Dysphagia…the basics

This is the first of series of blog posts on the topic of dysphagia and the link with nutrition, specifically malnutrition and the role a dietitian plays in the management of dysphagia. This first blog post will cover the basics of dysphagia. Look out for further blog post in this series including a guest blog post by a speech and language therapist.

What is dysphagia?

Dysphagia is the medical term given to swallowing difficulties and can occur in both children and adults. These swallowing difficulties usually arise due to an associated medical condition. It is estimated that approximately 8% of the world’s population are affected by dysphagia.

Dysphagia may not necessarily be an initial presenting symptom of a medical condition but may occur as the medical condition progresses such as neurological disorders e.g. Parkinson’s disease.

What are the signs and symptoms of dysphagia?

  • Coughing or choking when eating or drinking 
  • A ‘gurgly’ wet sounding voice 
  • A sensation that food is stuck in the throat 
  • Reduced ability to chew 
  • Taking a long time to finish a meal 
  • Persistent drooling of saliva 

What medical conditions are associated with dysphagia?

  • Stroke 
  • Neurological conditions such as Parkinson’s disease, motor neurone disease and Alzheimer’s 
  • Head & neck or oesophageal cancer 
  • Respiratory conditions such as chronic obstructive pulmonary disease  
  • Learning disabilities 
  • Traumatic brain injury 

What are the consequences of dysphagia?

If not identified or appropriately managed, the following consequences may arise:

  • dehydration
  • malnutrition or weight loss
  • chest infections
  • aspiration pneumonia
  • longer hospital stays or admission into hospital

How is dysphagia treated?

Treating dysphagia depends on what underlying condition or conditions a person may have. Some people experience dysphagia for only a short period of time, whereas others might have it for a longer period of time.

A speech and language therapist is the key healthcare professional for management of dysphagia. The role of a speech and language therapist includes:

  • Diagnosis of dysphagia
  • Help people regain their swallowing through exercises, techniques and positioning 
  • Promote patient safety through modifying the texture of food and fluids, reducing the risk of malnutrition, dehydration and choking
  • Promote quality of life, taking into account an individual’s and their families’ preferences and beliefs, and helping them adjust to living with swallowing difficulties
  • Work with other healthcare staff, particularly dietitians, to optimise nutrition and hydration
  • Educate and train others in identifying, assessing and managing dysphagia, including families and the wider health and care workforce

[Source: Royal College of Speech and Language Therapists]

Once an assessment by a speech and language therapist has taken place, advice may be provided on how to promote patient safety through the modification of the texture of food and fluids and swallowing exercises, technique and positioning.

What are texture modified diet and fluids?

Texture modification is common practice in dysphagia management.  The aim of texture modification is to prevent or reduce aspiration and potentially subsequent pneumonia. 

In April 2019 the UK implemented the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. This framework was developed by a global team of experts with the aim of improving patient safety for those individuals with dysphagia by standardising the terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures.

The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/
Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.

As mentioned above, dietitians work closely with Speech and Language Therapists once a diagnosis of dysphagia is made. Dietetic input will involve ensuring adequate nutrition and hydration particularly if texture modification of diet and fluids has been recommended.

A later blog post in this mini series about dysphagia, will discuss the role of the dietitian in dysphagia management.

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