Dysphagia may be treated by various specialties or ideally by a multispecialty team. The clinical and radiological approach to dysphagia request pdf. 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. Perspectives on swallowing and swallowing disorders dysphagia, 91, pp. Oropharyngeal dysphagia is best evaluated by video. Exploration and approach to artificial airway dysphagia. Brief clinical consult approach to dysphagia approach to dysphagia jenweiying 20180t16. It is the sensation of hesitation or delay in passage of food during swallowing.
August september 2012 exploration and approach to artificial airway dysphagia issn. Dysphagia is defined as an abnormal delay in the movement of a food bolus from the oropharynx to the stomach. The intention of this chapter is to introduce a multidisciplinary diagnostic workup, and, in particular, to present a practical and structured radiological approach to patients with dysphagia. An expanded approach to clinical practice in dysphagia. The world gastroenterology organisation wgo guidelines provide a resourcesensitive approach in the form of diagnostic and treatment cascades. Management of dysphagia dysphagia, or swallowing difficulties, is a prevalent disorder associated with certain neurological, obstructive and muscular conditions. A gold standard approach is only feasible if the full range of diagnostic tests and medical treatment options are available. 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. Mcneill dysphagia therapy program 10 years of research. Current approach to dysphagia article pdf available in gastroenterology and hepatology 54 april 2009 with 4,470 reads how we measure reads. Request pdf the clinical and radiological approach to dysphagia the intention of this chapter is to introduce a multidisciplinary diagnostic workup, and, in particular, to present a practical. Clues to the cause of dysphagia might include poor dentition, buccal lesions such as lichen planus, tongue fasciculations, asymmetric palate elevation and labial droop. They may lead to hemodynamic compromise and luminal narrowing. Approach to the evaluation of dysphagia in adults uptodate.
Table 2 most common causes of esophageal dysphagia. The word dysphagia is derived from the greek phagia to. Jul 15, 2019 compensatory techniques are used to alter the swallow, however compensations may not create a lasting effect to the swallow. Pdf current approach to dysphagia ronnie fass academia. The process of swallowing food consists of 2 stages. Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. Approach of dysphagia oropharyngeal dysphagia solids and liquids suggest. It is ostensibly simple when defined by trouble swallowing, yet its subtleties in deciphering and its variations in. Dysphagia from the greek, difficulty swallowing refers to two related, but distinct. Aug 30, 20 the causes of oropharyngeal dysphagia after acss are multifactorial and involve neuronal, muscular, and mucosal structures. Home a guide to the mrcp paces examination station 5. Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. Dysphagia evaluation and management in otolaryngology. In the gastroenterological diagnostic armamentarium, dysphagia is considered as an important symptom for diseases of the esophagus.
Dysphagia in greek dys with difficulty phagia to eat. Assessment of dysphagia approach bmj best practice. Abdel jalil aa, katzka da, castell do, approach to the patient with dysphagia, the american journal of medicine 2015, doi. Approach to the patient with dysphagia loyola medicine. Dysphagia is an alarm symptom that warrants prompt evaluation to define the exact cause and initiate appropriate therapy. Lembo a, cremonini f lembo, anthony, and filippo cremonini chapter 35.
Objectives anatomy of pharynx and esophagus physiology of swallowing types of dysphagia causes of dysphagia approach to dysphagia management 3. Pdf dysphagia is a common condition that can have a signifi cant impact on patient quality of life and can be associated with significant. Esophageal dysphagia which is caused by a mechanical or. Compensatory strategies may be short term or used more longterm, such as with patients with head and neck cancer. Current approach to dysphagia ronnie fass, md professor of medicine case western reserve university. Not only does eating provide nutrients, but it also serves as important role in social interaction. Approach to the patient with dysphagia sciencedirect. 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. Too often, speechlanguage pathologists function clinically with insufficient interaction with, or understanding. Apr 01, 2000 dysphagia assessment and treatment planninga team approach. Approach to dysphagiaapproach to dysphagia fuad ridha mahabotfuad ridha mahabot 1. Assessment of dysphagia differential diagnosis of symptoms.
The exact definition of dysphagia varies, but, in brief, dysphagia is difficulty with the act of swallowing solids or liquids. Jun 18, 2017 dysphagia surgery causes, types and approach 1. Dysphagia is a wide spread problem in the elderly, with many going untreated. There are two types of dysphagia, oropharyngeal and esophageal dysphagia, which are usually the result of either structural or motility disorders. Castell, mda aesophageal disorders program, division of gastroenterology and hepatology, medical university of south carolina, charleston. Approach to dysphagia standard treatment guidelines. Dysphagia due to a diaphragmlike localized narrowing in the lower esophagus lower esophageal ring. Approach to the patient with dysphagia or odynophagia. Morphological changes of the mucosa can be diagnosed by flexible endoscopy and radiographic examinations.
