From the Guidelines
To evaluate dysphagia, I recommend a comprehensive approach starting with a detailed clinical history and physical examination, followed by appropriate diagnostic tests, as outlined in the most recent guidelines from the American College of Radiology 1. The evaluation of dysphagia should prioritize the identification of the underlying cause, which can be structural, functional, or a combination of both.
- A modified barium swallow study (videofluoroscopy) is a crucial diagnostic tool, allowing for real-time visualization of the swallowing process 1.
- Fiberoptic endoscopic evaluation of swallowing (FEES) provides direct visualization of the pharynx and larynx during swallowing, helping to identify potential aspiration risks 1.
- For suspected esophageal causes, an upper endoscopy (EGD) is essential to directly visualize the esophageal lumen and obtain biopsies if needed 1.
- Esophageal manometry helps assess motility disorders by measuring pressure changes during swallowing, which can be particularly useful in patients with suspected achalasia or other motility disorders 1.
- Additional imaging such as CT or MRI of the neck and chest may be necessary to identify structural abnormalities, such as tumors or vascular malformations 1.
- Laboratory tests, including complete blood count, comprehensive metabolic panel, and thyroid function tests, should be ordered to identify systemic causes of dysphagia, such as thyroid disorders or nutritional deficiencies 1. This multi-modal approach is crucial because dysphagia can result from various conditions affecting different parts of the swallowing pathway, including neurological disorders, structural abnormalities, or inflammatory conditions, and proper diagnosis guides appropriate treatment.
- The use of thickened fluids or modified consistency foods may be beneficial in patients with neurogenic dysphagia, as it can help improve swallowing safety and reduce the risk of aspiration 1.
- Percutaneous endoscopic gastrostomy (PEG) tube placement may be necessary in patients who are unable to take food orally, as it can provide a safe and effective means of enteral nutrition 1.
From the Research
Studies Evaluating Dysphagia
- The study "Evaluation and treatment of swallowing impairments" 2 evaluates dysphagia, which may occur due to various structural or functional conditions, including stroke, cancer, neurologic disease, and gastroesophageal reflux disease.
- Another study, "Fiberoptic endoscopic evaluation of swallowing" 3, assesses pharyngeal dysphagia and implements rehabilitation interventions to promote safe and efficient swallowing.
- The study "Dysphagia. Pathophysiology, causes, and evaluation" 4 distinguishes between two types of dysphagia, oropharyngeal and esophageal, and discusses their evaluation and causes.
- "Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing" 5 utilizes an air pulse stimulus of mechanoreceptors within the larynx to evaluate swallowing function in children and adults.
- "Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: functional outcomes for patients after stroke" 6 investigates the clinical utility of a speech-language pathologist-led FEES service on functional outcomes for patients after acute stroke, finding a significant reduction in pneumonia rates and improved diet on discharge.
Evaluation Methods
- Videofluorographic swallowing study is used to identify the pathophysiology of a swallowing disorder and to empirically test therapeutic and compensatory techniques 2.
- Fiberoptic endoscopic evaluation of swallowing (FEES) is a technique used to assess pharyngeal dysphagia and implement rehabilitation interventions 3, 5, 6.
- Barium esophagography and fiberoptic endoscopy are used in the initial evaluation of esophageal dysphagia 4.
- Esophageal manometry is indicated when a motor disorder is suspected 4.