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 study from 2019 1. The evaluation of dysphagia should be tailored to the patient's specific symptoms, with attention to whether the dysphagia is for solids, liquids, or both, and whether it's progressive or intermittent.
- A modified barium swallow study (videofluoroscopy) is a valuable tool that allows visualization of all phases of swallowing and can identify anatomical or functional abnormalities.
- Fiberoptic endoscopic evaluation of swallowing (FEES) is another valuable tool that uses a flexible endoscope to directly observe the pharyngeal phase of swallowing.
- For suspected esophageal causes, an upper endoscopy (EGD) should be performed to visualize the esophageal lumen and obtain biopsies if needed.
- Esophageal manometry measures pressure changes during swallowing and is particularly useful for motility disorders like achalasia.
- pH monitoring may be indicated if gastroesophageal reflux is suspected.
- Additional tests like CT or MRI scans may be necessary if structural abnormalities or neurological causes are suspected. This systematic approach helps identify the underlying cause, which could range from mechanical obstruction to neuromuscular disorders, allowing for appropriate treatment planning, as supported by studies from 2016 1, 2013 1, and 2018 1.
From the Research
Studies Evaluating Dysphagia
- The study 2 evaluates dysphagia using fiberoptic endoscopic evaluation of swallowing, which allows for the assessment of pharyngeal dysphagia and the implementation of rehabilitation interventions.
- Another study 3 discusses the pathophysiology, causes, and evaluation of dysphagia, including the two types of dysphagia: oropharyngeal and esophageal.
- The study 4 introduces pediatric FEESST, a technique that utilizes an air pulse stimulus of mechanoreceptors within the larynx to evaluate swallowing with sensory testing in children and adults.
- A study 5 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.
- The study 6 compares endoscopic and videofluoroscopic evaluations of swallowing and aspiration, finding good agreement between the two procedures, especially for the finding of aspiration.
Evaluation Techniques
- Fiberoptic endoscopic evaluation of swallowing (FEES) is a technique used to assess pharyngeal dysphagia and implement rehabilitation interventions 2, 4, 5, 6.
- Videofluoroscopy is another technique used to evaluate swallowing and aspiration, often compared to FEES 3, 6.
- Barium esophagography is also used in the evaluation of dysphagia, particularly for esophageal dysphagia 3.
- Esophageal manometry is indicated when a motor disorder is suspected 3.