The Diagnosis, Implications, and Treatment for Dysphagia

What is dysphagia?

Etymologically speaking, dysphagia means “disordered eating”. It’s a symptom that refers to difficulty or discomfort involving the formation or movement of alimentary bolus–or rounded balls of food–from the mouth to the stomach. 

Depending on the moment in the process where the anomaly takes place, there are two types of dysphagia:

• Oropharyngeal dysphagia: this type of dysphagia affects the upper phase of swallowing.
• Esophageal dysphagia: in this case, the esophagus is involved.

This condition is quite prevalent, especially in patients with neurological diseases, such as Parkinson’s and Alzheimer’s. It’s also prevalent in elderly persons nursing homes, people with brain cancer, and children with neurological diseases, such as cerebral palsy.

Diagnosis and treatment for dysphagia

There are several diagnostic algorithms, depending on the medical center. However, all of them have one thing in common: diagnosis should be based on both clinical and complementary methods.

In order to diagnose dysphagia, doctors will need to conduct a holistic evaluation, starting with an individual’s clinical history. In this sense, the most commonly used test is the Eating Assessment Tool (EAT-10). The test consists of ten questions that a patient may or may not fulfill.

Once the clinical history is prepared, then it’ll be time for clinical exploration. Most often, doctors conduct a swallow study in order to evaluate the effectiveness of the patient’s swallowing. The study involves the progressive oral administration of different volumes and textures. Depending on the individual’s tolerance, the medical professional will establish if the dysphagia affects the passage of liquids, solids, or both.

In order to confirm or rule out the presence of dysphagia, several complementary methods exist. For example, the barium swallow test is the gold standard technique, meaning it’s the most precise and effective. It’s a radiological technique that evaluates dysphagia after a patient ingests a barium-containing liquid.

The nutritional implications of dysphagia

There are several nutritional implications of dysphagia, which include malnutrition, dehydration, and pneumonia from aspiration. This last implication is the leading cause of death in individuals with dysphagia. Therefore, it requires special attention.

Treatment for dysphagia

The treatment for dysphagia should involve postural, medical, and nutritional measures. Therefore, an interdisciplinary team will be responsible for establishing the right course of treatment.

Rehabilitative treatment: treatment for dysphagia

Some types of rehabilitative treatments for dysphagia include:

• Postural strategies: type B evidence shows that inclining the head forward once the food is ingested encourages the passing of alimentary bolus through the digestive tract.
• Mechanical stimulation of the tongue or modifications in the temperature and volume of foods may also be part of rehabilitative treatment. However, there’s little evidence to support its success.
• The Shaker maneuver is one of the strategies with the greatest prognostic success.
• In patients who don’t have cognitive difficulties and are able to cooperate, specific swallowing maneuvers may also be effective.
• The most recent technique is transcutaneous electrostimulation. However, further research is necessary in order to evaluate its effectiveness.

The nutritional treatment for dysphagia

The modification of the volume and viscosity of alimentary bolus is the treatment of choice for many of these patients. This is because it has the highest level of supportive evidence. However, a lack of standardization in the formulation of these volumes and textures constitutes a problem.

In this context, The Internacional Dysphagia Diet Standardisation Initiative —IDDSI— appeared. Its objective is unifying and creating a system of easily reproducible viscosities that are valid throughout the world.

General recommendations for people with dysphagia

One of the first recommendations is for patients with dysphagia to eat calmly and without distractions. This way, they can pay full attention to the process of eating. A good strategy for improving adherence is to fraction ingestion. In other words, eating more times per day, in lesser volumes. These volumes should be adapted to the results of the barium test in order to minimize choking.

Maintaining proper hydration can be complicated in these patients because they often dislike water with thickeners. Natural peach juice is a good option for those who can tolerate this nectar type texture.

It’s also important to avoid mixed textures and always look for homogeneity. Therefore, it’s best to avoid soups as well as fruits such as oranges, as they have a double texture. When it comes to the temperature of foods, evidence suggests that patients have less difficulty swallowing hot and cold foods than lukewarm foods.

As we’ve mentioned, the treatment for dysphagia needs to be multidisciplinary. In this sense, patients need to maintain good oral hygiene and incorporate postural measures such as eating in an upright position and lying down once they have ingested their food.