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 multidisciplinary approach to esophageal dysphagia. We report a 39yearold native american female with an almost 20year history of dysphagia that had increased in the 6 months prior to the initial evaluation. Investigation revealed a number of distinct esophageal disorders including plummervinson syndrome, gastroesophageal reflux disease with esophagitis, distal esophageal stricture, esophageal intramural pseudodiverticulosis, and. This is an excellent addition to the book, one that provides both practical and databased evidence for assessing and treating dysphagia in infants and children. Jan 19, 2015 approach to dysphagiaapproach to dysphagia fuad ridha mahabotfuad r slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Concerning the history of illness, symptoms such as retrosternal pain and heartburn are often associated with gastroesophageal reflux disease. Our applied research over the past 10 years has shown consistent functional benefit to most but not all patients with long standing, severe swallowing problems. Oropharyngeal dysphagia after anterior cervical spine. Assessment occurs across seven different areas of human function involved in the process of learning to eat.
A neck exam may be helpful if a mass or adenopathy is detected, such as a virchows node associated with esophageal cancer. Dysphagia was present in 60% of study group patients vs 23% of control group patients p approach to the cervical spine. Smith, md, mba, chief of gastroenterology and hepatology, mount sinai west and mount sina. The unique value of this book is the multidisciplinary approach it presents.
The clinical and radiological approach to dysphagia. Approach to the patient with dysphagia american journal of. The gastroenterologists approach to dysphagia springerlink. 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. Based on location, the esophagus is subject to external compression by surrounding structures within the mediastinum. A modified extrathoracic approach to treatment of dysphagia lusoria the r. Dysphagia assessment and treatment planninga team approach. A personalized assessment approach allows for individualized consideration of the risks and benefits of the proposed treatment approach and the expected course of dysphagia if no intervention is offered. A wgo cascade is a hierarchical set of diagnostic, therapeutic, and management. An evidencebased approach to differential diagnosis henderson mc, tierney lm, jr.
A team approach, fourth edition is ideal for graduate dysphagia courses in speechlanguage pathology programs. In addition, neurologists, dieticians, oncologists, general surgeons, and thoracic surgeons are. Swallowing difficulties are known to adversely affect all aspects of quality of life. A holistic approach to diagnosing and treating dysphagia. Traditional management approaches typically view dysphagia as a mechanical andor physiologic problem. A modified extrathoracic approach to treatment of dysphagia. The word dysphagia derives from the greek words dys with difficulty and phagein to eat and is defined as difficulty in swallowing. Older adults are at an increased risk due to having many factors that lead to swallowing difficulties. It may be due to a structural or motility abnormality in the passage of solids or liquids from the oral cavity to the stomach. Oropharyngeal dysphagia after anterior cervical spine surgery. Nov 19, 2015 the evidence base supporting mdtp as a beneficial approach for dysphagia rehabilitation is included among the references at the end of this monologue. Dysphonia and dysphagia following the anterior approach to. Since mucosal lesions are common, endoscopy is the procedure of choice for odynophagia. If you continue browsing the site, you agree to the use of cookies on this website.
People with dysphagia have dificulty swallowing and may even experience pain while swallowing odynophagia. An expanded approach to clinical practice in dysphagia introduction this webinar will explore an expanded approach to dysphagia assessment and treatment designed to maximize an individuals eating and swallowing safety, efficiency, and pleasure. The goal of this pediatric dysphagia continuing education module for speechlanguage pathologists, nurses, and occupational therapists is to enhance the ability of clinicians to assess and treat pediatric feeding difficulties and to assist the nurses who care for. Therefore, dysphagia differs from odynophagia, which refers to pain with swallowing. 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. This is a pdf file of an unedited manuscript that has been accepted for publication. Mar, 2018 a division of gastroenterology grand rounds presented by michael s. The core of such a team includes the patients primary care physician, otolaryngologists, speech and swallowing therapists, gastroenterologists, and radiologists. As a result, for oropharyngeal dysphagia which is mostly attributable to dysmotility, a video modified barium swallow is the initial diagnostic test of choice.
739 1079 839 419 1340 1451 197 156 884 1089 730 52 759 1109 61 500 791 1372 944 1042 1057 924 511 574 305 404 711 160 1065 733 731 334 666 1076 335 168 978 243 467 474 898 1111 1160 840 1119 882 553 564 651 976