DOCSLIB.ORG

Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment ISSN: 2572-4193 Philipsen. J Otolaryngol Rhinol 2019, 5:063 DOI: 10.23937/2572-4193.1510063 Volume 5 | Issue 3 Journal of Open Access Otolaryngology and Rhinology REVIEW ARTICLE Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment * Bahareh Bakhshaie Philipsen Check for updates Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark *Corresponding author: Dr. Bahareh Bakhshaie Philipsen, Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark, Tel: +45 31329298, Fax: +45 66192615 the vocal folds adduct to prevent aspiration. The esoph- Abstract ageal phase is completely involuntary and consists of Difficulty swallowing is called dysphagia. There is a wide peristaltic waves [2]. range of potential causes of dysphagia. Because there are many reasons why dysphagia can occur, treatment Dysphagia is classified into the following major depends on the underlying cause. Thorough examination types: is important, and implementation of a treatment strategy should be based on evaluation by a multidisciplinary team. 1. Oropharyngeal dysphagia In this article, we will describe the mechanism of swallowing, the pathophysiology of swallowing dysfunction and different 2. Esophageal dysphagia causes of dysphagia, along with signs and symptoms asso- 3. Complex neuromuscular disorders ciated with dysphagia, diagnosis, and potential treatments. 4. Functional dysphagia Keywords Pathophysiology Dysphagia, Deglutition, Deglutition disorders, FEES, Video- fluoroscopy Swallowing is a complex process and many distur- bances in oropharyngeal and esophageal physiology including neurologic deficits, obstruction, fibrosis, struc- Introduction tural damage or congenital and developmental condi- Dysphagia is derived from the Greek phagein, means tions can result in dysphagia. Breathing difficulties can “to eat” [1]. Dysphagia is any disruption in the swallow- sometimes affect the ability to swallow [3]. Some causes ing process during bolus transport from the oral cavity of dysphagia are explained here. to the stomach. The swallowing process is divided into Causes of oral dysphagia four stages: Pre-oral, oral, pharyngeal and esophageal [2]. Various reasons for this type of dysphagia can be [4]: Pre-oral phase is when the food is transferred from • Bad teeth plate to mouth. The oral phase is completely voluntary • Problems with the jaw and involves the entry of food into the oral cavity and • Xerostomia - dry mouth preparation for swallowing. The pharyngeal phase is ini- tiated as the tongue propels the bolus posteriorly and • Tumors - cavum oris cancer, pharyngeal or laryngeal the base of tongue contacts the posterior pharyngeal cancer wall, starting a reflexive action. The soft palate elevates • Masses outside the pharynx, such as osteophytosis to prevent nasal reflux. The pharyngeal constrictor on the vertebrae that press on pharynx musculature contracts to push the bolus through the pharynx. The epiglottis inverts to cover the larynx and • Complication of head or neck surgery Citation: Philipsen BB (2019) Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment. J Otolaryngol Rhinol 5:063. doi.org/10.23937/2572-4193.1510063 Accepted: August 19, 2019: Published: August 21, 2019 Copyright: © 2019 Philipsen BB. This is an open-access article distributed under the terms of the Cre- ative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Philipsen. J Otolaryngol Rhinol 2019, 5:063 • Page 1 of 4 • DOI: 10.23937/2572-4193.1510063 ISSN: 2572-4193 • Radiation leading to fibrosis, structural, mechanical, come weak and neurologic deficits • Dementia • Stroke or some neurological disease like Parkinson’s • Brain tumor disease, multiple sclerosis or ALS • Scleroderma - a rheumatic disease leading to a Functional dysphagia thickening, fibrosis and scarring of tissue Functional dysphagia, defined in some patients as having no organic cause for dysphagia that can be found. • Immune system diseases such as polymyositis There are several different causes to functional dysphagia • Cricopharyngeal dysfunction- can result in material [7]: remaining in posterior pharynx with risk of aspiration • Post traumatic syndrome stress disorder of material into the airway after the swallow • Stress attack • Age-related changes in swallow function • Anxiety Causes of esophageal dysphagia • Different psychosocial disorders Diseases that can cause esophageal dysphagia can be grouped into different categories. Diseases that narrow Symptoms the