Dysphagia disrupts swallowing that affects patient’s ability to eat.
Dysphagia denotes difficulty in eating due to disruptions in the swallowing process.
It is secondary in any 3 phases of swallowing as follows:
Oral phase
Pharyngeal phase
Esophageal phase
Dysphagia differs from disorders obstructing food transfer without causing actual difficulty in swallowing.
Feeding disorder and gastric outlet obstruction involves challenges in food intake and passage respectively are not classified as types of dysphagia.
Recent advances in dysphagia treatment enhance management options and tests for swallowing disorders and related malnutrition.
Successful oral feeding and growth in infants and children rely on functional deglutition and a variety of neurodevelopmental skills and behaviours.
Children with cerebral palsy handle solid boluses better than liquids and small liquids better than large liquids.
Epidemiology
Neurologic swallowing disorders are common in rehabilitation medicine practice. Stroke causes neurologic dysphagia in 51-73% of affected patients.
Dysphagia delays recovery in stroke patients and significantly increases pneumonia risk in this population.
US Medicare data reveals higher post-stroke dysphagia rates in Asians and minorities compared to whites indicates racial disparities in its development.
90% of children faced chewing issues and 43% had swallowing problems, while 33.3% struggled with both.
Anatomy
Pathophysiology
Penetration denotes the active entry of food into the trachea including bolus entry into the laryngeal vestibule.
Aspiration refers to food entering the trachea passively but is used to describe any bolus entry into the trachea.
Cognitive deficits can impair swallowing initiation to increase food pocketing and risk of aspiration in individuals.
Small food amounts are retained in valleculae or pyriform sinus post-swallowing.
Impaired esophageal function can cause food and liquid retention post-swallowing due to mechanical obstruction, motility disorders, or lower esophageal sphincter issues.
Etiology
The causes of Dysphagia are:
Central nervous system disorders
Muscular disorders
Neuropathic disorders
Endocrine disorders
Surgical causes
Genetics
Prognostic Factors
Stroke patients gradually recover swallowing function with therapy.
A study of 128 acute stroke patients found swallowing abnormalities in 51% clinically and 64% via videofluoroscopy.
Recovery and normalization of swallowing may take 3 weeks to 6 months or longer.
After nine months post-stroke, some patients may need partial or nonoral calorie support.
Post-stroke swallowing dysfunction after 6 months raises morbidity and mortality risks.
Clinical History
Clinical History:
Collect details including the chief complaint, specific food triggers, nature of dysphagia, and medical history to understand clinical history of patients.
Physical Examination
Head and Neck Examination
Neurological Examination
Respiratory Examination
Gastrointestinal Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Sudden difficulty swallowing, often with facial droop, slurred speech, sudden inability to swallow, choking sensation, stridor, drooling
Chronic symptoms are:
Progressive dysphagia for solids, weight loss, night sweats, slowly progressive difficulty swallowing both solids and liquids, chronic heartburn
Differential Diagnoses
Achalasia
Dermatomyositis
Myasthenia Gravis
Pediatric Poliomyelitis
Polymyositis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Dysphagia treatment aims for nutritional intake and airway protection maximization.
Oral and pharyngeal swallowing disorders may treat with rehabilitation and techniques.
Surgery for swallowing disorders is uncommon, but severe cases may require bypassing the oral cavity for enteral nutrition.
Multiple treatments for oropharyngeal dysphagia in adults include direct and indirect strategies.
Frustration over inconsistent food textures and nomenclature prompted a task force to create a new diet grounded in scientific properties and clinical swallowing challenges.
Botulinum toxin type A is injected into the gastroesophageal sphincter to alleviate cricopharyngeal spasms and dysphagia.
Cystine-depleting therapy with cysteamine effective for dysphagia in cystinosis.
Patients facing oral preparatory swallowing issues, food pocketing, or severe pharyngeal retention of solids are advised to consume pureed foods.
Food texture refers to physical properties from food structure that can be sensed by touch.
