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The premier source of information for the management of patients with Dysphagia

Incidence of dysphagia

As dysphagia is not a single disease, but a symptom of an underlying medical problem (3,4), it is difficult to estimate how many patients are suffering from dysphagia. Any estimation of the incidence of dysphagia is highly influenced by the definition of dysphagia. As there is no standardized definition for dysphagia, an estimation of the incidence will vary from publication to publication. It is probable, however, that dysphagia is under diagnosed in many patients (2,4).

Incidence and outcome of dysphagia in stroke patients

Stroke is considered to be one of the major causes of dysphagia. In 2002 the World Health Organisation calculated that about 15 million people worldwide suffer from a stroke every year. Swallowing problems occur in about half of these patients (12, 13). In many patients, the swallowing function will recover within two months. In a small group, recovery of swallowing function may take many months to several years (12, 13). In several cases of stroke patients this recovery does not occur. It is not known exactly how many patients receive long term tube feeding after stroke. It is estimated that in England 1.7% of all stroke patients are long term tube dependent (14). Generally, stroke patients are discharged from swallowing rehabilitation six to twelve months after a stroke, because no further recovery is to be expected. When there are still swallowing problems at the end of the treatment period, the patient often requires (partial) tube feeding for an extended period of time.

Incidence and outcome of dysphagia in patients with other neurological disorders

A prospective study into recovery of dysphagia in patients with other neurological conditions shows that the average duration of swallowing rehabilitation for patients who are (partially) dependent on tube feeding prior to therapy is two months. Of this patient group, only 55% returns to an oral diet (15).

In many degenerative neurogenic disorders, swallowing problems occur in different degrees of severity. It is difficult to say, however, which problems occur specifically with these conditions. There appears to be a large variability in the time between diagnosis and the occurrence of dysphagia. The incidence of dysphagia in patients with neurodegenerative diseases is estimated to be 40% (4, 5, 8).

The treatment of swallowing problems in degenerative conditions consists predominantly of advice on posture while eating and drinking and learning compensatory strategies. Exercises to strengthen particular muscles or muscle groups is usually contraindicated for these patient groups (3, 8).

Incidence and outcome of dysphagia in patients with head-and-neck cancer

Head-and-neck cancer patients with dysphagia constitute a heterogeneous population strongly related to the extent of surgery and use of (chemo) radiation either in postoperative or primary setting (3, 4,16).

The cause of dysphagia for patients undergoing surgical resection is evident. Tissue loss because of surgical excision, transection of muscles and nerves, and resulting scar and loss of sensation result in marked alteration in the functioning of tissues vital for normal swallowing. Swallowing rehabilitation is generally believed to be efficacious. Some studies suggest that postural techniques clearly result in decreased aspiration by 50% to 75% and that swallowing exercises may improve swallowing efficacy (17).

Incidence and outcome of presbyphagia

It has been recognized that 40%–60% of the institutionalized elderly have identifiable signs and symptoms of oropharyngeal dysphagia (2, 4). For these patients, widely accepted interventions such as meal texture modification, compensatory postures, food administration techniques, and direct therapeutic procedures are used (4,5). No outcome figures are available on interventions in this population.


REFERENCES:

2. Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., Ortega, P. (2002). Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17, 139-146.

3. Logemann, J. (1999). Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed.

4. Rofes, L., Arreola, V., Akmirali, J., Cabré, M., Camins L., García-Peris, P., Speyer, R., Clavé, P. (2011). Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology Research and Practice Volume 2011, Article ID 818979, 13 pages.

5. Schindler, A., Vincon, E., Grosso, E., Miletto, A.M., Rosa di, R., Schindler, O. (2008). Rehabilitative management of oroopharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital. Dysphagia 23, 230–236.

8. Easterling E.A. and Robbins, E. (2008). Dementia and dysphagia. Geriatric Nursing 29, 275-285.

12. Dogget, D.L., Tappe, K.A., Mitchell, M.D., Chapell, R., Coates, V., Turkelson, C.M. (2001). Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence based comprehensive analysis of the literature. Dysphagia 16, 279-295.

13. Becker, R., Nieczaj, R., Egge, K., Moll, A., Meinhardt, M., Schulz, R-J. (2010). Functional dysphagia therapy and PEG treatment in a clinical geriatric setting. Dysphagia, DOI 10.1007/s00455-009-9270-8.

14. Elia, M., Stratton R.J., Holden, C., Meadows, N., Micklewright, A., Russel, C., Scott, D., Thomas, A., Shaffer, J., Wheatley, C., Woods, S.; Committee of the British Artificial Nutrition Survey (BANS). (2001). Home enteral tube feeding following cerebrovascular accident. Clinical Nutrition 20, 27-30.

15. Prosiegel, M., Heintze, M., Wagner-Sonntag, E., Hannig, C., Wuttge-Hannig, A., Yassouridis, A. (2002). Schluckstörungen bei neurologischen Patienten. Eine porspektive Studie zu Diagnostik, Störungsmustern, Therapie und Outcome. Nervenarzt 73, 364-370.

16. Nguyen, N.P., Frank, C., Moltz, C.C., Karlsson, U., Nguyen, P.D., Ward, H.W., Vos, P., Smith, H.J., Huang, S., Nguyen, L.M., Lemanski, C., Ludin, A., Sallah, S. (2009). Analysis of factors influencing dysphagia severity following treatment of head and neck cancer. Anticancer Research 29, 3299-3304.

17. Langmore, S.E., Terpenning, M., Schork, A., Chen, Y., Murray, J., Lopatin, D., Loesche, W. (1988) Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 13, 69-81.

 

 


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