SHM's Clinical Quick Talks-Evaluation and Management of the Inpatient Dysphagia Complaint

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Dysphagia, defined as difficulty moving food from the oropharynx into the stomach, is a prevalent issue in inpatient settings, affecting 2% to 40% of patients. It is associated with increased mortality and longer hospital stays. Dysphagia should be differentiated from odynophagia (pain with swallowing) and globus sensation (feeling of being stuck in the esophagus) and must be classified into oropharyngeal or esophageal dysphagia.<br /><br />The initial assessment of dysphagia includes thorough clinical history-taking and physical examination. Important considerations include symptom onset, progression, associated red flags like weight loss, and potential triggers. Examining the function of cranial nerves and conducting a bedside swallow assessment are pivotal in identifying the underlying cause. Special attention is given to potential signs of underlying diseases such as cachexia, skin changes in scleroderma, or eosinophilic esophagitis.<br /><br />The differential diagnosis for dysphagia includes oropharyngeal causes such as neurological dysfunctions (e.g., Parkinson's, multiple sclerosis) and anatomical abnormalities (e.g., Zenker's diverticulum, tumors). Esophageal dysphagia could be due to neuromuscular dysfunctions such as achalasia or mechanical obstructions including esophageal rings, strictures, and carcinoma.<br /><br />Diagnosis involves several modalities. Bedside swallow assessments have moderate utility but can underestimate the problem. Other diagnostic tools include video fluoroscopic swallowing study, fiber optic endoscopic evaluation, endoscopy, manometry, and barium esophagram, each offering unique insights into the mechanisms of dysphagia and its etiology.<br /><br />Management of oropharyngeal dysphagia involves aspiration precautions, dietary modifications, and swallowing exercises. For esophageal dysphagia, treatment options include proton pump inhibitors for GERD, dietary modifications, antispasmodic medications, and various endoscopic procedures to alleviate mechanical obstructions or dysmotility.<br /><br />Overall, accurate assessment and tailored interventions are essential in managing dysphagia in hospitalized patients to improve outcomes and reduce complications.

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Evan Blake Daugherty, Ryan Salerno, Nicole Terrigno

Keywords

dysphagia

oropharyngeal dysphagia

esophageal dysphagia

diagnosis

management

hospitalized patients

swallowing assessment

neurological dysfunctions

mechanical obstructions

treatment options