From the Guidelines
The management of dysphagia should begin with a comprehensive swallowing evaluation by a speech-language pathologist, ideally using a valid screening tool, and may involve videofluoroscopic swallow studies or fiberoptic endoscopic evaluation of swallowing, as recommended by the most recent guidelines 1. The initial assessment should prioritize identifying patients at risk for pharyngeal dysphagia or poor airway protection, and a referral to a speech-language pathologist, occupational therapist, dietitian, or other trained dysphagia clinician should be made promptly if abnormal results are found 1. Key considerations in the management of dysphagia include:
- Dietary modifications, such as thickened liquids and soft or pureed foods, to reduce aspiration risk
- Postural techniques, like the chin-tuck maneuver, to protect the airway
- Specific swallowing exercises, including the Mendelsohn maneuver, effortful swallow, and Shaker exercise, performed regularly
- Consideration of enteral feeding via nasogastric tube or percutaneous endoscopic gastrostomy in cases of severe dysphagia with malnutrition or recurrent aspiration
- Education of patients, families, and caregivers on swallowing and feeding recommendations, as well as the importance of good oral hygiene to reduce the risk of pneumonia 1. It is crucial to address dysphagia promptly, as it can lead to malnutrition, dehydration, aspiration pneumonia, and reduced quality of life if left untreated, and an interprofessional team approach to dysphagia management using evidence-based protocols and standardized care can improve patient outcomes 1.
From the Research
Dysphasia Workup
- The management and treatment plan for a patient with dysphasia involves a comprehensive approach, including the use of modified barium swallow studies to assess swallowing abnormalities 2.
- The decision to insert a percutaneous endoscopic gastrostomy (PEG) tube is typically made on clinical grounds, taking into account the patient's neurological deficits and risk of aspiration pneumonitis 2.
- PEG tubes are often used as an alternative to nasogastric tubes for long-term enteral nutrition, and clinical guidelines have been developed to provide guidance on their use 3.
Diagnostic Tools
- The barium swallow study is a useful diagnostic tool for evaluating esophageal dysphagia, and can help identify subtle strictures and other abnormalities 4.
- The timed barium swallow (TBS) protocol provides a more standardized assessment of esophageal emptying, and can be used to evaluate therapeutic response in conditions such as achalasia 4.
- High-resolution manometry is generally considered more accurate than barium swallow for diagnosing achalasia, but barium swallow can still be useful in cases where manometry is equivocal 4.
Treatment Options
- PEG tubes have been shown to be more effective and safe than nasogastric tubes for adults with swallowing disturbances, with a lower risk of intervention failure and complications 5, 6.
- The choice of treatment option will depend on the individual patient's needs and circumstances, and should be made in consultation with a healthcare professional.
- Clinical guidelines and evidence-based recommendations should be followed when making decisions about the use of PEG tubes and other treatment options for dysphasia 3, 5, 6.