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Part II Nutrition Assessment, Consequences, and Implications

TABLE 10.2 Anatomic Location of Swallowing Dysfunction Based on Patients’ Description Oropharyngeal

Esophageal What does it feel like? When does it occur?

Are there associated symptoms or conditions?

The patient cannot initiate a swallow, or food feels like it is hanging in the neck.

Within 1 second of an attempted swallow

• Inability to chew or propel the bolus • Sialorrhea, drooling, or food spillage

• Coughing, choking, or nasal regurgitation

• The need to swallow repeatedly to clear food from the pharynx

• Hoarseness, slurred or nasal speech, dysarthria, or dysphonia

• Referred otalgia may indicate a cancer of the hypopharynx, larynx, pharynx, or tongue base.

• Prolonged intubation • Head and neck surgery or radiation • Swallowing with gurgling noise, sensation of fullness in the neck, halitosis, and late regurgitation of undigested food may point to a Zenker diverticulum.

How is relief achieved after the bolus impaction?

• Repeated swallowing, raising the arms, throwing shoulders back, or performing the Valsalva maneuver

• Ability to expectorate the offending bolus

Do you have a systemic illness?

Stroke, Parkinson disease, myasthenia, multiple or amyotrophic lateral sclerosis, thyrotoxicosis, and other related conditions

Collagen vascular diseases such as scleroderma, CREST syndrome, rheumatoid arthritis, systemic lupus erythematosus, and Sjögren’s syndrome

Source: Reprinted with permission from Aslam M, Vaezi M. Dysphagia in the elderly. Gastroenterol Hepatol (N-Y). 2013;9(12):784795. Copy- right © 2013, Gastro-Hep Communications, Inc.

After swallowing, food sticks behind the sternum or in the epigastrium or, less commonly, in the neck.

A few seconds after swallowing

• Chest pain • Nocturnal or late regurgitation of undigested food

• Chronic heartburn, hematemesis, coffee ground emesis, and anemia may point toward GERD complications; however, the presence or absence of heartburn is not specific.

• Dysphagia with both solids and liquids from the onset indicates a motility disorder.

• Progressive dysphagia from solids to liquids suggests a structural lesion (stricture, ring, web, or tumor).

• Intermittent dysphagia to solids without significant weight loss is often related to an esophageal ring.

• Odynophagia is often indicative of esophageal inflammation (erosive, pill- induced, or infectious), esophagitis, or caustic ingestion.

Regurgitation or vomiting