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June 1 kicks off Dysphagia Awareness Month in the US.

Monday, June 1, 2020  

 

 

June 1 kicks off Dysphagia Awareness Month in the US.


On September 27, 2008, the US Congress passed a bipartisan statute which declared June as National Dysphagia Awareness Month. Dysphagia Awareness Month provides an excellent opportunity to raise awareness about what dysphagia is, its symptoms, causes, available treatments, and the roles of the various professionals who can help those with dysphagia. Please help us embark on the mission to spread dysphagia awareness by sharing the information provided below. 


What is dysphagia? Put simply, dysphagia is swallowing difficulty (Logemann, 1998). However, the act of swallowing is extremely complex. It is estimated to involve at least 30 pairs of muscles and multiple nerves. And we do it often! We swallow about 600 times a day and don’t even think twice about it. And yet, swallowing is something we all take for granted – that is, until a problem occurs. 


How many people have dysphagia? Dysphagia is a serious medical condition that affects between 300,000 and 700,000 individuals in the United States each year (Patel et al, 2018; Peery et al, 2019). Although 1 in 6 adults report experiencing dysphagia, only 50% had discussed their difficulty with a clinician (Adkins et al, 2019). It is likely that you or someone you know will experience dysphagia. 


How do I know if I or a loved one has dysphagia? Common signs and symptoms of dysphagia include, but are not limited to: difficulty with weight gain (in children), unintentional weight loss (in adults), coughing during or after meals, recurrent lung infections, liquid/food coming out of nose/mouth, liquid/food coming back up into mouth or throat after its been swallowed (regurgitation), avoiding foods once enjoyed, and feeling of food remaining “stuck”. 


What causes it? Dysphagia is a symptom caused by various diseases/conditions, including congenital and developmental disorders (e.g., cleft lip/palate, Down syndrome), head and neck cancers, pulmonary conditions (e.g., chronic obstructive pulmonary disease), and a variety of congenital or acquired neurologic conditions such as stroke, dementia, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Parkinson's disease, muscular dystrophy, cerebral palsy, and many more. Since it is a common symptom in these diseases and may develop gradually over time, dysphagia often goes unnoticed and is underreported. 


What are the effects of dysphagia? The consequences of dysphagia can be dire, including malnutrition (poor nutrition), pneumonia (lung infection), and even death (Blanař et al, 2019;Tagliaferria et al, 2019). But, it doesn’t end with effects on health – dysphagia can impact quality of life as well. So many life events involve eating and drinking. As a result, those with dysphagia may avoid social interaction and suffer from depression and social isolation (Ekberg et al, 2002). Additionally, clinically relevant symptoms of anxiety are present in almost 40% of individuals with dysphagia (Verdonschot et al, 2013). 


In hospitalized patients, patients also with dysphagia stay longer, have higher costs, and are more likely to have worse outcomes (Patel et al, 2018). Higher costs contribute to substantial economic and societal burden. Dysphagia is responsible for an estimated $7 billion in additional hospital costs per year (Patel et al, 2018). Despite the extensive impact dysphagia has on health and quality of life, unfortunately, not everyone seeks treatment. In fact, evidence supports that only about 1/2 of individuals with dysphagia seek treatment (Adkins et al, 2019). 

 

How do healthcare professionals help those with dysphagia? Diagnosis and treating dysphagia often requires interdisciplinary efforts, including (but not limited to) speech-language pathology (SLP), dietary/nutrition (RD), primary care, gastroenterology (GI), otolaryngology (ENT), and nursing (RN). Additional healthcare professionals involved in dysphagia treatment may include occupational therapy (OT), physical therapy (PT), neurology, pulmonary and critical care, and palliative medicine.