esophageal lumen through inflammation, fibrosis, Signs and symptoms associated with dysphagia may or tumors, diseases that compromise the esophageal include: lumen, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter function by their • Salvia, food, liquid, or pills are sticking in the throat effects on esophageal smooth muscle [5]: • Coughing or choking food or liquid • Gastroesophageal reflux disease • Sensing of a “lump” in the throat • Esophagitis-can be caused by different problems, • Having the sensation of food getting stuck behind such as infections sternum • Eosinophilic esophagitis • Wet voice • Esophageal spasm • Bringing food back up (regurgitation) • Achalasia-muscles in the esophagus lose their ability • Having food or stomach acid back up into the throat to relax and open • Unexpected weight loss • Diverticula • Pain • Tumors in the esophagus • Developing aspirations pneumonia • Masses outside the esophagus, such as tumors and osteophytosis on the vertebrae Diagnosis • Radiotherapy treatment that causes stricture, fibro- When the dysphagia is frequent, and the cause is not sis and stenosis clear, a comprehensive evaluation of dysphagia should • Scleroderma-a rare condition that causes stiffening include several medical disciplines including ENT doc- of the esophagus muscle tors, gastroenterologist, occupational therapist, speech pathologist and dietitian. An examination begins with a • Immune system diseases such as polymyositis clinical examination that includes a detailed history of • Age-related changes subjective complaints and medical status. The ENT spe- cialist will examine the mouth and throat and with flex- Causes of dysphagia in patient with complex neu- ible laryngoscope through the nose examine the throat romuscular disorder in greater detail [8]. Damage to the neuromuscular system can interfere Several instrumental assessments of swallowing ex- with the nerves responsible for starting and controlling ist to provide objective information about swallowing swallowing. Some neurological causes of dysphagia function and safety. The most widely used procedure include [6]: is a videofluoroscopic assessment of swallowing (Figure • Stroke 1) and fiber-optic endoscopic evaluation of swallowing (FEES) (Figure 2). Videofluoroscopy describes X-rays re- • Neurological conditions that cause damage to the cords and shows how food and liquids move down, and brain and nervous system, including Parkinson’s dis- helps to evaluate the entire swallowing process, the ease, multiple sclerosis, motor neuron disease anatomy changes and dynamics of the swallow, identify • Myasthenia gravis-that causes the muscles to be- the etiology of residue, penetration and aspiration, and Philipsen. J Otolaryngol Rhinol 2019, 5:063 • Page 2 of 4 • DOI: 10.23937/2572-4193.1510063 ISSN: 2572-4193 Figure 1: Videofluoroscopic assessment of swallowing. assess the benefit of treatment strategies during the study. FEES consist of passing a thin, flexible endoscope into the pharynx and observing the act of swallowing. It provides excellent visualization of anatomical changes Figure 2: Fiber-optic endoscopic evaluation of swallowing (FEES). and identifies the etiology of residue, penetration and aspiration. Videofluoroscopy and FEES is thought to be the “gold standard” for assessment of in oropharyngeal in pharynx, larynx and esophagus are often treated with dysphagia [8]. antibiotic medicines. Botox injection of cricopharyngeus muscle and esophagus is used to treat dysphagia in pa- Esophagoscopy is used to look at the esophagus and tients with underlying muscle spasm and hypertonicity ventricle. Manometry evaluates pressure created by [15,16]. the throat and esophagus muscles. The pH monitoring is used to see how often acid from the stomach gets Complications of Dysphagia into the esophagus and how long it stays there. In The most common complications of dysphagia are some patients medical imaging modalities, for example pulmonary complications, dehydration and malnutri- ultrasound, computed tomography scanners, magnetic tion. Other possible complications, such as social isola- resonance imaging or proton emission tomography are tion, mental and emotional health issues or intellectual necessary [9]. and body development deficit in children with dyspha- Treatment gia, have not been studied thoroughly. The main pul- Treatment usually depends on the cause and type of monary complications are aspiration pneumonia, toxic dysphagia. Many cases of dysphagia can be improved aspiration syndromes and pulmonary fibrosis [17]. with careful management, but a cure is not always pos- Summary sible [10,11]. Successful management requires multidis- ciplinary collaboration, accurate diagnostic workup and Dysphagia is the medical term for the symptom of effective therapeutic
