From the Guidelines
Dysphagia is a swallowing disorder that can occur at any stage of the swallowing process, characterized by difficulty swallowing, which may present as trouble initiating a swallow, feeling food stuck in the throat or chest, coughing or choking during meals, or regurgitation of food.
Definition and Classification
Dysphagia can be categorized as oropharyngeal (difficulty transferring food from the mouth to the esophagus) or esophageal (sensation of food sticking in the chest) 1.
Causes and Risk Factors
Common causes include neurological disorders like stroke or Parkinson's disease, structural problems such as esophageal strictures or tumors, and motility disorders like achalasia 1.
Management and Treatment
Management depends on the underlying cause and may include dietary modifications (thickened liquids, soft foods), swallowing therapy exercises, medications to address specific conditions, or surgical interventions in severe cases 1.
Importance of Evaluation and Multidisciplinary Approach
Proper evaluation by a healthcare provider is essential, as untreated dysphagia can lead to malnutrition, dehydration, aspiration pneumonia, or airway obstruction 1.
- A multidisciplinary approach involving speech therapists, gastroenterologists, and dietitians often provides the best outcomes for patients with swallowing difficulties.
- Early dysphagia screening is recommended for acute stroke patients to identify dysphagia or aspiration, which can lead to pneumonia, malnutrition, dehydration, and other complications 1.
- Instrumental evaluation (video fluoroscopy, fiberoptic endoscopic evaluation of swallowing, or fiberoptic endoscopic evaluation of swallowing with sensory testing) is more sensitive than bedside assessment of hearing loss 1.
From the Research
Definition of Dysphagia
- Dysphagia is a complaint that suggests difficulty in swallowing, characterized based on the symptoms and location of pathology 2.
- It is defined as impairment of the swallowing process, a common symptom that can be a significant source of morbidity and mortality in the general population 3.
- Dysphagia, or difficulty in swallowing, is a condition with a strong age-related bias, with rates varying due to differences in method between studies 4.
Types of Dysphagia
- Oropharyngeal dysphagia is typically due to difficulty initiating a swallow and is generally due to structural, anatomic, or neuromuscular abnormalities 2.
- Esophageal dysphagia arises after the swallow and causes include intrinsic structural pathology, extrinsic compression, or disruption in normal motility 2.
Causes and Prevalence
- Dysphagia can be caused by various factors, including cognitive decline, lowered immunity, malnutrition, and end-of-life decisions, especially in geriatric patients 4.
- The prevalence of dysphagia varies, with rates lower in the community than in nursing home facilities 4.
- Dysphagia is a concern in adults with multiple sclerosis (MS), resulting in complications such as aspiration pneumonia, reduced quality of life, and increased mortality rate 5.
Treatment and Management
- The management and treatment of dysphagia are complicated by underlying conditions, such as cognitive decline and malnutrition 4.
- Botulinum toxin injections to the cricopharyngeus muscle can alleviate dysphagia in patients with inclusion body myositis 6.
- Electrical stimulation and botulinum toxin treatment have shown promise in reducing swallowing impairment in adults with MS, but require further research to determine their clinical applicability and long-term treatment effects 5.