Causes of Dysphagia in a Tertiary-Care Swallowing Center
Dysphagia can be caused by a myriad of disease processes, and it has significant impacts on patients' quality of life, life expectancy, and economic burden. To date, the most common causes of dysphagia in outpatient tertiary-care swallowing centers are unknown. We undertook this study to determine these prevalences. We also describe the diagnostic techniques utilized to establish the diagnosis.
The electronic charts of 100 consecutive patients who presented to an outpatient tertiary-care university swallowing center between January 2010 and April 2011 were retrospectively reviewed. Information regarding patient demographics, validated symptom surveys, diagnostic workups, and ultimate diagnoses was abstracted and tabulated into a central database. Descriptive statistics were used to evaluate the association between patient symptoms and diagnoses.
The mean age of the entire cohort was 62 +/- 13.5 years, and 58% of the cohort was male. The most common identified causes of dysphagia were reflux (27%), postirradiation dysphagia (14%), and cricopharyngeus muscle dysfunction (11%). In 13% of cases, the cause of dysphagia was undetermined. The diagnostic tests utilized included flexible laryngoscopy (71%; 17% with endoscopic swallow evaluation), modified barium swallow study (45%), esophagoscopy (35%), barium esophagography (21%), manometry (10%), and ambulatory pH testing (2%).
The most common causes of dysphagia in a tertiary-care swallowing center are reflux, postirradiation dysphagia, and cricopharyngeus muscle dysfunction. A precise cause for the symptom could not be identified in 13% of our cohort. Endoscopic visualization (laryngoscopy, flexible endoscopic evaluation of swallowing, and transnasal esophagoscopy) and fluoroscopic swallow studies were the investigations most often utilized. These techniques can be used to arrive at a diagnosis in 80% of cases.
Available from: Douglas W Mapel
- "Dysphagia is a very common symptom, and the manifestation of a wide range of disorders, so one must sort through a complex algorithm of diagnostic possibilities before arriving at functional dysphagia  . In a case-series review of patients referred for evaluation of dysphagia at an otolaryngology-based tertiary referral centre, only 13% could not be found to have specific aetiology for the symptom after a complete diagnostic evaluation . The development of high-resolution manometry has improved the detection and diagnosis of esophageal motility disorders and reclassifies many patients who would have been diagnosed as functional or idiopathic dysphagia to specific and treatable neuromuscular conditions . "
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ABSTRACT: The project aim was to review current cost-effectiveness research for each functional gastrointestinal disorder, as defined by the Rome III classification system.
Biomedical databases were searched for articles with the functional gastrointestinal disorders and their pseudonyms included in the title, abstract, or medical subject headings, plus the terms benefit, cost, effectiveness, outcomes, test, utility, or utilization in any search field.
Highly prevalent conditions such as dyspepsia and irritable bowel syndrome have advanced cost-effectiveness analyses including cost-utility studies that have helped support current management guidelines. The rarer functional gastrointestinal disorders have few or no published cost-effectiveness analyses, but the Rome III classification system provides a framework for identifying the specific cost data or outcomes measures available or needed for future research.
The Rome process has provided a useful system for defining the functional gastrointestinal disorders and identifying specific clinical questions to be examined using cost-effectiveness analysis techniques.
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ABSTRACT: Dysphagia is a common problem that has the potential to result in severe complications such as malnutrition and aspiration pneumonia. Based on the complexity of swallowing, there may be many different causes. This article presents a systematic literature review to assess different comorbid disease associations with dysphagia based on age. The causes of dysphagia are different depending on age, affecting between 1.7% and 11.3% of the general population. Dysphagia can be a symptom representing disorders pertinent to any specialty of medicine. This review can be used to aid in the diagnosis of patients presenting with the complaint of dysphagia.
Available from: Hatem Ezzeldin Hassan
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ABSTRACT: Bedside tests are important predictor of aspiration during swallowing and they are the most widely used tests. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is one of the important tests for dysphagia evaluation. The aim of this work is to answer the question, what is the value of bedside tests in comparison to the results of FEES among our population.
To assess the value of bedside tests in comparison with FEES.
Patients and methods
74 patients were presented to phoniatrics clinic for the assessment of swallowing difficulties during the period from May 2011 to August 2013. They were 47 males and 27 females with a mean age of 52 years and range between 20 and 91 years.
Aspiration correlates were assessed using bedside tests (water swallow test, pulse oximetry and gag reflex). FEES was performed to most of the patients to detect sensitivity and specificity in comparison with bedside tests.
Dysphagia was recorded in 56% of the patients. Bedside tests showed 73% sensitivity and 68% specificity when correlated with FEES. Moreover combination of voice change and chocking/cough results in sensitivity of 86.5% and specificity of 75.2%.
Bedside tests are highly sensitive and specific for the detection of dysphagia. Combination of chocking/cough and change of voice as parameters of aspiration compared with FEES showed high sensitivity and specificity.
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