How to recognize dysphagia in patients with multiple sclerosis? Review article
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Published:
Mar 31, 2017
Keywords:
multiple sclerosis, complications, dysphagia, diagnosis, management
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Abstract
Patients suffering from multiple sclerosis (MS) are at risk for development of dysphagia. It is important to diagnose dysphagia early and address it therapeutically to prevent its complications and improve patients survival and quality of life. Screening questionnaires such as DYMUS or EAT-10 and screening tests such as Dysphagia Limit may be useful in early diagnosis and monitoring of dysphagia progress in MS. Patients with positive screening should be referred for further dysphagia assessment by speech language therapist and in some cases by instrumental methods. The main prevention strategies for pneumonia include, except of safe eating or feeding technique and diet modification, regular oral hygiene, keeping upright position after meals. To prevent malnutrition systematic monitoring of nutritional status is recommended and where appropriate timely nutritional intervention including referral for percutaneous endoscopic gastrostomy insertion.
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References
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2. Guan X.L., Wang H., Huang H.S., Meng L.: Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol. Sci. 2015; 36(5): 671-681.
3. Abraham S., Scheinberg L.C., Smith C.R., LaRocca N.G.: Neurologic Impairment and Disability Status in Outpatients with Multiple Sclerosis Reporting Dysphagia Symptomatology. Neurorehabil. Neural. Repair 1997; (11): 7-13.
4. Thomas F.J., Wiles C.M.: Dysphagia and nutritional status in multiple sclerosis. J. Neurol. 1999; 246(8): 677-82.
5. Poorjavad M., Derakhshandeh F., Etemadifar M. et al.: Oropharyngeal dysphagia in multiple sclerosis. Mult. Scler. 2010; 16(3): 362-365.
6. de Pauw A., Dejaeger E., D’hooghe B., Carton H.: Dysphagia in multiple sclerosis. Clin. Neurol. Neurosurg. 2002; 104(4): 345-351.
7. Prosiegel M., Schelling A., Wagner-Sonntag E.: Dysphagia and multiple sclerosis. Int. MS J. 2004; 11(1): 22-31.
8. Terre-Boliart R., Orient-Lopez F., Guevara-Espinosa D. et al.: [Oropharyngeal dysphagia in patients with multiple sclerosis]. Rev. Neurol. 2004; 39(8): 707-710.
9. Fernandes A.M., Duprat A.C., Eckley C.A. et al.: Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz. J. Otorhinolaryngol. 2013; 79(4): 460-465.
10. Calcagno P., Ruoppolo G., Grasso M.G. et al.: Dysphagia in multiple sclerosis – prevalence and prognostic factors. Acta Neurol. Scand. 2002; 105(1): 40-43.
11. Abraham S.S., Yun P.T.: Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia 2002; 17(1): 69-74.
12. Warnecke T., Dziewas R.: Neurogene Dysphagien. Diagnostik und Therapie. W. Kohlhammer GmbH, Stuttgart 2013.
13. Loser C.: Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl. Int. 2010; 107(51-52): 911-917.
14. Lim S.L., Ong K.C., Chan Y.H. et al.: Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin. Nutr. 2012; 31(3): 345-350.
15. Elia M.: The economics of malnutrition. Nestle Nutr. Workshop Ser. Clin. Perform Programme 2009; 12: 29-40.
16. Finestone H.M., Greene-Finestone L.S., Wilson E.S., Teasell R.W.: Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch. Phys. Med. Rehabil. 1995; 76(4): 310-316.
17. Finestone H.M., Greene-Finestone L.S., Wilson E.S., Teasell R.W.: Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients. Arch. Phys. Med. Rehabil. 1996; 77(4): 340-345.
18. Wiesner W., Wetzel S.G., Kappos L. et al.: Swallowing abnormalities in multiple sclerosis: correlation between videofluoroscopy and subjective symptoms. Eur. Radiol. 2002; 12(4): 789-792.
