Dysphagia in Severe Anorexia Nervosa and Potential Therapeutic Intervention: A Case Series

Abstract

The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.

Gastrointestinal complications associated with anorexia nervosa: A systematic review

“…In a case‐control prospective study that aimed to evaluate the frequency of esophageal motility abnormalities and related symptoms in a small group of female patients with AN (11 patients with AN‐R, mean age 19.9 years, mean body mass index (BMI) 13.2 kg/m 2 ; 12 patients with AN‐binge/purge (AN‐BP), mean age 25.4, mean BMI 15.5 kg/m 2 ), Benini et al found a relatively low rate of dysphagia with no difference between AN subtypes (3/11 patients with ANR, 1/12 patients with AN‐BP); of note the rate of dysphagia in AN was higher than the rate seen in the matched control group. Patients in the latter study had relatively higher BMIs than those described in the former case series . The small sample sizes in both studies described make it difficult to speculate an overall rate and nature of dysphagia in patients with AN but suggest that targeted therapy helps alleviate symptoms.…”

“…Given the reality that dysphagia impacts a patient's ability to be successfully refeed, it is imperative that the initial clinical assessment include questions pertaining to swallowing and that appropriate investigations be undertaken in cases where difficulties are identified. Oro‐pharyngeal dysphagia symptoms were the presenting symptoms described in a case series of three female patients ages 24–33 years with severe AN [body mass index (BMI) range 9.6–12.7 kg/m 2 ] . During bedside swallowing tests (video‐fluoroscopic swallowing study scales), all the three patients were found to have dysphagia (mild to moderate in two patients; severe in one patient), abnormal oro‐pharyngeal swallowing function, and signs of aspiration.…”

“…Authors described significant improvements in the dysphagia symptoms and swallowing function score tests for all three patients following dysphagia therapy using 6–9 sessions of neuromuscular electrical stimulation (NMES) and swallowing therapy (including strengthening exercises). Additionally, patients displayed no further signs of aspiration, tolerated oral diets, and gained weight (0.4–3 kg) . Authors speculate that patients with AN may suffer from dysphagia because of the weakening of smooth and skeletal musculature secondary to starvation mediated atrophy, as well as damage caused by potentially long‐standing GERD and recurrent vomiting .…”

Avoiding Medical Complications During the Refeeding of Patients With Anorexia Nervosa

“…Aspiration may also occur in AN due to dysphagia that is caused by pharyngeal muscle weakness resulting from protein-calorie malnutrition (Holmes, Gudridge, Gaudiani, & Mehler, 2012). Difficulty swallowing and uncoordinated transfer of the food bolus from the mouth to the stomach may lead to aspiration and then pneumonia.…”

Electrical Stimulation in Treatment of Pharyngolaryngeal Dysfunctions

“…Numerous case reports on patients with various types of dysphagia also suggest great improvements in swallowing functions [64,65,66,67,68,69]. From the 25 studies [29,32,34,37,38,39,40,41,42,43,44,48,49,51,52,53,54,55,56,57,58,59,60,61,62] identified in this literature search, 18 reported positive results for NMES treatment of dysphagia (table 1).…”