About dysphagia
吞嚥困難 (Dysphagia)
Refers to difficulty swallowing food or liquids. Symptoms of dysphagia vary from person to person and can be mild to severe.
Some people with dysphagia cannot swallow. Swallow certain textured foods or liquids, while some cannot swallow even saliva.
Symptoms of dysphagia include:
- Choking and coughing easily while eating
- need to swallow several times before swallowing, or feel pain when swallowing
- Difficulty chewing food
- food or acid reflux, sometimes food comes out through the nose
- Feeling like food gets stuck in throat or heart after swallowing
- Food residue in the mouth after eating
- hoarse voice after meal, like phlegm
- Often easy to choke on saliva or keep drooling
- long-term weight loss or repeated chest infections
The International Dysphagia Diet Standardisation Initiative (IDDSI)
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a generic term used to describe food texture and thickened beverages for people with dysphagia.
The IDDSI framework contains eight consecutive grades from 0-7, where grades 0-4 are beverage grades and 3-7 are food grades.
Causes of Difficulty Swallowing
Since swallowing is a complex process, there are many causes of dysphagia. Dysphagia is relatively common among older adults as the muscles used for swallowing weaken with age, and older adults are more likely to suffer from diseases that affect swallowing function (see below). Reports from Taiwan and the West show that, on average, about 12% of the elderly living in the community have varying degrees of dysphagia, while those living in institutions are even higher[1,2]. According to statistics from the Institute of Swallowing of the University of Hong Kong, the proportion of elderly people in day care centers and elderly homes with dysphagia is 40% and 60% respectively [3].
Conditions that increase the chance of swallowing difficulties include:
Stroke (4-70% of them have dysphagia[1])
Brain damage, such as trauma, brain tumor
Neurodegenerative diseases such as Parkinson’s disease, dementia, multiple sclerosis
Head and neck cancer, including cancer of the mouth, throat, or esophagus
Gastroesophageal reflux (also known as acid reflux) – stomach acid leaks back into the esophagus, causing long-term scarring and narrowing of the esophagus
Radiation therapy – narrows the esophagus due to inflammation and scarring
Dysphagia severity level
Dysphagia Severity Scale (DSS)
There are different grades of dysphagia in academics, and Dysphagia Severity Scale is one of them.
The health effects of dysphagia cannot be ignored. The following are complications that can result from dysphagia:
Choking – food or liquid accidentally slips off and blocks the airway so that you can’t breathe
Malnutrition or dehydration – patients may avoid eating and drinking for fear of choking, resulting in decreased appetite, which can lead to malnutrition and dehydration, which can lead to weight loss in the long term
Affecting mental health – not enjoying meals and attending social situations due to inability to eat properly, resulting in loss of appetite, feeling isolated, and even depression or anxiety
Aspiration pneumonia or chronic lung disease – food or liquid entering the airways can cause aspiration pneumonia or chronic lung disease, which can be fatal in severe cases
References:
[1]World Gastroenterology Organisation (2014). World gastroenterology organisation global guidelines: Dysphagia. Available at: https://www.worldgastroenterology.org/guidelines/global-guidelines/dysphagia/dysphagia-english
[2]國健署106年新聞稿 (2017) 吞嚥沒問題 營養有保障 長者「吃得下」 身心快活 Available at: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1137&pid=8068
[3]香港大學吞嚥研究所 About Us. Available at: https://swallow.edu.hku.hk/about-us/
[4]Nishimura, K., Kagaya, H., Shibata, S., Onogi, K., Inamoto, Y., Ota, K., Miki, T., Tamura, S. and Saitoh, E., 2015. Accuracy of dysphagia severity scale rating without using videoendoscopic evaluation of swallowing. Japanese Journal of Comprehensive Rehabilitation Science, 6, pp.124-128.