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The Medical Clinics of North America Sep 2021Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population.... (Review)
Review
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
Topics: Deglutition; Deglutition Disorders; Gastroesophageal Reflux; Humans; Laryngopharyngeal Reflux; Physical Examination; Primary Health Care; Risk Factors
PubMed: 34391544
DOI: 10.1016/j.mcna.2021.05.013 -
Neurological Sciences : Official... Nov 2020Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop... (Review)
Review
Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient's quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy.
Topics: Botulinum Toxins, Type A; Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Humans; Quality of Life
PubMed: 32506360
DOI: 10.1007/s10072-020-04495-2 -
American Family Physician Jan 2021Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive... (Review)
Review
Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.
Topics: Deglutition; Deglutition Disorders; Esophagus; Family Practice; Female; Humans; Male; Pharynx; Physical Examination
PubMed: 33448766
DOI: No ID Found -
JAMA Otolaryngology-- Head & Neck... Feb 2020Awareness of swallowing dysfunction in the pediatric population is growing. As many as 50% of parents report that their otherwise healthy children have a feeding... (Review)
Review
IMPORTANCE
Awareness of swallowing dysfunction in the pediatric population is growing. As many as 50% of parents report that their otherwise healthy children have a feeding problem. Dysphagia is increasingly common in the pediatric population, especially as advances in health care improve the survival of extremely premature infants and children with complex congenital anomalies. Symptoms of dysphagia and aspiration prompt referral to otolaryngologists.
OBSERVATIONS
Dysfunction can exist at any of the 4 phases of the physiologic swallow. Dysphagia manifests differently in children at each age in their development. Dysphagia can present in otherwise healthy children but is more common in patients with a history of prematurity, neuromuscular disorders, cardiopulmonary disorders, anatomic anomalies of the upper aerodigestive tract, and gastrointestinal tract disorders. Workup involves clinical feeding evaluations, imaging studies, and endoscopic evaluations. Appropriate management depends on the cause of dysphagia.
CONCLUSIONS AND RELEVANCE
The causes of dysphagia in children are varied and often multifactorial. Evaluation by a multidisciplinary team can facilitate accurate diagnosis and guide management.
Topics: Child; Deglutition; Deglutition Disorders; Humans; Patient Care Team; Risk Factors
PubMed: 31774493
DOI: 10.1001/jamaoto.2019.3622 -
Annals of Nutrition & Metabolism 2015Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and... (Review)
Review
Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia.
Topics: Airway Obstruction; Child, Preschool; Deglutition; Deglutition Disorders; Endoscopy; Esophagus; Fluoroscopy; Humans; Infant; Infant, Newborn; Larynx; Respiratory Aspiration
PubMed: 26226994
DOI: 10.1159/000381372 -
Primary Care Sep 2023Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can... (Review)
Review
Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can be differentiated with a careful history. Neuromuscular processes are more prevalent than structural causes in oropharyngeal dysphagia, therefore, investigation should start with a modified barium swallow. In contrast, structural processes dominate in esophageal dysphagia, and endoscopy can offer biopsy and therapy by way of dilation. Manometry is performed for esophageal dysphagia when no structural etiology is found. Specific management of dysphagia is dependent on the etiology and mechanism of dysphagia.
Topics: Humans; Deglutition Disorders; Biopsy; Manometry
PubMed: 37516505
DOI: 10.1016/j.pop.2023.03.001 -
F1000Research 2019The literal definition of dysphagia is "disturbed eating". However, it is more accurately described in clinical practice as a sensation of food or liquid being stuck in... (Review)
Review
The literal definition of dysphagia is "disturbed eating". However, it is more accurately described in clinical practice as a sensation of food or liquid being stuck in the esophagus or chest. If this sensation is associated with pain, it is labeled odynophagia, and if it is associated with persistent obstruction and bolus retention, it is categorized as a food impaction. Through research and technological advances, we continue to expand our understanding of the etiologies and underlying pathophysiology relating to this complaint. However, for now, our clinical algorithms focus on endoscopy and manometry to break down dysphagia into three categories: obstructive dysphagia, esophageal motility disorders, and functional dysphagia. Here, we review some critical pitfalls in our current clinical diagnoses, new proposed underlying mechanisms of esophageal motor disorders, and developing technologies to aid in diagnosis and treatment.
Topics: Deglutition Disorders; Esophageal Motility Disorders; Humans; Manometry; Muscle Contraction
PubMed: 31508201
DOI: 10.12688/f1000research.18900.1 -
Home Healthcare NowDysphagia, or difficult swallowing, can result in malnutrition, dehydration, aspiration pneumonia, and airway obstruction. Some primary etiologies of dysphagia include...
Dysphagia, or difficult swallowing, can result in malnutrition, dehydration, aspiration pneumonia, and airway obstruction. Some primary etiologies of dysphagia include neurological disorders, traumatic brain injury, Parkinson's disease, chronic obstructive pulmonary disease, head and neck cancer, cervical spine injury, and stroke. Home care clinicians are often the first healthcare professionals to encounter patients exhibiting signs of dysphagia and can play an important role in identifying, referring, and educating patients with dysphagia. This article will discuss the broad types of dysphagia, the signs and symptoms that suggest dysphagia, and the possible etiology and treatment.
Topics: Humans; Deglutition Disorders; Pneumonia, Aspiration; Parkinson Disease; Stroke
PubMed: 36607208
DOI: 10.1097/NHH.0000000000001134 -
Revista de Neurologia Jun 2020The prevalence of oropharyngeal dysphagia is high after a stroke. Clinically, it manifests as alterations affecting swallowing efficiency and safety, with the consequent... (Review)
Review
INTRODUCTION
The prevalence of oropharyngeal dysphagia is high after a stroke. Clinically, it manifests as alterations affecting swallowing efficiency and safety, with the consequent morbidity and mortality associated with nutritional and respiratory alterations.
AIM
To carry out an updated review of the diagnostic and therapeutic aspects of oropharyngeal dysphagia after a stroke that can be applied in daily clinical practice, and of the non-invasive neurostimulation techniques.
DEVELOPMENT
The process of diagnosis and treatment of oropharyngeal dysphagia aims to screen, identify and diagnose patients at risk of dysphagia, and establish the dietary and therapeutic measures that ensure proper nutrition and hydration of patients under safe conditions. The diagnosis is based on the clinical examination of swallowing and on instrumental examinations such as videofluoroscopy and fibro-endoscopy. Therapeutic measures include compensatory and rehabilitative strategies (active manoeuvres, motor control exercises, neuromuscular electrostimulation and botulinum toxin treatment). Neurostimulation techniques include non-invasive central stimulation and intrapharyngeal electrical stimulation.
CONCLUSION
The prevalence of oropharyngeal dysphagia is high after a stroke. Diagnosis should include a clinical evaluation and an instrumental examination, and thus objectively indicate the treatment, which will include compensatory and restorative measures with which to reduce the associated morbidity and mortality.
Topics: Deglutition Disorders; Humans; Stroke
PubMed: 32500523
DOI: 10.33588/rn.7012.2019447 -
Mayo Clinic Proceedings Feb 2021Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative... (Review)
Review
Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient's history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.
Topics: Aged; Deglutition Disorders; Geriatric Assessment; Humans
PubMed: 33549267
DOI: 10.1016/j.mayocp.2020.08.001