Malnutrition increases pneumonia risk by causing oropharyngeal microbial changes and weakening the immune system.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-non-pharmacological-approach-for-dysphagia
Manage quiet and distraction-free setting that reduces the risk of choking of the patient to focus on swallowing.
Proper seating and posture should be done sit upright during meals and remain seated for at least 30 to 60 minutes after eating.
Create supportive and positive mealtime environment to improve their quality of life.
Proper awareness about dysphagia should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Use of Histamine H2 Antagonists
Cimetidine:
It inhibits histamine at H2 receptors of gastric parietal cells to reduced gastric acid secretion.
Ranitidine:
It blocks H2 receptors of gastric parietal cells to inhibit gastric secretions.
Use of Proton Pump Inhibitors
Omeprazole:
It inhibits the parietal cell H+/K+-adenosine triphosphate pump at the secretory surface of gastric parietal cells.
Pantoprazole:
It binds to H+/K+-exchanging ATPase in gastric parietal cells to result in blockage of acid secretion.
Surgical procedures include myotomy and cricopharyngeal myotomy.
Endoscopic procedures include esophageal dilation and botulinum toxin injections.
use-of-phases-in-managing-dysphagia
In the acute phase, the goal is to identify the underlying cause of dysphagia.
Pharmacologic therapy is effective in the treatment phase as it includes the use of histamine H2 Antagonists and proton pump inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Dysphagia disrupts swallowing that affects patient’s ability to eat.
Dysphagia denotes difficulty in eating due to disruptions in the swallowing process.
It is secondary in any 3 phases of swallowing as follows:
Oral phase
Pharyngeal phase
Esophageal phase
Dysphagia differs from disorders obstructing food transfer without causing actual difficulty in swallowing.
Feeding disorder and gastric outlet obstruction involves challenges in food intake and passage respectively are not classified as types of dysphagia.
Recent advances in dysphagia treatment enhance management options and tests for swallowing disorders and related malnutrition.
Successful oral feeding and growth in infants and children rely on functional deglutition and a variety of neurodevelopmental skills and behaviours.
Children with cerebral palsy handle solid boluses better than liquids and small liquids better than large liquids.
Neurologic swallowing disorders are common in rehabilitation medicine practice. Stroke causes neurologic dysphagia in 51-73% of affected patients.
Dysphagia delays recovery in stroke patients and significantly increases pneumonia risk in this population.
US Medicare data reveals higher post-stroke dysphagia rates in Asians and minorities compared to whites indicates racial disparities in its development.
90% of children faced chewing issues and 43% had swallowing problems, while 33.3% struggled with both.
Penetration denotes the active entry of food into the trachea including bolus entry into the laryngeal vestibule.
Aspiration refers to food entering the trachea passively but is used to describe any bolus entry into the trachea.
Cognitive deficits can impair swallowing initiation to increase food pocketing and risk of aspiration in individuals.
Small food amounts are retained in valleculae or pyriform sinus post-swallowing.
Impaired esophageal function can cause food and liquid retention post-swallowing due to mechanical obstruction, motility disorders, or lower esophageal sphincter issues.
The causes of Dysphagia are:
Central nervous system disorders
Muscular disorders
Neuropathic disorders
Endocrine disorders
Surgical causes
Stroke patients gradually recover swallowing function with therapy.
A study of 128 acute stroke patients found swallowing abnormalities in 51% clinically and 64% via videofluoroscopy.
Recovery and normalization of swallowing may take 3 weeks to 6 months or longer.
After nine months post-stroke, some patients may need partial or nonoral calorie support.
Post-stroke swallowing dysfunction after 6 months raises morbidity and mortality risks.
Clinical History:
Collect details including the chief complaint, specific food triggers, nature of dysphagia, and medical history to understand clinical history of patients.
