From the Guidelines
I strongly recommend a gastroenterology (GI) consultation to evaluate your difficulty swallowing after your stroke, as this condition, known as dysphagia, can lead to serious complications such as aspiration pneumonia, which can significantly impact your morbidity, mortality, and quality of life. Dysphagia is a common issue after strokes, affecting a significant percentage of patients, and can cause food to get caught when swallowing [ 1 ]. A GI specialist can perform tests like a modified barium swallow study or an endoscopy to determine the cause of the issue, whether it's in the throat muscles, which were likely affected by the stroke, or if there's another problem in the esophagus [ 1 ].
The GI doctor can then recommend specific treatments, such as:
- Swallowing therapy exercises to improve swallowing function
- Dietary modifications, like thickened liquids or softer foods, to reduce the risk of aspiration
- Procedures to help improve swallowing function, if necessary These treatments can help prevent serious complications like aspiration pneumonia, which can occur if food enters the lungs instead of the stomach [ 1 ].
Early identification and treatment of dysphagia are crucial to reduce the risk of developing adverse health consequences, such as pneumonia, malnutrition, dehydration, and overall decreased quality of life [ 1 ]. Instrumental evaluation, such as video fluoroscopy or fiberoptic endoscopic evaluation of swallowing, may be necessary to determine the presence or absence of aspiration and to guide the treatment plan [ 1 ].
In addition to the GI consultation, other healthcare providers, such as speech-language pathologists, can safely perform initial screenings for dysphagia, and evidence-based screening tools, like the Toronto Bedside Swallowing Screening test, can be used to identify patients at risk for aspiration [ 1 ].
Overall, getting a proper diagnosis and treatment for dysphagia now can significantly improve your quality of life and prevent future health problems [ 1 ].
From the Research
GI Investigation for Dysphagia
The patient's report of food getting caught when swallowing post-stroke suggests dysphagia, which can lead to serious complications such as aspiration pneumonia.
- Dysphagia can result from various factors, including neurological diseases like stroke, which can affect the swallowing process 2.
- A videofluoroscopic swallowing study (VFSS) is a dynamic exam that allows for the evaluation of the complete swallowing process, including the oral, pharyngeal, and esophageal phases 3, 2.
- The esophageal phase of swallowing can be abnormal in patients with dysphagia, and VFSS can detect these abnormalities, especially in patients without a pre-established etiological diagnosis 3.
- The study by 4 found that esophageal screening during VFSS can identify patients with esophageal disease, although its sensitivity is limited.
Role of GI Investigation
- GI investigation, including VFSS, can play a crucial role in evaluating and managing patients with dysphagia, particularly those with neurological diseases like stroke 2, 5.
- The gastroenterologist's role in the management of pregnant patients with GI disorders is well-established, but their role in evaluating and managing dysphagia in non-pregnant patients is also important 6.
- GI consultation can change the diagnosis and management of patients with dysphagia, highlighting the importance of GI investigation in these cases 6.
Appropriate Use of GI Investigation
- The patient's symptoms of food getting caught when swallowing post-stroke suggest that GI investigation, including VFSS, is appropriate to evaluate the swallowing process and detect any abnormalities 3, 2.
- The use of VFSS can help guide further esophageal investigation and management, particularly if clinical suspicion is high 4.
- GI investigation can help identify the underlying cause of dysphagia and guide appropriate management, reducing the risk of complications such as aspiration pneumonia 2, 5.