Download Literature study dysphagia

Literature study dysphagia
Susan Hegge, Melissa Mol, Janine van
der Toorn, Daphne Bot, Daisy
Hoedemaker
Tutor: Emine Türkeli
Introduction
There are many people living with the disease, dysphagia. This literature study is done to
investigate what dysphagia means, what the causes are, who are having it and what do they
need for a healthy living. The main question is: what is the effect of disease-specific
nutritional drinks on patients with Dysphagia?
Methods
A qualitative literature study has been executed, to assemble information on dysphagia.
There’s made use of the internet and specifically made use of “Google Scholar” and
“Informatorium voor voeding en diëtetiek”. Some terms of search were “dysphagia”, “swallow
disorders”, “dysphagia and nutrition” and “causes of dysphagia”.
Results
What is dysphagia?
Dysphagia is the medical term for all problems related to swallowing. In order to understand
which swallowing problems can occur, it is important to know how the normal swallowing
process works.1
The normal swallowing process
Swallowing is a complicated process. At first you are conscious of swallowing but once you
have started, the process becomes automatic. So swallowing is both regulated on a
conscious and an unconscious level. The process of swallowing takes place in several
phases.
The first phase is the oral phase. During this phase the bolus is pressed against the palate.
After that it gets pushed into the pharynx. The latter is sometimes also called the transport
phase.
The second phase is the pharyngeal phase. During this phase the bolus comes into contact
with the senses in the pharynx and the back of the pharynx, whereby a swallowing reflex is
generated. This swallowing reflex is an involuntary reflex. The larynx elevates and the
epiglottis moves downward. Then the bolus is pushed into the esophagus.
The last phase is the esophageal phase. This phase begins when the food enters the
esophagus. The bolus gets pushed in the direction of the stomach, and it enters the
stomach. A dry bolus travels much slower than for instance a liquid. 2
Causes of dysphagia
Dysphagia has many causes

Disorders in the preparatory phase:
o The patient has difficulty chewing food or forming the bolus. Causes can be:
 Bad teeth
 Loss of strength in e.g. the jaws and tongue
 Tumor formation around the mouth
 Disruption of saliva production
 Disturbances in the oral phase
o Inability to swallow
 The cause is usually a tongue paralysis.

Disorders in the pharyngeal phase:
o The food does not pass adequately through the pharynx. There is no
swallowing reflex, causing the patient to choke. Also the larynx may not
elevate, allowing food to enter the trachea. Furthermore, food particles may
remain in the throat because the throat muscles are too weak.

Disorders in the esophageal phase:
o The esophagus causes symptoms during this phase. The food does not pass
through the esophagus adequately or it flows back. The causes for this are:
 Disorders of muscle movements
 Mechanical obstruction, e.g. caused by a stenosis

Also, dysphagia can be caused by neurological diseases and mechanical disorders
o Neurological disorders
 Most neurological swallowing disorders are caused by stroke or
cerebrovascular accident (CVA). Also, swallowing disorders can occur
in neurodegenerative), multiple sclerosis (MS) and Parkinson's
disease, and in the final stage of dementia syndromes.
o Mechanical disorders
 Mechanical defects can be caused by surgery and radiotherapy of
tumors. The more tissue is removed in the head /neck area, the
greater the chance of a severe dysphagia. This can cause several
problems:
• Difficulty with transport of the food, because a part of the
tongue is missing
• Ingestion of food because the airway cannot be adequately
sealed during swallowing
• Side effects of radiotherapy can affect swallowing. There may
be difficulty and pain in swallowing.
 Other mechanical causes of dysphagia include inflammation of the
mouth or throat and obstruction in the esophagus.

