Dysphagia, or else swallowing disorders, are associated with any subjective or objective difficulty in swallowing solid or liquid foods or the appearance of coughing or choking when swallowing. It is a very serious symptom that should be treated promptly, to avoid more serious complications for the patient.
Dysphagia may be seen at various age groups, from infants to the elderly and may be the result of head and neck diseases, mouth, pharynx, larynx, palate malignancies, neuromuscular disorders, neurological diseases (multiple sclerosis, Parkinson’s disease etc.), strokes, or it may follow after head injuries, complications in surgery, or x-raying in the head and neck area. In children it is mainly due to congenital disorders, while in the elderly mainly due to degeneration of the central nervous system causing dysfunction in swallowing and other neurological diseases that lead to loss of consciousness, etc.
Swallowing disorders, however, can also occur suddenly, if they are a result of a car accident, trauma or postoperative complication, and in these cases immediate restoration of the feeding function is required for the patient’s survival. This can happen during feeding via a Levin tube or even gastrostomy.
FEEDING VIA AN INSERTED NASOGASTRIC LEVIN TUBE
This involves inserting a catheter through the nose of the patient in the patient’s stomach and it serves the artificial feeding of the patient, when entering food from the mouth is not suitable or not possible.
The Levin tube is extremely inconvenient for the patient and reduces daily quality of life and needs to be replaced at least every ten days, a rather painful procedure. The foreign body in the patient’s nose and throat is often excruciating for the patient and he often tries to remove it himself, especially in cases of patients with dementia. It is an extremely unpleasant situation where the patient may need to be immobilised to avoid removing it himself, since this is extremely dangerous. It is a way of feeding preferred only in exceptional cases where artificial feeding is not likely to last for a long period. The Levin tube is also used for gastric lavage.
Complications that may occur often include haemorrhagic injury of the nasopharynx, aspiration to the lung , injury of the oesophagus, stomach injury or perforation, and more rarely mediastinitis.
GASTROSTOMY
This is an alternative feeding method for patients with dementia, Parkinson’s disease and stroke, since feeding via a Levin tube has serious disadvantages and cannot be extended for long periods. it can now be applied bloodlessly and without surgery, through gastroscopy. It is currently a simple and safe procedure, selected worldwide as a method of feeding people with swallowing disorders. Unlike Levin, it is not at all annoying for the patient, and replacing it is a completely painless, safe and hardly discomforting procedure that takes place only once a year.
The gastrostomy tube is well fixed and doesn’t get blocked by food or cause aspiration and regressions of food into the oesophagus, like with Levin. Placing a gastrostomy tube does not require anaesthesia but only sedation of the patient, and he is usually hospitalised for 24 hours.
Complications associated with gastrostomy, either short- or long-term, are minimal, and mainly due to the fact that patients with gastrostomy indications are severe cases and elderly people with various comorbidities and underlying conditions, making them high-risk patients. The likelihood of serious complications occurring is 3%. It may involve, in rare cases, oesophageal perforation (during endoscopy), allergic reaction to anaesthesia drugs, or peritonitis, perforation of any other organ and bleeding.
TRACHEOSTOMY
In some cases, the patient may also require, besides assisted feeding, a tracheostomy to also restore his breathing function. This involves creating direct contact between the trachea and the environment through a hole. It is circumventing the respiratory tract of the mouth and throat and can be done scheduled or not, under general or local anaesthesia. The tracheal tube needs changing once a month, ordinary aspirates, and the patient must necessarily eat in a sitting position and remain this way for at least one hour.
A patient about to undergo an intubation procedure for assisted feeding and respiration (if he is concious) is possessed by great fear for the procedure itself, for anaesthesia, for its complications, for his own survival, and for any upcoming change in his life. His daily quality of life is about to change but he is also afraid of the aesthetic aspect. The treating physician prepares him accordingly for such a change and his family should be by his side to offer him the necessary care and love, and help him get used to the new reality.
5 frequently asked questions
What is dysphagia?
Any objective or subjective difficulty in swallowing solid or liquid foods or the appearance of coughing or choking when swallowing is called dysphagia.
What are the most common causes?
- These include strokes,
- chronic neurological conditions and changes in the anatomy of the mouth, pharynx, larynx, neck further to accidents, surgery or radiotherapy.
How is it diagnosed?
With a very specialised and affordable test, which can done at the clinic, at the hospital or at home if the patient cannot be transported. This examination is known as FEES (Flexible endoscopic evaluation of swallowing).
Which is a diagnosis of dysphagia required?
To accurately assess when a patient with these problems can receive food by mouth safely, without fear of aspiration.
Furthermore, to decide on what kind of food they should eat and how, to monitor the course of their recovery and to direct our therapeutic strategy.
Why is the diagnosis of dysphagia important?
For proper food intake (type-composition and way) and prevention of aspiration and consequently respiratory infections.
