From the Guidelines
Managing dysphagia requires a comprehensive approach that prioritizes early dysphagia screening, instrumental evaluation, and individualized treatment plans to minimize morbidity, mortality, and improve quality of life. The most recent and highest quality study, published in 2025 1, supports the use of chin tuck against resistance in addition to conventional dysphagia therapy to improve oropharyngeal swallow function. This technique targets suprahyoid musculature, which is essential for repositioning the laryngeal entrance to the airway and allowing a bolus to transit into the esophagus.
Key Components of Dysphagia Management
- Early dysphagia screening using a valid screening tool by a speech-language pathologist or other trained healthcare provider 1
- Instrumental evaluation, such as videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic examination of swallowing (FEES), to verify the presence or absence of aspiration and determine the physiological reasons for dysphagia 1
- Individualized treatment plans that include dietary modifications, compensatory swallowing techniques, and swallowing therapy with a speech-language pathologist 1
- Alternative feeding methods, such as nasogastric tubes or percutaneous endoscopic gastrostomy (PEG) tubes, in severe cases where oral intake remains unsafe 1
Treatment Options
- Chin tuck against resistance to improve oropharyngeal swallow function 1
- Respiratory muscle strength training to decrease aspiration and reduce the risk of associated respiratory complications 1
- Proton pump inhibitors, such as omeprazole or pantoprazole, for GERD-related dysphagia [@Example@]
- Endoscopic dilation for strictures or myotomy for achalasia [@Example@]
Importance of Regular Reassessment
Regular reassessment is crucial in dysphagia management, as treatment plans often require adjustment over time based on patient response and changing conditions 1. This ensures that patients receive the most effective treatment and minimizes the risk of complications, such as aspiration pneumonia, malnutrition, and dehydration.
From the Research
Management of Dysphagia
- Dysphagia can be managed through a collaborative approach involving family physicians, speech-language pathologists, and other specialists 2.
- The management of dysphagia involves evaluating the patient's symptoms, performing imaging tests such as esophagogastroduodenoscopy and barium esophagography, and providing structured assessments and recommendations for safe swallowing, palliative care, or rehabilitation 2.
- Patients with oropharyngeal dysphagia may benefit from functional training, including training of oral motor skills and sensation, compensatory swallowing techniques, and diet modification 3.
- Patients with esophageal dysphagia may require acid-suppressing therapy, and those with severe dysphagia may need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency 2, 4.
Rehabilitation and Treatment
- Various methods of rehabilitation for dysphagia have been suggested, including functional training, diet modification, and the use of nasogastric or gastrostomic feeding 4, 3.
- Percutaneous endoscopic gastrostomy (PEG) feeding may be considered for patients with severe dysphagia, although it is associated with a higher risk of complications and mortality compared to nasogastric tube feeding 3, 5.
- A study comparing PEG and nasogastric tube feeding found that PEG was associated with a lower probability of intervention failure and was more effective and safe than nasogastric tube feeding 5.
Special Considerations
- Patients with Parkinson's disease and related disorders may experience degenerative dysphagia, and their management requires a multidisciplinary approach, including speech-language pathologists and other specialists 4.
- Frail older adults with progressive neurologic disease may have significant but unrecognized dysphagia, which increases their risk of aspiration pneumonia and malnourishment, and requires a discussion about goals of care before potentially harmful interventions are considered 2.
- The treatment of dysphagia in the elderly requires a multi-professional setting, differentiated assessment, and functional training of oral motor skills and sensation and swallowing techniques 3, 6.