Other causes:
o Prolonged mechanical ventilation via a tracheal cannula can (temporarily)
cause swallowing disorders. And last, but not least, swallowing disorders can
occur as side effects of medications. Such disorders may be a dry mouth or
difficulty with bolus formation.3
When do people get dysphagia?
The largest group of people having dysphagia are the elderly. 45% of the elderly are having
difficulties with swallowing, and 65% of all the elderly living in a nursing home ore care home
are dealing with this disease. The main cause of this is because the muscles for chewing and
swallowing are weak, some are missing teeth, ore the saliva production is deceased.
Also people who have had an apoplexy, often occur to have dysphagia. 4
Consequences of dysphagia
Aspiration is a result of dysphagia. Food then enters the lungs, causing breathing difficulties
or the inability to breathe, which could be fatal. Furthermore, there may be nutritional
problems. The patient may not be able to eat certain foods, which could result in a nutrient
deficiency.5
The diagnosis
Multidisciplinary consultation is important for patients with dysphagia. Various specialists
may be involved in the diagnosis: the ENT specialist, the neurologist, the gastroenterologist,
the radiologist and speech therapist. the ENT specialist looks at the oral cavity, the pharynx
and the larynx. The neurologist can determine whether the swallowing disorder is a
neurological cause and the gastroenterologist mainly studies the functioning of the
esophagus. The speech therapist will perform a swallowing study and a study of the history.
Also radiological and endoscopic swallowing studies will be carried out. The dietitian will be
important in the case of unintentional weight loss. 3
What are the forms of speech therapy for dysphagia?
With causal therapy, the patient does exercises to train certain muscles, such as the tongue
muscles. With compensatory therapy, the patient learns how to avoid choking.
With diet adjustments, the diet is adapted to certain consistencies that the patient can
swallow. 6
Dysphagia and nutrition
With dysphagia there is no need for special nutrients and there is no special shortage. It’s
important that the nutritional status remains optimal. Therefore we assume the guidelines for
a healthy diet. By swallowing disorders it’s important that nutritional needs and fluid needs
are pleased. There’s a risk for malnutrition and dehydration. Malnutrition may be the result of
inadequate intake of nutrition, but it can also be the result of changing the consistency. By
changing the consistency it’s possible that certain nutrients are lost.
Nutrition need to be modified into a consistency which provides the patients with best control.
Smoother single-texture foods like yoghurt and custard are often more appropriate than
combination foods. Also food that changes from consistency in the mouth is also high risk for
patients with dysphagia to liquids. Fluids have to be thickened by thickeners and food has to
be pureed or cut into very small pieces.
There are some commercial proprietary thickeners: Clinutren Thickener (Nestle Healthcare
Nutrition), Nutilis (Nutricia Clinical Care), Thick and Easy Powder (Fresenius Kabi), Thixo-D
(Sutherland Health) Vitaquick (Vitaflo), Resource ThickenUp (Novartis Consumer Health).
This are powders for thickening up drinks.
It very important that the nutritional needs are satisfied. The individual nutrition need has to
be taken. To achieve this the presentation (food with a different texture can look very
unappetizing) of the food is important. There can also be used food fortification and
enrichment and artificial feeding. This is because people with dysphagia often can eat less
different products. Because of the less of variety of food the micronutrients what normally
comes from fresh products like fruit and bread, often lacking in the diet of patients with
dysphagia. Supplementation may be necessary. 7The dietitian has an important role in
reducing or preventing malnutrition by patients with dysphagia. In cooperation with the
speech therapist they choose for oral or non-oral food.3 When there’s expected that the
swallowing disorders persist longer than a week, there’s a risk of malnutrition. When the
patient has lost more than 5% or their bodyweight in a month, it’s the preferred time to
enabling the dietitian. Mostly this is an energy and protein enriched diet. 8
Often patients with dysphagia need to be helped by eating and drinking. There are some
courses for a reduces intake. Anxiety, depression, confusion and fear are barriers to eating.
It’s important that the patients understands how important it is to have a good nutritional
status. 9
Conclusion
The main question was : what is the effect of disease-specific nutritional drinks for patients
with Dysphagia? With this literature study, there could be said that the main population
having dysphagia are the elderly. Also people with dysphagia don’t need any special nutrition
beside the normal recommended daily allowance. But people having dysphagia do need a
special consistence of the food to prevent aspiration. If These people don’t eat like the
normal recommended daily allowance, there could be a nutrient deficiency.
Discussion
Some strong points of this literature study are that there is made use of scientific websites,
evidence based work has been delivered. Also this literature study answers exactly the main
question.
A weak point may be that the English language isn’t the mother language of the project
group, so there could be some mistakes made that hasn’t been seen.
Recapitulation
There are many people living with the disease, dysphagia. This literature study is done to
investigate what dysphagia means, what the causes are, who are having it and what do they
need for a healthy living. The main question is: what is the effect of disease-specific
nutritional drinks for patients with Dysphagia?
Dysphagia is the medical term for all problems related to swallowing. In order to understand
which swallowing problems can occur, it is important to know how the normal swallowing
process works.
Swallowing is a complicated process. At first you are conscious of swallowing but once you
have started, the process becomes automatic. So swallowing is both regulated on a
conscious and an unconscious level. The process of swallowing takes place in several
phases.
Dysphagia has many causes like: the patient has difficulty chewing food or forming the bolus,
inability to swallow, neurological disorders and mechanical disorders and many more.
Aspiration is a result of dysphagia. Food then enters the lungs, causing breathing difficulties
or the inability to breathe, which could be fatal. Furthermore, there may be nutritional
problems. The patient may not be able to eat certain foods, which could result in a nutrient
deficiency.
With dysphagia there is no need for special nutrients and there is no special shortage. It’s
important that the nutritional status remains optimal. Therefore we assume the guidelines for
a healthy diet. By swallowing disorders it’s important that nutritional needs and fluid needs
are pleased. There’s a risk for malnutrition and dehydration. Malnutrition may be the result of
inadequate intake of nutrition, but it can also be the result of changing the consistency. By
changing the consistency it’s possible that certain nutrients are lost.
The largest group of people having dysphagia are the elderly. 45% of the elderly are having
difficulties with swallowing, and 65% of all the elderly living in a nursing home ore care home
are dealing with this disease. The main cause of this is because the muscles for chewing and
swallowing are weak, some are missing teeth, ore the saliva production is deceased.
With this literature study, there could be said that the main population having dysphagia are
the elderly. Also people with dysphagia don’t need any special nutrition beside the normal
recommended daily allowance. But people having dysphagia do need a special consistence
of the food to prevent aspiration. If These people don’t eat like the normal recommended
daily allowance, there could be a nutrient deficiency.
Literature
1
http://www.dysphagiaonline.com/nl/pages/01_what_is_dysphagia.aspx Accessed on 18-022013
2
Anatomie en fysiologie een inleiding, vierde editie, Frederic H. Martini & Edwin F.
Bartholomew. Hoofdstuk 16 ‘het spijsverteringsstelsel’. Accessed on 18-02-2013
3
Informatorium voor voeding en diëtetiek, Kauw- en slikstoornissen, J.G. Kalf. Accessed on
18-02-2013
4
http://www.dysphagiaonline.com/nl/pages/02_who_does_it_affect.aspx Accessed on 21-022013
5
http://www.dysfagie.com/gevolgen.html Accessed on 02.18.2013
6
http://www.dysfagie.com/logopedie.html Accessed on 18.02.2013
7
manual of dietetic practice chapter 4.2 Accessed on 18.02.2013
8
artsenwijzer, slikklachten. Accessed on 19.02.2013
9
manual of dietetic practice chapter 4.2 Accessed on 18.02.2013