Load more

Recommended publications
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • Dysphagia Symptoms in People with Diabetes
    DYSPHAGIA SYMPTOMS IN PEOPLE WITH DIABETES: A PRELIMINARY REPORT MCKENZIE G. WITZKE Bachelor of Arts in Biology and Psychology The College of Wooster May 2015 submitted in partial fulfillment of requirements for the degree MASTER OF ARTS at the CLEVELAND STATE UNIVERSITY MAY 2020 We hereby approve this thesis For MCKENZIE G. WITZKE Candidate for the Master of Arts degree for the Department of Speech Pathology and Audiology And CLEVELAND STATE UNIVERSITY’S College of Graduate Studies by _______________________________________ Violet Cox Chair, Thesis Committee Department of Speech Pathology and Audiology ________________________________________ Myrita Wilhite Committee member Department of Speech Pathology and Audiology ________________________________________ Anne Su Committee member Department of Health Sciences ___________________April ______________________29, 2020 Date of Defense ACKNOWLEDGEMENTS I wish to express my sincere appreciation to my advisor, Dr. Violet Cox, who has expertly guided me through this process and showed me nothing but patience and support as I navigated this new experience. I would also like to thank Dr. Myrita Wilhite for her encouragement and willingness to provide resources to help me complete this project. Last but not least, I would like to acknowledge the support of my friends and family, who provided consistent camaraderie and encouragement. DYSPHAGIA SYMPTOMS IN PEOPLE WITH DIABETES: A PRELIMINARY REPORT MCKENZIE G. WITZKE ABSTRACT BACKGROUND: Diabetes mellitus is a systemic disease affecting whole-body functioning. The underlying mechanisms and associated concomitant conditions suggest an increased risk for the occurrence of oropharyngeal dysphagia. PURPOSE: This is a qualitative study designed to assess perception of symptoms of oropharyngeal dysphagia in people with diabetes. METHODS: Participants were recruited by word-of-mouth and asked to complete a survey by answering questions on a Likert-type scale indicating the frequency with which they experience each symptom.
    [Show full text]
  • Osteopathic Approach to the Spleen
    Osteopathic approach to the spleen Luc Peeters and Grégoire Lason 1. Introduction the first 3 years to 4 - 6 times the birth size. The position therefore progressively becomes more lateral in place of The spleen is an organ that is all too often neglected in the original epigastric position. The spleen is found pos- the clinic, most likely because conditions of the spleen do tero-latero-superior from the stomach, its arterial supply is not tend to present a defined clinical picture. Furthermore, via the splenic artery and the left gastroepiploic artery it has long been thought that the spleen, like the tonsils, is (Figure 2). The venous drainage is via the splenic vein an organ that is superfluous in the adult. into the portal vein (Figure 2). The spleen is actually the largest lymphoid organ in the body and is implicated within the blood circulation. In the foetus it is an organ involved in haematogenesis while in the adult it produces lymphocytes. The spleen is for the blood what the lymph nodes are for the lymphatic system. The spleen also purifies and filters the blood by removing dead cells and foreign materials out of the circulation The function of red blood cell reserve is also essential for the maintenance of human activity. Osteopaths often identify splenic congestion under the influence of poor diaphragm function. Some of the symptoms that can be associated with dysfunction of the spleen are: Figure 2 – Position and vascularisation of the spleen Anaemia in children Disorders of blood development Gingivitis, painful and bleeding gums Swollen, painful tongue, dysphagia and glossitis Fatigue, hyperirritability and restlessness due to the anaemia Vertigo and tinnitus Frequent colds and infections due to decreased resis- tance Thrombocytosis Tension headaches The spleen is also considered an important organ by the osteopath as it plays a role in the immunity, the reaction of the circulation and oxygen transport during effort as well as in regulation of the blood pressure.