19. Bergamaschi R., Crivelli P., Rezzani C. et al.: The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J. Neurol. Sci. 2008; 269(1-2): 49-53.
20. Alfonsi E., Bergamaschi R., Cosentino G. et al.: Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin. Neurophysiol. 2013; 124(8): 1638-1645.
21. Belafsky P.C., Mouadeb D.A., Rees C.J. et al.: Validity and reliability of the Eating Assessment Tool (EAT-10). Ann. Otol. Rhinol. Laryngol. 2008; 117(12): 919-924.
22. Cheney D.M., Siddiqui M.T., Litts J.K. et al.: The Ability of the 10-Item Eating Assessment Tool (EAT-10) to Predict Aspiration Risk in Persons With Dysphagia. Ann. Otol. Rhinol. Laryngol. 2015; 124(5): 351-354.
23. Rofes L., Arreola V., Mukherjee R., Clave P.: Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol. Motil. 2014; 26(9): 1256-1265.
24. Ertekin C., Aydogdu I., Yuceyar N.: Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J. Neurol. Neurosurg. Psychiatry 1996; 61(5): 491-496.
25. Aydogdu I., Kiylioglu N., Tarlaci S. et al.: Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17 years of experience in 1278 adults. Clin. Neurophysiol. 2015; 126(3): 634-643.
26. Potulska A., Friedman A., Krolicki L., Spychala A.: Swallowing disorders in Parkinson’s disease. Parkinsonism Relat. Disord. 2003; 9(6): 349-353.
27. Trapl M., Enderle P., Nowotny M. et al.: Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38(11): 2948-2952.
28. Simmons K.: Dysphagia management means diagnosis, exercise, reeducation. JAMA 1986; 255(23): 3209-3210, 3212.
29. Langmore S.E., Schatz K., Olsen N.: Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2(4): 216-219.
30. Loser C., Aschl G., Hebuterne X. et al.: ESPEN guidelines on artificial enteral nutrition-percutaneous endoscopic gastrostomy (PEG). Clin. Nutr. 2005; 24(5): 848-861.
31. Tablan O.C., Anderson L.J., Besser R. et al.: Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm. Rep. 2004; 53(RR-3): 1-36.
32. Sorensen R.T., Rasmussen R.S., Overgaard K. et al.: Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J. Neurosci. Nurs. 2013; 45(3): 139-146.
33. Wagner C., Marchina S., Deveau J.A. et al.: Risk of Stroke-Associated Pneumonia and Oral Hygiene. Cerebrovasc. Dis. 2015; 41(1-2): 35-39.
34. Robertson T., Carter D.: Oral intensity: reducing non-ventilator-associated hospital-acquired pneumonia in care-dependent, neurologically impaired patients. Can. J. Neurosci. Nurs. 2013; 35(2): 10-17.
35. van der Maarel-Wierink C.D., Vanobbergen J.N., Bronkhorst E.M. et al.: Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology 2013; 30(1): 3-9.
36. Schmidt M. [Preventive measures in long-term nursing care of elderly patients: oral hygiene reduces risk of pneumonia]. Pflege Z. 2009; 62(11): 668-670.
37. Yamaya M., Yanai M., Ohrui T. et al.: Interventions to prevent pneumonia among older adults. J. Am. Geriatr. Soc. 2001; 49(1): 85-90.
38. Yoshida M., Yoneyama T., Akagawa Y.: [Oral care reduces pneumonia of elderly patients in nursing homes, irrespective of dentate or edentate status]. Nihon Ronen Igakkai Zasshi 2001; 38(4): 481-483.
39. Watando A., Ebihara S., Ebihara T. et al.: Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest 2004; 126(4): 1066-1070.
40. El-Solh A.A.: Association between pneumonia and oral care in nursing home residents. Lung 2011; 189(3): 173-180.
41. Orozco-Levi M., Torres A., Ferrer M. et al.: Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am. J. Respir. Crit. Care Med. 1995; 152(4 Pt 1): 1387-1390.
