Diagnostic approach to uninvestigated dysphagia canadian. Guidance for medication assessment in patients with swallowing dysphagia or feeding disorders pharmacy benefits managementstrategic healthcare group pbm june 2006 the purpose of this clinical guidance is to provide pharmacists in the va with the information needed to conduct a medication regimen assessment for a patient with. It is expected that some mixed textures are tolerated on this diet. Ethics and standards committee 2011 page 2 guidelines for assessment and management of patients with dysphagia introduction. National dysphagia diet levels summarizedfoods figure 3b. Continuum of care by the slp and related professionals stephen enwefa, ph. If you suspect a person may have dysphagia, contacting the individuals physician is. Caregivers guide to dysphagia in dementia national. An educational manual for the dysphagia screening professional in the longterm care setting.
Guidance for medication assessment in patients with. Functional dysphagia nonobstructive dysphagia the presence of dysphagia to solids, liquids or both in the absence of an obstructive lesion, gerd or a motility disorder with a recognized pathologic basis usually a diagnosis of exclusion cause unknown dekel. Approach to the patient with dysphagia or odynophagia yamadas. The main diagnostic tests to evaluate dysphagia include modified barium swallow, barium esophagram, endoscopy, and manometry. A rightsided approach was favored by surgeons and was used in 5 patients. This site is like a library, use search box in the widget to get ebook that you want. Dysphagia is a common condition that can have a signifi cant impact on patient quality of life and can be associated with significant complications such as aspiration pneumonia, weight loss, and. A systematic approach to dysphagia management generally ensures all relevant issues have been covered before treatment is recommended and leads to the best possible outcome. A multidisciplinary approach to esophageal dysphagia. Approximately 60,000 individuals are diagnosed with parkinsons each year. Swallowing difficulties are known to adversely affect all aspects of quality of life. The strongest predictive factor necessitating enteral feeding for patients undergoing chemotherapy for head and neck cancers is. The national dysphagia diet is 10 years old this year.
This is especially true given the emergence of eosinophilic. Screening results should not be used to plan intervention. Dysphagia should not be confused with globus sensation, a feeling of having a lump in the throat, which is unrelated to swallowing and occurs without impaired transport. Dysphagia is defined as an abnormal delay in the movement of a food bolus from the oropharynx to the stomach. Gi series, can cause dysphagia with solids upper gi series says normal does not mean endoscopy will be normal what to do until gi sees patient if patient has symptoms of gerd andor significant reflux is seen on upper gi series, a trial of ppi is reasonable tell patient to watch out for worsening dysphagia, weight loss. Physiology, assessment, and management pamela dodrill a memorie m. Introduction hand, it refers to a patients awareness of impaire swallowing is a complex function that affects the physical and mental health of all human beings. Standard guidance for food and liquid textures for individuals requiring modified texture diets doctors or other clinicians often prescribe a modified texture diet for individuals who have difficulty swallowing dysphagia or problems preparing their food for swallowing. Patients should be assessed for tolerance to mixed textures. As you swallow, imagine you have a golf ball stuck in your throat. Rehabilitation of swallowing rehabilitative approaches aim to change the underlying physiology of the swallow. The team approach to best practice is a 1hour online continuing education ce course that focuses on the interdisciplinary team approach to identifying, treating and managing dysphagia. The word dysphagia is derived from the greek phagia to. Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva.
Rinki varindani desai is an ashacertified medical speechlanguage pathologist and biaacertified brain injury specialist, specializing in the rehabilitation of cognitivelinguistic and swallowing. This does not include the thousands that go undetected. Differential diagnosis odynophagia oesophageal candidiasis caustic ingestion drugs doxycycline bisphosphonates anticholinergics dry mouth inflammatory systemic sclerosis sjogrens dry mouth structural benign oesophageal stricture crohns stricture diffuse oesophageal spasm plummervinson syndrome hiatus hernia post intubation neoplastic oesophageal cancer barrets oesophagus gastric. Esophageal dysphagia may also result in aspiration. Perspectives on swallowing and swallowing disorders dysphagia, 91, pp. People with dysphagia have dificulty swallowing and may even experience pain while swallowing odynophagia. Pharyngoesophageal considerations while it is the responsibility of appropriately trained physicians to evaluate and diagnosis esophageal stage dysphagia. Gosa b a feeding and swallowing program, department of otolaryngology, boston childrens hospital, boston, mass. The basics a large proportion of these cases are due to dysphagia arising from a variety of causes, primarily stroke, degenerative neurological diseases, and head and neck cancer. The role of endoscopy in the evaluation and management of. Esophageal dysphagia lumen distension upto 4 cm dysphagia is always present diseases affecting striated mm common to both oropharyngeal mm and cervical esophagus diseases affecting smooth mm involve thoracic eso and les dysphagia when peristalsis are weakabsent and failure of les relaxation. As with all health related information, the definitive source for clinical evaluation, current practices, and treatment of dysphagia is the individuals primary care physician. As a condition, swallowing difficultyor dysphagiahas been studied for decades.