Assessment of swallowing to determine if dysphagia is present frequently includes a clinical assessment and an instrumental assessment. A clinical (bedside) swallow assessment is most frequently performed by a SLP. It can assist in describing current swallowing difficulties and help provide recommendations for additional testing and referrals, as well as to help guide appropriate treatment. The two most common instrumental assessments are fiberoptic endoscopic evaluation of swallowing (FEES) and modified barium swallow study (MBSS). FEES uses a camera inserted through the nose to directly visualize the pharynx (throat), while the individual swallows various liquids and foods provided. An MBSS, also called a videofluoroscopic swallowing study (VFSS), is a real-time X-ray procedure, often completed with radiology professionals. An individual may be asked to swallow various liquids and food mixed with barium, which is a substance that allows the clinician to observe how the swallowed material travels from the mouth into the esophagus (tube connecting throat to stomach). 


Once a diagnosis of dysphagia has been made, the healthcare team determines the most appropriate plan for treatment based on nature and cause of dysphagia, specific swallowing impairment(s) present, and severity of dysphagia. Dysphagia treatment may involve medical/surgical intervention(s) by a physician and/or behavioral intervention(s) by an SLP, including exercises. The focus of any dysphagia treatment is to optimize the swallow to be as safe and efficient as possible to improve health and quality of life. 


Why should I help raise dysphagia awareness? 


  • To support those with dysphagia and their caregivers/loved ones
  • To help with earlier identification in those who have dysphagia to prevent poor outcomes
  • To help those with dysphagia seek appropriate care 
  • To help educate the community about dysphagia
  • To help fund research efforts 


How can I help spread dysphagia awareness?



Thank you for your support! Because swallowing is a function that happens so often and easily for most people, it is often overlooked or dismissed. However, there is a community of researchers, clinicians and individuals who are working tirelessly to make swallowing less difficult for affected individuals. 


Take some time this June to reflect on the impact dysphagia has for those affected by it, the professionals who work to diagnose and treat it, and the researchers who are continuously working towards improving the lives of patients with dysphagia.


Thank you for helping us to eventually end this silent epidemic and give dysphagia a voice. 


References 

 

Adkins C, Takakura, W, Spiegel B.M.R., Lu, M., Vera-Llonch, M., Williams, J, Almario, C.V. (2019). Prevalence and characteristics of dysphagia based on a population-based survey. Clinical Gastroenterology & Hepatology, pii: S1542-3565(19)31182-6. doi: 10.1016/j.cgh.2019.10.029

 

Blanař, V., Hödl, M., Lohrmann, C., Amir, Y., & Eglseer, D. (2019). Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study. Journal of Advanced Nursing, 75(12), 3566–3576. DOI: 10.1111/jan.14188

 

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(2), 139-146. DOI: 10.1007/s00455-001-0113-5

 

Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd ed.). Austin, TX: Pro-Ed.

 

Patel, D. A., Krishnaswami, S., Steger, E., Conover, E., Vaezi, M. F., Ciucci, M. R., & Francis, D. O. (2018). Economic and survival burden of dysphagia among inpatients in the United States. Diseases of the Esophagus, 31(1), 1-7. DOI: 10.1093/dote/dox131

 

Peery, A. F., Crockett, S. D., Murphy, C. C., Lund, J. L., Dellon, E. S., Williams, J. L., Jensen, E. T., Shaheen, N. J., Barritt, A. S., Lieber, S. R., Kochar, B., Barnes, E. L., Fan, Y. C., Pate, V., Galanko, J., Baron, T. H., & Sandler, R. S. (2019). Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2018. Gastroenterology, 156(1), 254-272.e11. DOI: 10.1053/j.gastro.2018.08.063

 

Tagliaferria, S., Lauretanib, F., Peláa, G.,  Meschiab, T, & Maggioa, M. (2019). The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individuals. Clinical Nutrition, 38(6), 2684-2689. DOI: 10.1016/j.clnu.2018.11.022

 

Verdonschot, R. J., Baijens, L. W., Serroyen, J. L., Leue, C., & Kremer, B. (2013). Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. Journal of Psychosomatic Research, 75(5), 451–455. DOI: 10.1016/j.jpsychores.2013.08.02


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