Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology

Rainer Dziewas, Hans-Dieter Allescher, Ilia Aroyo, Gudrun Bartolome, Ulrike Beilenhoff, Jörg Bohlender, Helga Breitbach-Snowdon, Klemens Fheodoroff, Jörg Glahn, Hans-Jürgen Heppner, Karl Hörmann, Christian Ledl, Christoph Lücking, Peter Pokieser, Joerg C Schefold, Heidrun Schröter-Morasch, Kathi Schweikert, Roland Sparing, Michaela Trapl-Grundschober, Claus WalleschTobias Warnecke, Cornelius J Werner, Johannes Weßling, Rainer Wirth, Christina Pflug

Research output: Journal article (peer-reviewed)Journal article

Abstract

INTRODUCTION: Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies.

RECOMMENDATIONS: This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with.

CONCLUSIONS: The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online ( https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf ).

Original languageEnglish
Pages (from-to)23
JournalNeurological research and practice
Volume3
Issue number1
DOIs
Publication statusPublished - 4 May 2021

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