Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan

Abstract

Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased. Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations. Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing. In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship between aspiration and pharyngeal or laryngeal influx, we found that when pharyngeal and laryngeal influx were present, the risk of aspiration was high. Some patients (38.9 %) were able to eat despite lacking a cough reflex; thus, the absence of a cough reflex does not necessarily equate to an inability to eat, even in patients unable to ingest nutrition orally. One case could ingest nutrition, even with no cough reflex. The 6-month survival rate after the examination of patients on nil per os status was 57.1 %, specifically in patients unable to ingest nutrition orally. These results suggest that decreased eating and swallowing functions indicate a poor prognosis for the patient's quality of life, as eating and swallowing require smooth passage in the oral phase. Therefore, actively requesting a dental intervention and oral rehabilitation is important for a patient presenting these issues.

Influence of dental factors on oropharyngeal dysphagia among recipients of long‐term care

“…Oral health care and oral rehabilitation may result in enhanced deglutition. 24 In the study of Kikutani and colleagues, 19 there was a relationship between malnourished older persons and the presence of dysphagia.…”

“…Oral diseases seem to have an influence on the condition of dysphagia, even if they do not cause direct and severe difficulties in deglutition, such as the ones caused by brain and respiratory diseases. Oral health care and oral rehabilitation may result in enhanced deglutition …”

“…The feeling of a reduction in the salivary flow can also make it more difficult to retain dental prostheses and, when added the reduction in the number of teeth, it compromises the bolus formation . Therefore, the presence of normal saliva can also influence deglutition …”

“…29 Therefore, the presence of normal saliva can also influence deglutition. 24 Older persons can have their deglutition altered by the natural ageing process, even in the presence of natural teeth. 30 These problems appear to be fostered by older persons with fewer teeth and a deficient mastication.…”

Cost of establishing a general dentistry department in a small or medium-sized hospital

“…Japan is now a super-aged society, and the importance of oral healthcare management has become obvious [1,2], which has led to considerable expectations for dentists in hospital dentistry. However, although expenditures are not high, low hospital income remains a challenge in establishing and maintaining a hospital dentistry department.…”