Management Algorithm in Neurogenic Dysphagia: Indications for Instrumental Assessment
DOI:
https://doi.org/10.25759/spmfr.479Keywords:
Deglutition Disorders/diagnostic imaging, Deglutition, Endoscopy/methods, Fluoroscopy/methodsAbstract
Sixty-five percent of patients on the acute phase of stroke have dysphagia, a symptom that is also frequent among other neurologic diseases. Swallowing instrumental assessment (SIA) is the gold-standard on the diagnosis of neurogenic dysphagia. However, it is not always available. Algorithms and/or explicit indications for complementary diagnostic tests (CDT) prescription are not available in literature. We aim to propose specific indications for the prescription of CDT in adults with neurogenic dysphagia by creating an approach algorithm for the evaluation of these patients.Narrative review using the Medline data base to search the literature. Reviews and guidelines published in the last 5 years were included. We have also included publications of interest cited in the selected articles.There are 2 gold-standards for SIA: videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). Both are highly sensitive and specific on the diagnosis and etiologic definition of dysphagia. However, they require specialized equipment and people which are not always available. Hence, based on literature, we propose that all the adult patients with neurological disorders in risk of developing dysphagia should be submitted to dysphagia screening, using one of the tools available for that purpose, as soon as possible. Those with a positive screening or with other predictors for dysphagia (despite negative screening) should undergo clinical swallowing examination (CSE). Prescription of CDT should respect the following indications: 1) aspiration pneumonia or progressive malnutrition in certain patients with neurological disorders; 2) dysphagia on CSE with unknown etiology; 3) dysphagia on CSE in patient with poor collaboration; 4) dysphagia in patients with severe impairment of pharyngeal sensitivity; 5) dysphagia under swallowing therapy progressing not as expected.VFSS/FEES unavailability in certain contexts allows CSE to substitute SIA as a diagnostic, dietary modifying, and therapeutic guiding tool, despite its worst reliability. Hence, standard management algorithms for the evaluation of neurogenic dysphagia and definition of specific indications for CDT prescription are of major value.References
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