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Dysphagia: Complications, Management and Clinical Aspects 1st Edition 2017

Dysphagia: Complications, Management and Clinical Aspects 1st Edition 2017

Dysphagia Complications, Management and Clinical Aspects 1st Edition 2017

Dysphagia: Complications, Management and Clinical Aspects 1st Edition 2017

(Digestive Diseases: Research and Clinical Developments)

Dysphagia is the difficulty or improper swallowing of liquids, solids, or even saliva. This book provides new research on the complications,management and clinical aspects of dysphagia. Chapter One reviews the development of normal swallowing in infants and children and protective reflexes to prevent aspiration; the pathophysiologic events that occur due to aspiration and some of the disease processes in children associated with dysphagia; and current methods of diagnosis of dysphagia and its therapy in children. Chapter Two focuses on dysphagia after suffering a stroke. Chapter Three discusses the incidence, mechanism, and treatment of dysphagia and pneumonia in acute intracerebral hemorrhage. Chapter Four reviews the epidemiology of dysphagia in patients with Duchenne muscular dystrophy
(DMD) and the method of evaluating their swallowing problems.


Chapter 1 – Dysphagia in children, particularly if it leads to aspiration, is a significant cause of respiratory morbidity and sometimes mortality. Aspiration occurs in the setting of dysphagia when airway protective reflexes fail. Clinical symptoms and physical findings of dysphagia and aspiration in children can be nonspecific. However, advances in technology can lead to early diagnosis, and new therapeutic modalities can improve outcome and prognosis. In this chapter, the development of normal swallowing in infants and children and airway protective reflexes to prevent aspiration will first be reviewed. Next, the pathophysiologic events that occur due to aspiration and some of the disease processes in children associated with dysphagia will be reviewed. Finally, the current methods of diagnosis of dysphagia and its therapy in children will be reviewed.
Chapter 2 – Dysphagia is a common consequence after stroke, presenting in up to 50% of all acute stroke patients, with increased morbidity and 
mortality mainly because it dramatically increases the risk of aspiration pneumonia, and because it leads to malnutrition and dehydration as well. It has been reported that the incidence of dysphagia ranges from 25% to 81% depending on the timing of the assessment, diagnostic methods and criteria. The nervous system affected by a stroke damage is thought to reserve a variable ability to somehow reorganize damaged pathways and structures, allowing an effective recovery from swallowing impairment. Notwithstanding, about half of stroke patients remain dysphagic after seven days from symptoms onset, and approximately 13-15% of patients has persistent swallowing dysfunction after six months, with a dramatic impact on patients’ outcome in terms of increased likelihood of residential placement and
estimated lifetime costs in stroke survivor. To date, it is unclear why some stroke patients develop a persistent swallowing impairment after stroke or, in
other words, if the failure in recovery from dysphagia is due to a stroke involving the dominant swallowing hemisphere, rather than a swallowing key region, or even to any specific clinical or neuroradiological stroke factor. In this view, stroke severity upon admission, assessed using NIHSS, is an important clinical predictor of post-stroke dysphagia and of a persistent pattern of dysphagia as well. Regarding the site of the stroke lesion, it is widely accepted that swallowing function is provided by a complex neural network bilaterally involving the perirolandic sensorimotor cortex which, together with other cortical structures, projects and receives afferences to the brainstem’ Central Pattern Generator, through the basal ganglia, the thalamus and the periventricular white matter as well.

Despite several cortical areas have been described as related with swallowing impairment, a definite role in causing dysphagia has been not completely understood for all of them so far. Interestingly, recent studies reported that the disruption of cortical-cortical and cortical-subcortical white matter connections seems to increase the risk of dysphagia and aspiration pneumonia by lowering the threshold of input to the medullary swallowing center. Thus, dysphagia may result from the combined effects of an acute focal damage and a preexisting impairment of the subcortical white matter connecting pathways. In other words, the authors might think of dysphagia as a kind of deficit in executive functions, which they know to be particularly associated with leukoaraiosis and cognitive disorders, and of course age.
Chapter 3 – Dysphagia, defined as difficulty in the passage of solids or liquids from the mouth to the stomach, is common after stroke. Aspiration is a major risk factor for the development of pneumonia. Dysphagia and pneumonia in intracerebral hemorrhage (ICH), however, have not been well
  investigated. Incidence, mechanism, and treatment of dysphagia and pneumonia in acute ICH are discussed.
Chapter 4 – Duchenne muscular dystrophy (DMD) is the most common childhood onset muscular dystrophy, with an incidence estimated as 1:3000 live male births. It is an X-linked inherited condition, caused by mutation of the dystrophin gene. Although much of the literature on DMD states that the disease impacts on swallowing function and recommends swallowing assessment as part of their routine examination, the appropriate method of evaluating their swallowing problems had not yet been determined. Recently, the authors developed an 8-stage Neuromuscular Disease Swallowing Status Scale (NDSSS) and demonstrated its sufficient reliability, validity, and responsiveness in 134 patients with DMD. NDSSS is considered as a useful tool to evaluate swallowing disorders in clinical area, because it is easy to understand and administer by either medical or nonmedical staff.

The authors recommend that their swallowing function should be evaluated periodically
and followed up using the NDSSS, and timely consider more detailed assessment with videofluorography. In this chapter, they reviewed the epidemiology of dysphagia in patients with DMD and the method of evaluating their swallowing problems.

Product details

  • Series: Digestive Diseases: Research and Clinical Developments
  • pdf: 167 pages
  • Publisher: Nova Science Publishers, Inc.; 1 edition (January 10, 2017)
  • Language: English
  • ISBN-10: 1536104329
  • ISBN-13: 978-1536104325

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