Early detection of dysphagia prevents complications

The Spanish Society of Endocrinology and Nutrition (SEEN) has urged to improve the early diagnosis of dysphagia to avoid serious consequences, such as malnutrition, dehydration or aspiration pneumoniathe latter being the most feared complication of dysphagia, since it can have an associated mortality of the 50%.

The scientific society has recalled that dysphagia consists of difficulty moving food from the mouth to the stomach. Its origin can be neurological, structural or muscular, and it is common in patients with stroke, neurodegenerative diseases such as Parkinson’s or amyotrophic lateral sclerosis (ALS), and people undergoing surgery for head and neck tumors.

Around the 8% of the world’s population suffers from this condition, while in Spain its impact reaches 5.6% of adults, with higher figures in hospitalized patients, mainly in geriatric units (10.3%) and neurology services (7.5%).

“We should suspect the presence of dysphagia when a patient coughs frequently when eating or drinking, has a change in voice quality, becomes desaturated (significant decrease in oxygen level), is unable to keep the bolus in the mouth, cannot make a lip seal, drools, has food left in the mouth or at the pharyngeal level after swallowing, cannot swallow the bolus in a single swallow, suffers from frequent respiratory infections, is frequently dehydrated or becomes malnourished,” explained the SEEN Assistance member and member of the society’s Nutrition Area, Emilia Cancer.

The doctor has detailed that swallowing allows adequate nutrition and hydration, so its alteration produces malnutrition and/or dehydration, as well as oropharyngeal aspirations that can generate respiratory infections. “Up to 50% of patients who have aspiration develop pneumoniabeing the most feared complication of dysphagia, since it constitutes between five and 15% of the total acquired pneumonias and may have an associated mortality of 50%. “It’s not a minor problem,” he said.

All of this worsens the patient’s quality of life and survival, in addition to increasing hospital stays and healthcare costs. From the SEEN they have stressed the special attention they require older patients who have presbyphagia, a condition that affects between the 10 and the 30% of the older ones 65 yearssurpassing the 80% in older than 80 years; as well as in frail and hospitalized patients, in whom the figure also increases significantly.

Besides, Emilia Cancer has pointed out that the fear of choking and the need for modified textures in their diet make it difficult for patients to participate in family and social meals, which can cause social isolation. “Many patients stop enjoying something as everyday as eating. This affects their emotional well-being and their social integration. The treatment is not only clinical, but also human,” he noted.

Treatment and the role of the endocrine

Treatment of dysphagia can be compensatory, rehabilitative or a combination of bothand includes adaptation of textures and viscosities (avoiding foods that are lumpy, sticky, hard or with liquid inside), safe postures during eating, strict oral hygiene, thickeners and gelled waters to guarantee hydration, adapted kitchenware, caregiver supervision and swallowing exercises and muscle rehabilitation.

When oral feeding is not safe or there is malnutrition and/or sarcopenia, specialized nutritional intervention is necessary. “Sarcopenic dysphagia is due to sarcopenia, that is, the progressive loss of muscle mass and strength of muscles throughout the body and swallowing. It is an important risk factor for developing malnutrition, since it conditions reduced oral intake,” explained Emilia Cancer.

In this sense, he has pointed out that the treatment of dysphagia must be comprehensive and combine clinical evaluation, diet adaptation, rehabilitation and nutritional support, with special emphasis on the prevention of its consequences, without forgetting the need for patient support. To do this, it requires a multidisciplinary team of specialists that includes the collaboration of endocrinologists, otorhinolaryngologists, rehabilitators, speech therapists, geriatricians, digestive doctors, neurologists and oncologists.

“The specialist in Endocrinology and Nutrition, with his holistic vision of the problem, provides the most integrative, multi and interdisciplinary solutions, which will improve patient safety and quality of life. In fact, at SEEN we are getting strongly involved in it.developing different training tools for caregivers, patients and professionals with the aim of supporting the care of patients with dysphagia, such as the SEEN Virtual Classroom,” highlighted the specialist.

The RECALSEEN study carried out by the society highlights the presence and participation of endocrinologists in dysphagia clinical commissions even in the 40.5% of hospital centers and also the existence of monographic oropharyngeal dysphagia consultations in the 38.8% of the endocrinology services of hospital centers in Spain.

In turn, the SEEN has valued the creation of the International Dysphagia Diet Standardization Initiative (IDDSI), which has allowed food textures and liquid viscosities to be globally defined to improve safety. It has also highlighted new proposals such as molecular gastronomy applied to dysphagia within adapted restoration and innovations in neuromodulatory rehabilitation with promising results.

With this, Dr. Cancer has indicated that the challenge is now in her implementation in hospitals, residences and homesas well as increasing training for caregivers and professionals. “An individualized nutritional care plan must be established, early screening, action algorithms and a multidisciplinary approach must be carried out to stop serious complications,” the doctor concluded.