It is ostensibly simple when defined by trouble swallowing, yet its subtleties in deciphering and its variations in. Esophageal dysphagia which is caused by a mechanical or. Definitions differential diagnosis history and examination investigation management of dysphagia further reading approach to dysphagia gastrointestinal emergencies wiley online library. Jan 19, 2015 three fundamental aims should be met when taking a dysphagia history i. In addition, the timing of treatments should be considered. The exact definition of dysphagia varies, but, in brief, dysphagia is difficulty with the act of swallowing solids or liquids. Definition of dysphagiadefinition of dysphagia the word dysphagia is derived from the greek phagia to eat and dys with difficulty. Approach to dysphagiaapproach to dysphagia fuad ridha mahabotfuad r slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. This text provides the reader with a comprehensive understanding of pediatric swallowing and presents a practical, evidencebased approach to the diagnosis and management of swallowing difficulties in children. Current approach to dysphagia anita gasiorowska, md, phd, and ronnie fass, md dr. Fifty percent of patients with this approach were hoarse, and 64% had dysphagia. Oropharyngeal dysphagia after anterior cervical spine. Approximately half of the dysphagia patients are seen in ent clinics.
Standard guidance for food and liquid textures for. Dysphagia is a common condition that can have a signifi cant impact on patient quality of life and can be associated with significant complications such as aspiration pneumonia, weight loss, and malnutrition. The basics dysphagia, or difficulty with swallowing, is a medical disorder that impacts as many as 15 million americans, with approximately one million people annually receiving a new diagnosis of the. Definition dysphagia is defined as having difficulty in swallowing which may affect any part of the swallowing pathway from the mouth to the stomach. Dysphagia assessment and treatment planninga team approach. Oropharyngeal dysphagia is typically due to difficulty initiating a. Fass is professor of internal medicine at the university of arizona in tucson, arizona.
The most serious complication of oropharyngeal dysphagia is tracheal aspiration, with development of cough, asthma, or pneumonia. Rosemary martino, ma, msc, phd speech language pathologist. Oesophageal rings tend to cause intermittent solid food dysphagia. Clinicians should be aware that oropharyngeal swallowing function is often altered in patients with esophageal motility disorders and dysphagia. The evaluation of dysphagia begins with a detailed history followed by endoscopy to evaluate for any structural abnormalities including malignancy. Abdel jalil aa, katzka da, castell do, approach to the patient with dysphagia, the american journal of medicine 2015, doi.
Oropharyngeal dysphagia is best evaluated by video. It may be subjective or objective and can refer to the sensation of not being able to swallow, food sticking or not passing, choking episodes, or aspiration of food and. For example, in patients with functional dysphagia, symptoms may reflect a feeling of the passage of a bolus through the esophagus, even with normal transit. Rather than a specific technique, mdtp is a framework from which to provide individualized therapy to adult patients. He is also head of the neuroenteric clinical research group and director of gi motility laboratories at the university of arizona health sciences center and southern arizona va.
Exercises to strengthen the tongue and throat pharynx. The length of acute care hospitalization, however, has decreased over time with many individuals weak and frail upon admission for rehabilitation and possibly with continued dysphagia upon discharge. These practice standards and guidelines apply to the delivery of services by a slp to any patient with dysphagia, regardless of age, gender, ethnicity, aetiology or the setting in which the service is provided. Acknowledgements the swallowing lab is grateful to the following professionals for their work in developing the management of dysphagia in stroke. It may be due to a structural or motility abnormality in the passage of solids or liquids from the oral cavity to the stomach. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow usually described as oropharyngeal dysphagia or to the sensation that foods and or liquids are somehow being obstructed in their passage from the mouth to the stomach usually described as esophageal dysphagia. Dysphagia affects more than 50 % of stroke survivors. This resource guides students through a focused history and physical examination that is specific to the presenting complaint of dysphagia. Approach to the patient with dysphagia or odynophagia. Aspiration getting food or liquid into the airway pneumonia infection in the lungs malnutrition dehydration discomfort what causes dysphagia. A woman in her 70s presented with a 10month history of globus pharyngeus, intermittent dysphagia, odynophagia, and unintentional weight loss and was diagnosed with a pyriform schwannoma. Swallowing is a behaviour that healthy individuals carry out effortlessly more than times per day 1. If the individuals swallowing safety and efficiency cannot reach a level of adequate function, or if swallow function does not support nutrition and hydration adequately, the swallowing and feeding team may recommend alternative avenues of intake e. It may be subjective or objective and can refer to the sensation of not being able to swallow, food sticking or not passing, choking episodes, or aspiration of food andor liquids.
Esophageal dilation is a therapeutic procedure performed for the management of dysphagia. An estimated 710 million individuals worldwide are living with parkinsons. Dysphagia is a wide spread problem in the elderly, with many going untreated. It highlights particular clinical challenges and controversies in the management of pediatric dysphagia. Smith, md, mba, chief of gastroenterology and hepatology, mount sinai west and mount sinai st. Approach to dysphagia gastrointestinal emergencies.