42. Drakulovic M.B., Torres A., Bauer T.T. et al.: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999; 354(9193): 1851-1858.
43. Wang L., Li X., Yang Z. et al.: Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst. Rev. 2016; 1: CD009946.
44. Huang J.Y., Zhang D.Y., Yao Y. et al.: Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia. J. Int. Med. Res. 2006; 34(3): 303-306.
45. Steele C.M., Alsanei W.A., Ayanikalath S. et al.: The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2015; 30(1): 2-26.
2. Guan X.L., Wang H., Huang H.S., Meng L.: Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol. Sci. 2015; 36(5): 671-681.
3. Abraham S., Scheinberg L.C., Smith C.R., LaRocca N.G.: Neurologic Impairment and Disability Status in Outpatients with Multiple Sclerosis Reporting Dysphagia Symptomatology. Neurorehabil. Neural. Repair 1997; (11): 7-13.
4. Thomas F.J., Wiles C.M.: Dysphagia and nutritional status in multiple sclerosis. J. Neurol. 1999; 246(8): 677-82.
5. Poorjavad M., Derakhshandeh F., Etemadifar M. et al.: Oropharyngeal dysphagia in multiple sclerosis. Mult. Scler. 2010; 16(3): 362-365.
6. de Pauw A., Dejaeger E., D’hooghe B., Carton H.: Dysphagia in multiple sclerosis. Clin. Neurol. Neurosurg. 2002; 104(4): 345-351.
7. Prosiegel M., Schelling A., Wagner-Sonntag E.: Dysphagia and multiple sclerosis. Int. MS J. 2004; 11(1): 22-31.
8. Terre-Boliart R., Orient-Lopez F., Guevara-Espinosa D. et al.: [Oropharyngeal dysphagia in patients with multiple sclerosis]. Rev. Neurol. 2004; 39(8): 707-710.
9. Fernandes A.M., Duprat A.C., Eckley C.A. et al.: Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz. J. Otorhinolaryngol. 2013; 79(4): 460-465.
10. Calcagno P., Ruoppolo G., Grasso M.G. et al.: Dysphagia in multiple sclerosis – prevalence and prognostic factors. Acta Neurol. Scand. 2002; 105(1): 40-43.
11. Abraham S.S., Yun P.T.: Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia 2002; 17(1): 69-74.
12. Warnecke T., Dziewas R.: Neurogene Dysphagien. Diagnostik und Therapie. W. Kohlhammer GmbH, Stuttgart 2013.
13. Loser C.: Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl. Int. 2010; 107(51-52): 911-917.
14. Lim S.L., Ong K.C., Chan Y.H. et al.: Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin. Nutr. 2012; 31(3): 345-350.
15. Elia M.: The economics of malnutrition. Nestle Nutr. Workshop Ser. Clin. Perform Programme 2009; 12: 29-40.
16. Finestone H.M., Greene-Finestone L.S., Wilson E.S., Teasell R.W.: Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch. Phys. Med. Rehabil. 1995; 76(4): 310-316.
17. Finestone H.M., Greene-Finestone L.S., Wilson E.S., Teasell R.W.: Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients. Arch. Phys. Med. Rehabil. 1996; 77(4): 340-345.
18. Wiesner W., Wetzel S.G., Kappos L. et al.: Swallowing abnormalities in multiple sclerosis: correlation between videofluoroscopy and subjective symptoms. Eur. Radiol. 2002; 12(4): 789-792.
19. Bergamaschi R., Crivelli P., Rezzani C. et al.: The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J. Neurol. Sci. 2008; 269(1-2): 49-53.
20. Alfonsi E., Bergamaschi R., Cosentino G. et al.: Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin. Neurophysiol. 2013; 124(8): 1638-1645.
21. Belafsky P.C., Mouadeb D.A., Rees C.J. et al.: Validity and reliability of the Eating Assessment Tool (EAT-10). Ann. Otol. Rhinol. Laryngol. 2008; 117(12): 919-924.
