how to investigate if someone has dysphagia?

Question

if any1 is a doctor, u may be able to help!
i need to write an essay on my patient who has dysphagia. i need to say which process can investigate his dysphagia and his outcomes? the patient is 63 and is diagnosed with barrett's oesophagus, and has a clinical history of gastric reflux. any one that can help, please please advise me.

Answer 1

As as speech language pathologist, I have a great deal of experience working with patients with dysphagia. There are several ways to obtain an objective assessment of dysphagia. A referral to speech-language pathologist would be most helpful. The SLP would likely perform a bedside swallow evaluation in order to gain a subjective assessment of the patient's swallowing abilities. The SLP feeds the patient different consistencies of food and assesses for clinical signs and symptoms of aspiration, swallowing delays, oral stage difficulties (such as decreased mastication or oral residue), etc. If indicated, the SLP can recommend a Modified Barium Swallow Study. This is done via videofluoroscopy in conjuction with a Radiologist and/or a tech. During this test, the patient is given different foods and liquids coated with Barium. The Barium enables us to see the progression of the food /liquid in real-time. The MBS gives you a view of the pharyngeal stage of the swallow. If there is aspiration, the SLP can assess for any postures or maneuvers that might prevent aspiration. The SLP should also be able to recommend an appropriate diet level after the test.
If interested in the esophageal phase of the swallow, the Radiologist can pan down and assess motility and pressure as well as for any gastric reflux.
Another method for evaluating the swallow would be using FEES/FEEST which involves passing a scope to view the hypopharynx while eating food. The benefit of this testing is that the FEEST version involves sensory testing. There is some current research that shows that if a patient has limited to no sensation, they are more likely to aspirate. Another benefit to this method of assessing swallow function is that the patient will not be exposed to X-Rays. The downside to a FEEST is that it is more invasive than an MBS (the scope passes down the patient's nares).
If you are mainly concerned with the esophagus and the reflux vs. the dysphagia, the best bet would be to have a GI consult completed with a possible esophogram. A pH probe can also be helpful in determining how often the patient has episodes of reflux. Hope this helps.

Answer 2

This patient needs gastroscopy. The patient is first given a sedative. A fibre optic scope is passed down the esophagus and into the stomach and duodenum. The physician will be able to view the lining of the esophagus and stomach on the monitor screen, looking for visual evidence of tumours, ulcers, etc. Also he or she will be able to see evidence of narrowing due to scar tissue that may explain the patient's dysphagia. This is a common finding in a person with longstanding history of acid reflux.

If there is significant narrowing or stricture formation seen during the scope, the doctor can treat that during the gastroscopy by using either a balloon or a series of "bougies" to mechanically dilate and stretch out the narrowed segment of esophagus.

As well, during the scope biopsies would be taken to rule out esophageal cancer, which is one dreaded outcome of chronic reflux and Barrett's esophagus.

Another answerer suggested a swallowing assessment. This would be appropriate if there were any evidence that the patient had poor coordination of the swallowing muscles, but given the history you provided, the first thing to rule out is physical obstruction and development of precancerous and cancerous changes.

The first priority, given the history, is to rule out mechanical obstruction and tumour. The speech language pathology referral can wait.

Answer 3

The first step is to see the doctor and get a referral for a swallow study at the local hospital. Once that test date is set up the patient will go to the hospital as an outpatient. They will be given various textures of food and liquids from thin to thick etc and usually under videoflouroscopy the will be checked to see how well the chew and swallow the various textures. For more details read up on swallow study on the net. If he has dysphagia the doctor will recommned thickened liquids thickened to the consistency that the speech therapist recommends as well as altered food too. Such as nectar thickened liquids or honey consistency or pudding consistency. Food would be ground meat or mechanical soft diet or pureed diet etc.

Answer 4

I would pursue this with some sort of endoscopy to rule out the more serious diseases (esophagal tumors, etc.) If the patient has already been diagnosed with Barrett's esophagus, that would be the best explanation for any dysphagia.

Answer 5

There are three types of dysphagia, and they can overlap; oral, pharyngeal, and esophageal. Barret's esophagus is esophageal. Tools for investigation are manometry, upper GI series (barium swallow (NOT videofluoroscopy)), and endoscopy. These studies are ordered or done by a gastroenterologist. Videofluoroscopy is used as a real-time study for oro-pharyngeal dysphagia, is administered by a speech pathologist, and is a helpful tool if reflux reaches the hypopharynx.

Answer 6

For your patient!?!
And you are a Doctor?!?
And you need help to write an essay!?!
And you write like this?!?
And you are Asking for Answers on Yahoo!?!
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I've been treated for GURD for years. I have also had two (2) esophageal stretches that did no good. Both time the causes of Dysphagia were allergic reactions to medications.

Please check the side effects of your patient's medications first!

;-)
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Dysphagia should not be confused with the similarly pronounced dysphasia, a speech disorder.

Dysphagia (/dɪsˈfe(ɪ)ʒjə/) is a medical term defined as "difficulty swallowing." It derives from the Greek root dys meaning difficulty or disordered, and phagia meaning "to eat". It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach.[1] Dysphagia is distinguished from similar symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. A psychogenic dysphagia is known as phagophobia.

It is also worthwhile to refer to the physiology of swallowing in understanding dysphagia.
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Please check the following websites:

http://en.wikipedia.org/wiki/Dysphagia

http://www.nlm.nih.gov/medlineplus/swallowingdisorders.html

http://www.emedicine.com/pmr/topic194.htm

http://164.109.68.222/en/index.jsp?language=en

http://www.utmb.edu/otoref/grnds/Dysphagia-2001-11/Dysphagia-2001-11.htm

http://www.aafp.org/afp/20000615/3639.html

Answer 7

Dysphagia Wiki