If you have any questions or concerns, please contact your speech and language therapist or gp. Dysphagia is an alarm symptom that warrants prompt evaluation to define the exact cause and initiate appropriate therapy. Gi series, can cause dysphagia with solids upper gi series says normal does not mean endoscopy will be normal what to do until gi sees patient if patient has symptoms of gerd andor significant reflux is seen on upper gi series, a trial of ppi is reasonable tell patient to watch out for worsening dysphagia. One in 17 people will develop some form of dysphagia in their lifetime, including 50 to. Exercise based therapy for the treatment of dysphagia. This book offers a concise, readable explanation of the theory of dysphagia and bridges that with material on clinical application. Screening does not provide a detailed description of the patients swallow function but, rather, identifies individuals who are likely to have swallowing impairments related to function, activity, andor participation as defined.
Dysphagia ground includes all foods on ndd level 1. Jul 30, 2012 dysphagia affects up to 68% of elderly nursing home residents,7 up to 30% of elderly admitted to the hospital,8 up to 64% of patients after stroke,9,10 and %38% of elderly who live independently. Assessment effective treatment of dysphagia is reliant on accurate diagnosis, whether the treatment is compensatory or rehabilitative in nature. Pdf contemporary approaches to dysphagia management. Dysphagia swallowing problems this leaflet provides information about swallowing problems, also known as dysphagia, as well as the causes and the signs you should look out for. One study reported that 80 % of patients with prolonged dysphagia required alternative means of enteral feeding. Management of dysphagia in acute stroke uhnresearch. No doubt, as long as man has walked the earth, someone somewherehas experienced difficulty in swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach. An educational manual for the dysphagia screening professional. It may be due to a structural or motility abnormality in the passage of solids or.
Summary dysphagia is differentiated from odynophagia and globus sensation. Screening for dysphagia may be conducted by a speechlanguage pathologist or other member of the patients care team. The world gastroenterology organisation wgo guidelines provide a resourcesensitive approach in the form of diagnostic and treatment cascades. It specifically refers to the sensation of food being hindered in its normal passage from the mouth to the stomach. Management of dysphagia in acute stroke acknowledgements the heart and stroke foundation of ontario is grateful to the following professionals for their work in developing the management of dysphagia in acute stroke. The unique value of this book is the multidisciplinary approach it presents. Manual of dysphagia assessment in adults dysphagia series.
Pdf dysphagia is a common condition that can have a signifi cant impact on patient quality of life and can be associated with significant. Not only does eating provide nutrients, but it also serves as important role in social interaction. Approach to the patient with dysphagia request pdf. This is a pdf file of an unedited manuscript that has been accepted for publication. Fortunately, the majority of these patients recover swallowing function within 7 days, and only 11 % remain dysphagic after 6 months 3, 4. Dysphagia pureed in addition to the foods listed below food groups recommended avoid if thin liquids allowed. Improves the function of the larynx and strength of the esophageal opening. Dysphagia management in stroke rehabilitation pdf paperity. A team approach, fourth edition is ideal for graduate dysphagia courses in speechlanguage pathology programs. Management of dysphagia in stroke the swallowing lab. The role of endoscopy in the evaluation of dysphagia endoscopy is indicated in patients with dysphagia to determine the underlying etiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy, such as dilation. Since mucosal lesions are common, endoscopy is the procedure of choice for odynophagia. Medical skills in a clinical presentationbased curriculum.
A wgo cascade is a hierarchical set of diagnostic, therapeutic, and management. The side of approach to the cervical spine was ascertained in the study group, and the side of approach was evaluated with respect to symptoms. Mar, 2018 a division of gastroenterology grand rounds presented by michael s. Click download or read online button to get dysphagia book now. Approach to dysphagiaapproach to dysphagia fuad ridha mahabotfuad r. Squeeze as hard as you can with your throat muscles. Dysphagia evaluation and management in otolaryngology. Manual of dysphagia assessment in adults dysphagia series murray, joseph on. Covering both adult and paediatric swallowing assessment, treatment and management, the book will provide clinicians with common clinical presentations of dysphagia and a framework for a problem based learning approach. The practice portal, asha policy documents, and guidelines contain information for use in all settings.
Dysphagia is usually classified as orophayngeal dysphagia which produced by an abnormality in the preparation or transfer of food from mouth to upper esophagus, this may occur as a result of poor motor control of the toung, jaw or other oral structures or maybe due to abnormalities in swallowing reflex. Assessment of dysphagia approach bmj best practice. A complaint of dysphagia suggests difficulty in swallowing and is characterized based on the symptoms and location of pathology. With patience and careful questioning, a multitude of various disorders may be suggested before an objective test is. It is ostensibly simple when defined by trouble swallowing, yet its subtleties in deciphering and its variations in pathophysiology almost mandate a thorough knowledge of medicine itself. Mdtp is a systematic exercisebased approach to dysphagia therapy in adults. Caregivers guide to dysphagia in dementia published 07. Dysphonia and dysphagia following the anterior approach to. There are many reasons the muscles in the mouth or throat may not work properly for swallowing.