Head and Neck Examination
Neurological Examination
Respiratory Examination
Gastrointestinal Examination
Acute symptoms are:
Sudden difficulty swallowing, often with facial droop, slurred speech, sudden inability to swallow, choking sensation, stridor, drooling
Chronic symptoms are:
Progressive dysphagia for solids, weight loss, night sweats, slowly progressive difficulty swallowing both solids and liquids, chronic heartburn
Achalasia
Dermatomyositis
Myasthenia Gravis
Pediatric Poliomyelitis
Polymyositis
Dysphagia treatment aims for nutritional intake and airway protection maximization.
Oral and pharyngeal swallowing disorders may treat with rehabilitation and techniques.
Surgery for swallowing disorders is uncommon, but severe cases may require bypassing the oral cavity for enteral nutrition.
Multiple treatments for oropharyngeal dysphagia in adults include direct and indirect strategies.
Frustration over inconsistent food textures and nomenclature prompted a task force to create a new diet grounded in scientific properties and clinical swallowing challenges.
Botulinum toxin type A is injected into the gastroesophageal sphincter to alleviate cricopharyngeal spasms and dysphagia.
Cystine-depleting therapy with cysteamine effective for dysphagia in cystinosis.
Patients facing oral preparatory swallowing issues, food pocketing, or severe pharyngeal retention of solids are advised to consume pureed foods.
Food texture refers to physical properties from food structure that can be sensed by touch.
Malnutrition increases pneumonia risk by causing oropharyngeal microbial changes and weakening the immune system.
Physical Medicine and Rehabilitation
Manage quiet and distraction-free setting that reduces the risk of choking of the patient to focus on swallowing.
Proper seating and posture should be done sit upright during meals and remain seated for at least 30 to 60 minutes after eating.
Create supportive and positive mealtime environment to improve their quality of life.
Proper awareness about dysphagia should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Cimetidine:
It inhibits histamine at H2 receptors of gastric parietal cells to reduced gastric acid secretion.
Ranitidine:
It blocks H2 receptors of gastric parietal cells to inhibit gastric secretions.
Physical Medicine and Rehabilitation
Omeprazole:
It inhibits the parietal cell H+/K+-adenosine triphosphate pump at the secretory surface of gastric parietal cells.
Pantoprazole:
It binds to H+/K+-exchanging ATPase in gastric parietal cells to result in blockage of acid secretion.
Physical Medicine and Rehabilitation
Surgical procedures include myotomy and cricopharyngeal myotomy.
Endoscopic procedures include esophageal dilation and botulinum toxin injections.
Physical Medicine and Rehabilitation
In the acute phase, the goal is to identify the underlying cause of dysphagia.
Pharmacologic therapy is effective in the treatment phase as it includes the use of histamine H2 Antagonists and proton pump inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Dysphagia disrupts swallowing that affects patient’s ability to eat.
Dysphagia denotes difficulty in eating due to disruptions in the swallowing process.
It is secondary in any 3 phases of swallowing as follows:
Oral phase
Pharyngeal phase
Esophageal phase
Dysphagia differs from disorders obstructing food transfer without causing actual difficulty in swallowing.
Feeding disorder and gastric outlet obstruction involves challenges in food intake and passage respectively are not classified as types of dysphagia.
Recent advances in dysphagia treatment enhance management options and tests for swallowing disorders and related malnutrition.
Successful oral feeding and growth in infants and children rely on functional deglutition and a variety of neurodevelopmental skills and behaviours.
Children with cerebral palsy handle solid boluses better than liquids and small liquids better than large liquids.
Neurologic swallowing disorders are common in rehabilitation medicine practice. Stroke causes neurologic dysphagia in 51-73% of affected patients.
Dysphagia delays recovery in stroke patients and significantly increases pneumonia risk in this population.
US Medicare data reveals higher post-stroke dysphagia rates in Asians and minorities compared to whites indicates racial disparities in its development.
90% of children faced chewing issues and 43% had swallowing problems, while 33.3% struggled with both.
