Dysphagia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
The main objective of treating dysphagia is to avoid aspiration of the food and bolus impaction, reduce the morbidity associated with ongoing symptoms. Effective medical management begins with early identification of the underlying cause with a detailed history, physical examination and, judicious use of investigations. Several postural techniques and swallowing maneuvers are used to help the patient swallow the food bolus. Other management options are dietary modification, environmental modification, feeding tubes and oral prosthetic devices. Medications that can worsen dysphagia should be avoided. Botulinum toxin injection can be used in the treatment of hypercontractile disorders of esophagus.
Medical Therapy of Dysphagia
Medical treatment:
The medical treatment of dysphagia is as follows:[1][2][3]
- Supportive care
- Treat the underlying disorder.
- Postural techniques
- Swallowing maneuvers that facilitate strengthening of the swallowing muscles.
- Dietary modification
- Medications known to cause or worsen dysphagia (potassium tablets, doxycycline,NSAIDs, bisphosphonates) should be avoided.
- After assessment, a Speech Language Pathologist will determine the safety of the patient's swallow and recommend treatment accordingly.
- Boltulinum toxin injection is employed for the use of hypercontractile disorders of the esophagus such as achalasia.
Postural Techniques
Each specific postural technique has a particular effect on the flow food and coordination of oropharyngeal structures. They provide compensation for the specific defects in oropharyngeal swallow. The following postural techniques and other postural combinations are used to prevent the complications of dysphagia:[4][5][6]
- Chin down (flexion): This technique is used in patients who have difficulty initiating the swallow.
- It allows the oropharyngeal passage to become wider and narrows the airway to prevent aspiration.
- Head turned (extension):
- This posture employs the use of gravity to help move the food from the front of the mouth to the back.
- Head tilted (turning head to look over shoulder):
- In this technique the head is turned to the damaged or weaker side with chin down.
- Lying down on one side:
- This technique is used when there is weakness of the pharyngeal muscles and causes the residue to be aspirated.
The following video demonstrate the postural techniques:{{#ev:youtube|H4S1Afq4fps}}
Swallowing Maneuvers
The following maneuvers are used to manage dysphagia:
- Supraglottic swallow:
- Super-supraglottic swallow:
- Mendelsohn maneuver:
- The maneuver is used when there is discoordination in swallowing.
- The patient is taught to hold their adam's apple up during the swallow.
Video
The following video helps demonstrate the mendelsohn maneuver used in the management of dysphagia. {{#ev:youtube|XbKVZN7yJSI}}
Dietary Modification:
- Dietary modification, such as thickened liquid diet are commonly used for the prevention of aspiration in oropharyngeal dysphagia.[7][8][9]
Environmental modification:
- Environmental modification can be suggested to assist and reduce risk factors for aspiration.
For example:
- Using a straw while drinking liquids.
- Putting a pillow behind the patient's head during feeding.
Feeding tubes
Feeding tubes can be used to provide nutrition to the patient while they are recovering their ability to swallow. Following feeding tube can be used:
- Nasogastric tube
- Percutaneous endoscopic gastrostomy tube
Complications:
- Infection
- Internal bleeding
Prosthetics
- Palatal lift or obturator
- Maxillary denture
Swallowing Rehabilitation in the elderly
Elderly patients benefit from swallowing rehabilitation programs regardless of the fact that underlying cause is treatable or not.[10][11]
References
- ↑ Lind CD (2003). "Dysphagia: evaluation and treatment". Gastroenterol Clin North Am. 32 (2): 553–75. PMID 12858606.
- ↑ Saito K (1995). "[Temporal and spatial pattern analysis of pharyngeal swallowing in patients with abnormal sensation in the throat]". Nihon Jibiinkoka Gakkai Kaiho. 98 (7): 1154–63. PMID 7562237.
- ↑ Hamdy S, Jilani S, Price V, Parker C, Hall N, Power M (2003). "Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury". Neurogastroenterol Motil. 15 (1): 69–77. PMID 12588471.
- ↑ Kahrilas PJ, Logemann JA, Gibbons P (1992). "Food intake by maneuver; an extreme compensation for impaired swallowing". Dysphagia. 7 (3): 155–9. PMID 1499358.
- ↑ Newman R, Vilardell N, Clavé P, Speyer R (2016). "Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD)". Dysphagia. 31 (2): 232–49. doi:10.1007/s00455-016-9696-8. PMC 4929168. PMID 27016216.
- ↑ Groher ME, McKaig TN (1995). "Dysphagia and dietary levels in skilled nursing facilities". J Am Geriatr Soc. 43 (5): 528–32. PMID 7730535.
- ↑ Castellanos VH, Butler E, Gluch L, Burke B (2004). "Use of thickened liquids in skilled nursing facilities". J Am Diet Assoc. 104 (8): 1222–6. doi:10.1016/j.jada.2004.05.203. PMID 15281038.
- ↑ Kotecki S, Schmidt R (2010). "Cost and effectiveness analysis using nursing staff-prepared thickened liquids vs. commercially thickened liquids in stroke patients with dysphagia". Nurs Econ. 28 (2): 106–9, 113. PMID 20446381.
- ↑ Malandraki, Georgia; Robbins, Joanne (2013). "Dysphagia". 110: 255–271. doi:10.1016/B978-0-444-52901-5.00021-6. ISSN 0072-9752.
- ↑ Khan, Abraham; Carmona, Richard; Traube, Morris (2014). "Dysphagia in the Elderly". Clinics in Geriatric Medicine. 30 (1): 43–53. doi:10.1016/j.cger.2013.10.009. ISSN 0749-0690.