Aspects of the assessment and management of pharyngoesophageal dysphagia

Abstract

Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.

Education for professionals in the management of patients with dysphagia

“…First, this study has developed an educational program based on the idea that professional development is necessary to enable high-quality dysphagia management. It has been reported that long-term treatment outcomes of dysphagia can be optimized when a multidisciplinary team provides comprehensive management for each patient on an individual basis (Allen et al, 2020). In Japan, the revision of the medical fee system for fiscal year 2020 established an additional fee for swallowing support under medical planning and support for patients with dysphagia by the feeding support team.…”