Penetration denotes the active entry of food into the trachea including bolus entry into the laryngeal vestibule.
Aspiration refers to food entering the trachea passively but is used to describe any bolus entry into the trachea.
Cognitive deficits can impair swallowing initiation to increase food pocketing and risk of aspiration in individuals.
Small food amounts are retained in valleculae or pyriform sinus post-swallowing.
Impaired esophageal function can cause food and liquid retention post-swallowing due to mechanical obstruction, motility disorders, or lower esophageal sphincter issues.
The causes of Dysphagia are:
Central nervous system disorders
Muscular disorders
Neuropathic disorders
Endocrine disorders
Surgical causes
Stroke patients gradually recover swallowing function with therapy.
A study of 128 acute stroke patients found swallowing abnormalities in 51% clinically and 64% via videofluoroscopy.
Recovery and normalization of swallowing may take 3 weeks to 6 months or longer.
After nine months post-stroke, some patients may need partial or nonoral calorie support.
Post-stroke swallowing dysfunction after 6 months raises morbidity and mortality risks.
Clinical History:
Collect details including the chief complaint, specific food triggers, nature of dysphagia, and medical history to understand clinical history of patients.
Head and Neck Examination
Neurological Examination
Respiratory Examination
Gastrointestinal Examination
Acute symptoms are:
Sudden difficulty swallowing, often with facial droop, slurred speech, sudden inability to swallow, choking sensation, stridor, drooling
Chronic symptoms are:
Progressive dysphagia for solids, weight loss, night sweats, slowly progressive difficulty swallowing both solids and liquids, chronic heartburn
Achalasia
Dermatomyositis
Myasthenia Gravis
Pediatric Poliomyelitis
Polymyositis
Dysphagia treatment aims for nutritional intake and airway protection maximization.
Oral and pharyngeal swallowing disorders may treat with rehabilitation and techniques.
Surgery for swallowing disorders is uncommon, but severe cases may require bypassing the oral cavity for enteral nutrition.
Multiple treatments for oropharyngeal dysphagia in adults include direct and indirect strategies.
Frustration over inconsistent food textures and nomenclature prompted a task force to create a new diet grounded in scientific properties and clinical swallowing challenges.
Botulinum toxin type A is injected into the gastroesophageal sphincter to alleviate cricopharyngeal spasms and dysphagia.
Cystine-depleting therapy with cysteamine effective for dysphagia in cystinosis.
Patients facing oral preparatory swallowing issues, food pocketing, or severe pharyngeal retention of solids are advised to consume pureed foods.
Food texture refers to physical properties from food structure that can be sensed by touch.
Malnutrition increases pneumonia risk by causing oropharyngeal microbial changes and weakening the immune system.
Physical Medicine and Rehabilitation
Manage quiet and distraction-free setting that reduces the risk of choking of the patient to focus on swallowing.
Proper seating and posture should be done sit upright during meals and remain seated for at least 30 to 60 minutes after eating.
Create supportive and positive mealtime environment to improve their quality of life.
Proper awareness about dysphagia should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Cimetidine:
It inhibits histamine at H2 receptors of gastric parietal cells to reduced gastric acid secretion.
Ranitidine:
It blocks H2 receptors of gastric parietal cells to inhibit gastric secretions.
Physical Medicine and Rehabilitation
Omeprazole:
It inhibits the parietal cell H+/K+-adenosine triphosphate pump at the secretory surface of gastric parietal cells.
Pantoprazole:
It binds to H+/K+-exchanging ATPase in gastric parietal cells to result in blockage of acid secretion.
Physical Medicine and Rehabilitation
Surgical procedures include myotomy and cricopharyngeal myotomy.
Endoscopic procedures include esophageal dilation and botulinum toxin injections.
Physical Medicine and Rehabilitation
In the acute phase, the goal is to identify the underlying cause of dysphagia.
Pharmacologic therapy is effective in the treatment phase as it includes the use of histamine H2 Antagonists and proton pump inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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