22. Cheney D.M., Siddiqui M.T., Litts J.K. et al.: The Ability of the 10-Item Eating Assessment Tool (EAT-10) to Predict Aspiration Risk in Persons With Dysphagia. Ann. Otol. Rhinol. Laryngol. 2015; 124(5): 351-354.
23. Rofes L., Arreola V., Mukherjee R., Clave P.: Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol. Motil. 2014; 26(9): 1256-1265.
24. Ertekin C., Aydogdu I., Yuceyar N.: Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J. Neurol. Neurosurg. Psychiatry 1996; 61(5): 491-496.
25. Aydogdu I., Kiylioglu N., Tarlaci S. et al.: Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17 years of experience in 1278 adults. Clin. Neurophysiol. 2015; 126(3): 634-643.
26. Potulska A., Friedman A., Krolicki L., Spychala A.: Swallowing disorders in Parkinson’s disease. Parkinsonism Relat. Disord. 2003; 9(6): 349-353.
27. Trapl M., Enderle P., Nowotny M. et al.: Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38(11): 2948-2952.
28. Simmons K.: Dysphagia management means diagnosis, exercise, reeducation. JAMA 1986; 255(23): 3209-3210, 3212.
29. Langmore S.E., Schatz K., Olsen N.: Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2(4): 216-219.
30. Loser C., Aschl G., Hebuterne X. et al.: ESPEN guidelines on artificial enteral nutrition-percutaneous endoscopic gastrostomy (PEG). Clin. Nutr. 2005; 24(5): 848-861.
31. Tablan O.C., Anderson L.J., Besser R. et al.: Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm. Rep. 2004; 53(RR-3): 1-36.
32. Sorensen R.T., Rasmussen R.S., Overgaard K. et al.: Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J. Neurosci. Nurs. 2013; 45(3): 139-146.
33. Wagner C., Marchina S., Deveau J.A. et al.: Risk of Stroke-Associated Pneumonia and Oral Hygiene. Cerebrovasc. Dis. 2015; 41(1-2): 35-39.
34. Robertson T., Carter D.: Oral intensity: reducing non-ventilator-associated hospital-acquired pneumonia in care-dependent, neurologically impaired patients. Can. J. Neurosci. Nurs. 2013; 35(2): 10-17.
35. van der Maarel-Wierink C.D., Vanobbergen J.N., Bronkhorst E.M. et al.: Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology 2013; 30(1): 3-9.
36. Schmidt M. [Preventive measures in long-term nursing care of elderly patients: oral hygiene reduces risk of pneumonia]. Pflege Z. 2009; 62(11): 668-670.
37. Yamaya M., Yanai M., Ohrui T. et al.: Interventions to prevent pneumonia among older adults. J. Am. Geriatr. Soc. 2001; 49(1): 85-90.
38. Yoshida M., Yoneyama T., Akagawa Y.: [Oral care reduces pneumonia of elderly patients in nursing homes, irrespective of dentate or edentate status]. Nihon Ronen Igakkai Zasshi 2001; 38(4): 481-483.
39. Watando A., Ebihara S., Ebihara T. et al.: Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest 2004; 126(4): 1066-1070.
40. El-Solh A.A.: Association between pneumonia and oral care in nursing home residents. Lung 2011; 189(3): 173-180.
41. Orozco-Levi M., Torres A., Ferrer M. et al.: Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am. J. Respir. Crit. Care Med. 1995; 152(4 Pt 1): 1387-1390.
42. Drakulovic M.B., Torres A., Bauer T.T. et al.: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999; 354(9193): 1851-1858.
43. Wang L., Li X., Yang Z. et al.: Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst. Rev. 2016; 1: CD009946.
44. Huang J.Y., Zhang D.Y., Yao Y. et al.: Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia. J. Int. Med. Res. 2006; 34(3): 303-306.
45. Steele C.M., Alsanei W.A., Ayanikalath S. et al.: The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2015; 30(1): 2-26.