Dr Lucas, in February 1761, was performing an autopsy on the recently deceased Jane Fordham. His conclusion was that the emaciated woman had died of obstructed deglutition, although he could find no cause for the condition.
Present during the autopsy was David Bayford. Following the completion of the autopsy by Dr Lucas, Bayford discovered a compression of the esophagus by an aberrant right subclavian artery had caused the obstructed deglutition. In order to pinpoint this as a distinct medical condition, he coined the term ‘dysphagia lusoria’, for which he is noted to this day.
Who’s at Risk from Dysphagia
In medical terminology, dysphagia is the term used to describe difficulty in swallowing. Some sufferers may have difficulty in swallowing only certain solid foods or liquids. In more extreme cases, victims of this condition cannot swallow anything.
Globally, figures show that around 5% of the population suffer with dysphagia to some degree or another. Unfortunately, it is thought that up to 50% of dysphagia cases go undiagnosed. This high figure is thought to be due to the elderly, in some parts of the world, are more likely to be cared for within the family unit, as opposed to being in an elderly care facility. Predominantly, this is true throughout Southeast Asia.
Prevalence of the disorder is far more common in the elderly, although the condition can be bought on in younger people as a result of other underlying health issues. In the elderly, it is common for patients with Parkinson’s disease, dementia, cancer in the neck, or those having suffered a stroke, to be most at risk.
Diagnosing Dysphagia
Skilled technicians are able to diagnose dysphagia with a high degree of medical accuracy. It is important that sufferers seek the best possible diagnostics in order to receive the best available treatment. Fortunately, Samitivej hospital has recognized the importance of accurate diagnostics of this condition, and with that in mind, they established the Swallow Solutions Center. A unique and modern facility dedicated to those suffering with dysphagia.
At the center, patients will be given an initial health check, prior to undergoing any specific diagnostic procedure. Following the initial health check a videoflouroscopic swallowing study, or VFSS, will be undertaken. This procedure is also sometimes referred to as a modified barium swallow (MBS). The procedure is conducted by the center’s team that consists of multiple medical disciplines, including radiologists, nurses, doctors, and occupational therapists.
Videoflouroscopic Swallowing Study
This diagnostic procedure is conducted in one of the center’s modern X-ray suits, and requires the patient to imbibe barium sulphate, a non-organic, odorless, crystalline compound. Small amounts of the compound are blended with food and drinks, of varying density and texture, for the patient to swallow.
The VFSS allows the team to closely monitor the pharyngeal and esophageal phases of the swallowing process. Any eccentricities in the physical process of swallowing can be accurately observed by the team. As part of the process, varying swallowing techniques and patient posture maybe used to enhance assessment of the disorder.
Following this diagnostic procedure, some patients may find that the barium sulphate compound leaves deposits in the mouth, for which the patient will be assisted in cleaning their oral cavity. Additionally, some patients may experience some level of constipation, for this the doctor will prescribe appropriate laxative medication.
Videoendoscopic Swallowing Study
A videoendoscopic swallowing study, referred to as VESS is sometimes called a fiberoptic endoscopic evaluation of swallowing, or FEES. This is distinguishable from the videoflouroscopic swallowing study by way of it allowing the center’s clinicians to document and evaluate the swallowing process from the inside, as opposed to using X-rays which are taken externally.
To conduct this procedure the center’s clinician will use a distal-chip, or fiberoptic nasolaryngoscope. This allows a detailed examination to be conducted on the patient’s larynx, pharynx, tongue, and palate. Following this the patient’s swallowing abilities will be assessed.
The nasolaryngoscope will be positioned below the nasopharynx and will be facing downwards. The patient will then swallow dyed substances of varying textures and consistencies. The doctor can then ascertain as whether all of the swallowed solids or liquids go to the entrance of the esophagus and if any remnants are retained in the space above.
Following this procedure some patients may feel nauseous and slightly unwell. Should the patient be visiting the center for this type of examination, it is advised that they are accompanied by a friend or relative to assist them, post procedure.
Treatment for Dysphagia
Following the detailed diagnostic procedure at the Samitivej Swallow Solutions Center, the practitioner will refer the patient to one of the center’s qualified occupational therapists. The therapist will draw up a detailed treatment plan, specific to the needs of each individual patient.
These occupational therapists are key members of the center’s team. Through educating, physical demonstration and coaching of the patient the quality of life for each sufferer invariably improved by a significant margin.
There are some specific swallowing techniques which, depending on the individual swallowing defect, will be taught to the patient. For example, the Masako Maneuver and the Shaker exercise, also there is the super-supraglottic swallowing method and the effortful swallow, all of which are taught by the therapists at the center.
The importance of maintaining the correct posture whilst eating cannot be underestimated and the occupational therapists will coach the patients on the correct posture to adopt whilst eating, and importance of posture immediately following the consumption of food and drink.
It may be that the therapist will recommend dietary changes to ease a sufferer’s dysphagia. It may also be prudent for a patient to adopt recommended lifestyle changes to ease the condition. A patient may also be instructed on a number of differing muscle exercises that improve the function of the lips, cheeks, tongue, and jaw.
Each treatment plan will be multi-faceted, with each element of the therapy specifically designed to complement the others, whilst the plan as a whole is flexible to work with a patient’s changing condition. It is through this cohesive, yet flexible, structure of treatment that the Center has had unprecedented success in the treatment of dysphagia.
The Samitivej Swallow Solutions Center in Bangkok is now treating more indigenous people, resident expats and medical tourists than ever before. Its world class accreditations bring world class treatment, along with peace of mind and improved quality of life.