    [Show full text]
  • 17 Nutrition for Patients with Upper Gastrointestinal Disorders 403
    84542_ch17.qxd 7/16/09 6:35 PM Page 402 Nutrition for Patients with Upper 17 Gastrointestinal Disorders TRUE FALSE 1 People who have nausea should avoid liquids with meals. 2 Thin liquids, such as clear juices and clear broths, are usually the easiest items to swallow for patients with dysphagia. 3 All patients with dysphagia are given solid foods in pureed form. 4 In people with GERD, the severity of the pain reflects the extent of esophageal damage. 5 High-fat meals may trigger symptoms of GERD. 6 People with esophagitis may benefit from avoiding spicy or acidic foods. 7 Alcohol stimulates gastric acid secretion. 8 A bland diet promotes healing of peptic ulcers. 9 People with dumping syndrome should avoid sweets and sugars. 10 Pernicious anemia is a potential complication of gastric surgery. UPON COMPLETION OF THIS CHAPTER, YOU WILL BE ABLE TO ● Give examples of ways to promote eating in people with anorexia. ● Describe nutrition interventions that may help maximize intake in people who have nausea. ● Compare the three levels of solid food textures included in the National Dysphagia Diet. ● Compare the four liquid consistencies included in the National Dysphagia Diet. ● Plan a menu appropriate for someone with GERD. ● Teach a patient about role of nutrition therapy in the treatment of peptic ulcer disease. ● Give examples of nutrition therapy recommendations for people experiencing dumping syndrome. utrition therapy is used in the treatment of many digestive system disorders. For many disorders, diet merely plays a supportive role in alleviating symptoms rather than alter- ing the course of the disease.
    [Show full text]
  • XEROSTOMIA (Dry Mouth)
    XEROSTOMIA (Dry Mouth) What is xerostomia? Are you constantly thirsty? Do you have difficulty swallowing certain foods? Is your saliva thick, foamy, or dry? If you answered “yes” to any of these questions, you may have xerostomia. Xerostomia is a condi- tion characterized by a decrease in saliva production. This happens when the salivary glands stop working or do not function properly, leaving the mouth dry and uncomfortable. Why is xerostomia a problem? Saliva is important because it helps with the digestion process, prevents tooth decay and gingivitis, and protects and lubricates the tongue and other delicate tissues inside the mouth. Saliva also plays an impor- tant role in helping us taste the foods we eat. Dry mouth sufferers are more likely to develop tooth decay, fungal infection of the mouth, denture sores, gum disease, bad breath, and general irritation and discomfort of the oral tissues. What causes dry mouth? Prescription and over-the-counter medications are the most common cause of dry mouth, contributing to more than 80% of all cases. There are, however, many more factors that can play a role in this condition. Let’s explore all potential factors below: Medications – there are over 350 medications that can contribute to dry mouth • Antiseizure (epilepsy) or Antiparkinsonian • Diuretics (blood pressure): Dyazide, Lasix •Antihypertensives (blood pressure): Atenolol, Tenormin, Inderal • Bronchodilators: Albuterol, Proventil, Ventolin, Beclovent, Vanceril, Pulmicort • Sedatives and tranquilizers • Antidepressants/antianxiety:
    [Show full text]
  • Abdominal Pain - Gastroesophageal Reflux Disease
    ACS/ASE Medical Student Core Curriculum Abdominal Pain - Gastroesophageal Reflux Disease ABDOMINAL PAIN - GASTROESOPHAGEAL REFLUX DISEASE Epidemiology and Pathophysiology Gastroesophageal reflux disease (GERD) is one of the most commonly encountered benign foregut disorders. Approximately 20-40% of adults in the United States experience chronic GERD symptoms, and these rates are rising rapidly. GERD is the most common gastrointestinal-related disorder that is managed in outpatient primary care clinics. GERD is defined as a condition which develops when stomach contents reflux into the esophagus causing bothersome symptoms and/or complications. Mechanical failure of the antireflux mechanism is considered the cause of GERD. Mechanical failure can be secondary to functional defects of the lower esophageal sphincter or anatomic defects that result from a hiatal or paraesophageal hernia. These defects can include widening of the diaphragmatic hiatus, disturbance of the angle of His, loss of the gastroesophageal flap valve, displacement of lower esophageal sphincter into the chest, and/or