobulbar palsy.  Mechanical causes include: peptic esophagitis; esophageal carcinoma; external esophageal compression; pharyngeal pouch, systemic sclerosis; esophageal web or leiomyoma.
  • Oropharyngeal dysphagia: Causes may include: stroke; multiple sclerosis; myasthenia gravis; Parkinson's disease; Bell's palsy; bulbar & pseudobulbar palsy; radiation; neurotoxins; pharyngitis; and others.

COMPLICATIONS

  • Poor nutrition or dehydration
  • Risk of aspiration, which can lead to pneumonia and chronic lung disease due to food entering the airways
  • Less enjoyment of eating or drinking
  • Embarrassment involving eating

DIAGNOSIS
Evaluation from a speech-language pathologist (SLP) is usually the first step in diagnosis. Besides chronicling the patient history and symptoms, the SLP will check swallowing muscle strength and movement and observe feeding. Special tests may also be administered, including:

  • Modified Barium Swallow (MBS) study: patient is x-rayed while swallowing food or drink with barium in it
  • Endoscopic Assessment: a lighted scope is inserted through the nose and the swallow can be viewed on-screen

The Modified Barium Swallow (MBS) study (also known as the videofluoroscopic swallow study) is a widely used exam generally conducted in the radiology department by an SLP in conjunction with a radiologist and/or radiologic technologist. It has two primary functions:

  • to assess the degree of a patient’s dysphagia and which viscosities of liquids or foods the patient can safely ingest without aspirating and
  • to evaluate the patient’s response to therapeutic interventions over time.

The MBS study involves capturing on video the dynamic swallowing process, especially looking for potential of aspiration or penetration of ingested liquids or foods through or onto the vocal cords respectively.
A fluoroscopic x-ray device captures the image of the ingested bolus as it is swallowed and makes a video recording of the exam. Such materials must incorporate barium into the mixture in order for them to be seen on the x-ray images. The SLP and/or radiologist can review the swallowing process live during the procedure, or after the exam on the video, to make a diagnosis.

Accurate assessment of the degree of the swallowing deficit, implementation of appropriate therapeutic interventions, and subsequent exams to evaluate response are foundational to proper patient management. The MBS study is the gold standard for such patient evaluation and management.1,2

A critical element to any successful MBS study is to use consistent viscosities of materials for the patient to swallow, because understanding exactly what patients can safely ingest and what they cannot is the key end point of the study. The SLP typically prepares several different viscosities to test with a patient and scores them on which ones the patient “passes” or “fails.”

Concerns from the SLP community exist today about the accuracy and reproducibility of results of an MBS study from institution to institution, from one SLP to another, and even in the same patient with the same SLP in multiple exams over time. This recognition by the speech pathology community of the study disparities led to a movement to create more standardization in the study in order to ensure the most accurate patient diagnosis and treatment. The SLP community continues to explore various strategies to bring more standardization to the MBS study.


REFERENCES: 1. Lundy DS, Smith C, Colangelo L, et al. Aspiration: cause and implications.Otolaryngol Head Neck Surg. 1999;120(4):474-478. 2. Bevan K, Griffiths MV. Chronic aspiration and laryngeal competence. J Laryngol Otol. 1989;103(2):196-199.

 

About Dysphagia

What is dysphagia?

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FAQs

Frequently asked questions

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Why Varibar?

The MBS study is designed specifically for assessment of swallowing function.

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Indications and Usage:
VARIBAR products are indicated for use in radiography of the esophagus, pharynx and hypopharynx. VARIBAR is indicated for adult use only.

VARIBAR PUDDING is a radiographic contrast agent indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients 6 months of age and older.

IMPORTANT SAFETY INFORMATION:
For Oral Administration. This product is contraindicated in patients with known or suspected perforation of the gastrointestinal (GI) tract, known obstruction of the GI tract, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents. Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration.

Please download full Prescribing Information for VARIBAR® by clicking here.

You are encouraged to report negative side effects of prescription drugs to the FDA.  Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

VARIBAR is manufactured by E-Z-EM Canada Inc., for E-Z-EM, Inc., a subsidiary of Bracco Diagnostics Inc., Monroe Twp., NJ 08831.

VARIBAR is a registered trademark of E-Z-EM, Inc

.