Esophageal Dysphagia in the Elderly

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H

“…In some cases, such as esophageal cancer, this rate rises to 70%. 12 , 45 ) Although it can vary regionally, the most common cause of ED is gastroesophageal reflux (GER). 45 , 46 ) In addition, structural and inflammatory problems of the gastrointestinal tract (GIT), such as stricture, web, ring, malignancy, esophagitis, and/or motility disorders, can cause ED in older people.…”

“…Screening tests are considered the first-line method for diagnosis in the literature. 3 , 4 , 12 , 45 ) However, in recent years, these tests have been recommended to be completed with a comprehensive clinical examination for both OPD and ED. 23 , 45 ) Since the present paper is intended for application in clinical practice, we recommended clinical evaluations in addition to screening tests only in cases accompanied by aspiration-related parameters.…”

“…Therefore, the proposed diagnosis algorithm in the present study was first-line screening tests, second-line clinical evaluation, and third-line instrumental evaluation. 3 , 4 , 12 , 45 )…”

“…Endoscopy has been proposed as a first-line modality in instrumental evaluation, especially in patients with symptoms of persistent dysphagia. 2 , 12 , 23 , 45 ) In the present study, we added the VF as this method allows evaluation of the mouth to the LES, including the observation of UES patency and bolus transport. In addition, the American College of Radiology recommends the VF for dysphagia.…”

“…Thus, the first-line treatment is the elimination of factors that can cause dysphagia before using rehabilitation modalities. 45 , 48 ) In OPD, first-line modalities include surgery (in the presence of tumors and cervical osteophytes), medical treatment (in cases such as myasthenia gravis and oral candidiasis), and botulinum injection (in the presence of sialorrhea and dystonia). 23 , 43 ) Similarly, the use of antiviral, antifungal, and antibiotic drugs in infectious esophagitis causing ED and medical treatment of GER and gastroparesis are first-line treatment modalities.…”