failure of the phrenoesophageal membrane. Symptoms, however, can be accentuated by a variety of factors including dietary habits, eating behaviors, obesity, pregnancy, medications, delayed gastric emptying, altered esophageal mucosal resistance, and/or impaired esophageal clearance. Signs and Symptoms Typical GERD symptoms include heartburn, regurgitation, dysphagia, excessive eructation, and epigastric pain. Patients can also present with extra-esophageal symptoms including cough, hoarse voice, sore throat, and/or globus. GERD can present with a wide spectrum of disease severity ranging from mild, intermittent symptoms to severe, daily symptoms with associated esophageal and/or airway damage. For example, severe GERD can contribute to shortness of breath, worsening asthma, and/or recurrent aspiration pneumonia.
    [Show full text]
  • High Risk Percutaneous Endoscopic Gastrostomy Tubes: Issues to Consider
    NUTRITIONINFLAMMATORY ISSUES BOWEL IN GASTROENTEROLOGY, DISEASE: A PRACTICAL SERIES APPROACH, #105 SERIES #73 Carol Rees Parrish, M.S., R.D., Series Editor High Risk Percutaneous Endoscopic Gastrostomy Tubes: Issues to Consider Iris Vance Neeral Shah Percutaneous endoscopy gastrostomy (PEG) tubes are a valuable tool for providing long- term enteral nutrition or gastric decompression; certain circumstances that complicate PEG placement warrant novel approaches and merit review and discussion. Ascites and portal hypertension with varices have been associated with poorer outcomes. Bleeding is one of the most common serious complications affecting approximately 2.5% of all procedures. This article will review what evidence exists in these high risk scenarios and attempt to provide more clarity when considering these challenging clinical circumstances. INTRODUCTION ince the first Percutaneous Endoscopic has been found by multiple authors to portend a poor Gastrostomy tube was placed in 1979 (1), they prognosis in PEG placement (3,4, 5,6,7,8). This review Shave become an invaluable tool for providing will endeavor to provide more clarity when considering long-term enteral nutrition (EN) and are commonly used these challenging clinical circumstances. in patients with dysphagia following stroke, disabling motor neuron diseases such as multiple sclerosis and Ascites & Gastric Varices amyotrophic lateral sclerosis, and in those with head The presence of ascites is frequently viewed as a and neck cancer.They are also used for patients with relative, if not absolute, contraindication to PEG prolonged mechanical intubation, as well as gastric placement. Ascites adds technical difficulties and the decompression in those with severe gastroparesis, risk for potential complications (see Table 1).
    [Show full text]
  • PE3334 Difficulty Swallowing (Dysphagia)
    Difficulty Swallowing (Dysphagia) This handout talks about problems your child has in the throat (pharynx) when they swallow, how we diagnose it and how we treat it. What is dysphagia? Dysphagia means difficulty swallowing. Food and drink can get stuck (dis-FAY-je-ya) in the esophagus or “go down the wrong pipe” to the lungs (called aspiration) instead of the stomach. It can also go into the voice box but not all the way into the lungs (called penetration). Epiglottis up for breathing Mouth Throat Liquid in throat (oral (pharyngeal cavity) space) Epiglottis down for eating and drinking Windpipe Liquid in Swallowing tube (Airway or airway (Esophagus) Trachea) Where does dysphagia Difficulty swallowing can happen in 3 places: in the mouth (oral happen? dysphagia), in the throat (pharyngeal dysphagia), and in the swallowing tube (esophageal dysphagia). This handout focuses on pharyngeal dysphagia. Why is pharyngeal When swallowing doesn’t happen the right way in the throat, it can dysphagia a problem? lead to liquid or food getting into the lungs (penetration and aspiration). What are the Food and drink going down the windpipe can damage the lungs. consequences of Some examples of damage are: getting liquid or food • Frequent or long-lasting colds or lung infections into the lungs • Frequent wheezing, coughing, or asthma symptoms (aspiration)? • Difficulty with feeding and growth • In the long-term, this can result in permanent damage to the lungs 1 of 3 To Learn More Free Interpreter Services • Otolaryngology • In the hospital, ask your nurse. 206-987-2105 • From outside the hospital, call the • Ask your child’s healthcare provider toll-free Family Interpreting Line, 1-866-583-1527.
