Dysphagia

This is a symptom that impedes or hinders many people’s intake of liquid or solid foods without gagging. Swallowing consists of several phases: oral, pharyngeal and esophageal. When an alteration appears in any of the swallowing phases, this causes dysphagia or difficulty in consuming or swallowing liquids and/or solids.

Swallowing is a complex activity involving the coordinated action of 25 facial and oral muscles and six cranial nerves.

Patients who have an elevated risk of suffering dysphagia include those suffering from neurological illnesses, patients with cancer or the head or neck, post-ICU (extubated) patients, sufferers of cerebrovascular accidents, the elderly and COVID-19 patients.

The most frequent symptoms are:

– frequent coughing and drooling
– prolonged time needed for eating
– incapacity to ingest a spoonful of food in one go
– food accumulating in the cheeks
– saliva and food falling from the mouth during eating
– frequent gagging
– loss of weight
– smoky or gurgling voice
– changes in eating habits due to a tendency to reject certain types of difficult-to-eat foods

Complications:

The most frequent complications encountered in a person with dysphagia primarily affect two aspects:

  • Complications at the respiratory level

As a result of gagging, food sometimes enters the lungs due to bronchial aspiration, causing lung damage and in some cases respiratory infection that can be severe in diseases such as pneumonia.

  • Nutritional complications

Persons suffering from oropharyngeal dysphagia avoid eating and drinking, which leads to malnutrition and dehydration.

To avert malnutrition and dehydration in the person with oropharyngeal dysphagia, a series of food and drink modifications must be introduced to ensure proper nutrition and hydration and to be successful in maintaining a healthy condition.

The main objectives of nutritional intervention in patients with dysphagia are the following:

optimising the nutritional situation to prevent dehydration and malnutrition

  • Foods with high nutrient density and low volume

Helping patients swallow to prevent gagging and aspiration

  • Texture-modified solid foods (TMF).
  • Thickening liquids.

Unidad Funcional de Disfagia Orofaríngea del Hospital Universitario Príncipe de Asturias. Disfgia orofaríngea: Solucionesmultidisciplinares. 1ª edición. Madrid: Aula Médica; 2018.

Mª Mercedes Velasco, Viridiana Arreola, Pere Clavé y Carolina Puiggrós. Abordaje clínico de la disfagia orofaríngea: diagnóstico y tratamiento. Nutr Clin Med. 2007.

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