    [Show full text]
  • The Gastrointestinal System and the Elderly
    2 The Gastrointestinal System and the Elderly Thomas W. Sheehy 2.1. Introduction Gastrointestinal diseases increase with age, and their clinical presenta­ tions are often confused by functional complaints and by pathophysio­ logic changes affecting the individual organs and the nervous system of the gastrointestinal tract. Hence, the statement that diseases of the aged are characterized by chronicity, duplicity, and multiplicity is most appro­ priate in regard to the gastrointestinal tract. Functional bowel distress represents the most common gastrointestinal disorder in the elderly. Indeed, over one-half of all their gastrointestinal complaints are of a functional nature. In view of the many stressful situations confronting elderly patients, such as loss of loved ones, the fears of helplessness, insolvency, ill health, and retirement, it is a marvel that more do not have functional complaints, become depressed, or overcompensate with alcohol. These, of course, make the diagnosis of organic complaints all the more difficult in the geriatric patient. In this chapter, we shall deal primarily with organic diseases afflicting the gastrointestinal tract of the elderly. To do otherwise would require the creation of a sizable textbook. THOMAS W. SHEEHY • Birmingham Veterans Administration Medical Center; and University of Alabama in Birmingham, School of Medicine, Birmingham, Alabama 35233. 63 S. R. Gambert (ed.), Contemporary Geriatric Medicine © Plenum Publishing Corporation 1988 64 THOMAS W. SHEEHY 2.1.1. Pathophysiologic Changes Age leads to general and specific changes in all the organs of the gastrointestinal tract'! Invariably, the teeth show evidence of wear, dis­ cloration, plaque, and caries. After age 70 years the majority of the elderly are edentulous, and this may lead to nutritional problems.
    [Show full text]
  • Xerostomia and Hyposalivation (“Dry Mouth”)
    Division of Oral Medicine and Dentistry Xerostomia and Hyposalivation (“Dry Mouth”) What is xerostomia and hyposalivation? What causes hyposalivation? Xerostomia is the sensation of having a dry mouth. Many Te three most common causes of hyposalivation are (but not all) patients who have this sensation will also have a medications, chronic anxiety or depression, and dehydration. noticeable and measurable decrease in the amount of saliva Some medications that cause dry mouth are treatments for in their mouths, a condition referred to as “hyposalivation” sinusitis, high blood pressure (such as “water pills”), anxiety or “salivary gland hypofunction”. Many doctors use the and depression, psychiatric disorders, or a hyperactive bladder. terms “xerostomia” and “hyposalivation” interchangeably Patients on multiple medications are particularly prone to because most (but not all) patients with xerostomia also have getting a dry mouth. An uncommon but important cause of dry hyposalivation. Sometimes your mouth may feel dry without it mouth is radiation therapy for head and neck cancer, during actually being dry (xerostomia without hyposalivation). Saliva which the salivary glands are irreversibly damaged. In diseases not only lubricates the mouth but also helps to fght infections, such as Sjögren syndrome (an autoimmune disease) and chronic so a reduction in the amount of saliva puts you at risk for graf-versus-host disease seen in bone marrow transplant discomfort in the mouth, and also may increase tooth decay recipients, the patient’s own immune system can damage the and yeast infections. salivary glands. Although it is normal to produce less saliva while sleeping, How do we know you have hyposalivation? patients with dry mouth commonly describe their mouths An experienced clinician can usually make the diagnosis by as feeling “parched”, “like sandpaper” or “like a desert” at all listening to the history and examining the patient.
    [Show full text]
  • Gastroenterology - Outpatient
    Gastroenterology - Outpatient Goal Gastroenterology encompasses the evaluation and treatment of patients with disorders of the gastrointestinal tract, pancreas, biliary tract, and liver. It includes disorders of organs within the abdominal cavity and requires knowledge of the manifestations of gastrointestinal disorders in other organ systems, such as the skin. Additional areas include knowledge of nutrition and nutritional deficiencies, and screening and prevention, particularly for colorectal cancer. The general internist should have a wide range of competency in gastroenterology and should be able to provide primary and in some cases secondary preventive care, evaluate a broad array of gastrointestinal symptoms, and manage many gastrointestinal disorders. The general internist is not expected to perform most technical procedures with the important exception of flexible sigmoidoscopy. However, he or she must be familiar with the indications, contraindications, interpretation, and complications of these procedures. Lead Faculty Grace Elta, MD Objectives 1 0 Patient Care and Medical Knowledge 1 1 Dysphagia Differentiate oropharyngeal from esophageal Know the general approach to diagnosis Oropharyngeal dysphagia Use of barium esophagogram/swallowing study Use of endoscopy Use of ENT/speech pathology Know the general approach esophageal dysphagia Use of endoscopy Use of barium esophagogram Know causes of esophageal dysphagia Rings GERD Stricture Pill esophagitis Cancer Know when to include radiology, gastroenterology 1 2 Gastroesophageal
    [Show full text]
  • Oropharyngeal Dysphagia: an Association Between
    DOI 10.20398/jscr.v11i1.20955 OROPHARYNGEAL DYSPHAGIA: AN ASSOCIATION BETWEEN DYSPHAGIA LEVEL, SYMPTOMS AND COMORBIDITY DISFAGIA OROFARÍNGEA: ASSOCIAÇÕES ENTRE O GRAU DE DISFAGIA, SINTOMAS E COMORBIDADES Lidiane Maria de Brito Macedo Ferreira¹; Kallil Monteiro Fernandes²; Cynthia Meira de Almeida Godoy³; Hipólito Virgilio Magalhães Junior4; Henrique de Paula Bedaque5. 1. Adjunct Professor at Otorhinolaryngology on Department of Surgery, Federal University of Rio Grande do Norte (UFRN). Natal-RN. Brazil. 2. Otorhinolaryngologist Physician. Natal-RN. Brazil. 3. Speech therapist on EBSERH (Empressa Brasileira de Serviços Hospitalares), UFRN. Natal-RN. Brazil. 4. Adjunct Professor at Department of Speech-Language and Hearing Sciences, UFRN. Natal-RN. Brazil. 5. Physician, Otorhinolaryngology resident. UFRN. Natal-RN. Brazil. Department of Surgery, Federal University of Rio Grande do Norte (UFRN), Brazil. Financial Support: None. Conflict of interest: None. Mailing address: Department of Surgery, Federal University of Rio Grande do Norte (UFRN), AV. Nilo Peçanha 620, Natal – RN, Brazil. E-mail: [email protected]. Submitted: may 18; accepted after revision, may 18, 2020. ABSTRACT Objective: Associate levels of dysphagia according to the patient health condition. Methods: Retrospective study analyzing 149 medical records of patients who underwent Fiberoptic endoscopic evaluation of swallowing (FEES) in a tertiary hospital from 2016 to 2018. Data was collected on symptoms, comorbidities, FESS findings and oropharynx dysphagia classification. Statistical analysis was performed through descriptive and bivariate analysis using the Chi-square and Fisher's exact tests with a 5% significance level. Results: Most patients are elderly, female and with the main complaint of gagging for liquids and solids (30.9%), and gagging only for liquids was associated with the presence of mild dysphagia.
    [Show full text]