Dysphagie – von der Pathophysiologie zur Therapie

Schluckstörungen können vielfältige Ursachen haben und die unterschiedlichsten Symptome hervorrufen: Bei ösophagealer Dysphagie kommt es zu Regurgitation, Erbrechen, Schmerzen und Fremdkörpergefühl im Bereich des Ösophagus. Die oropharyngeale Dysphagie ist charakterisiert durch Husten, Räuspern und Atemwegsaffektionen. Neben der diagnostischen Abklärung und spezifischen Therapie sollte immer auch eine ernährungsmedizinische Unterstützung erfolgen.

Abstract

More than 5 million persons in Germany suffer from swallowing disorders (dysphagia), predominantly oropharyngeal dysphagia. Due to the demographic changes in our population, the prevalence rates are expected to increase. Multiple conditions may be the cause of dysphagia and dysphagia may lead to various symptoms. Esophageal dysphagia is predominantly accompanied by regurgitation, vomiting, pain and foreign body sensation in the esophageal region. Oropharyngeal dysphagia is characterized by cough, hawking and airway disease. In some patients with oropharyngeal dysphagia, symptoms may be completely absent or are not attributed to dysphagia. Both forms of dysphagia are regularly accompanied by difficulties with nutritional intake and consecutive malnutrition. Therefore, the diagnostic and therapy of dysphagia should always be accompanied by nutritional support.

Schlüsselwörter

Aspiration - Schluckstörung - Dysphagie - Malnutrition

Key words

aspiration - swallowing disorder - dysphagia - malnutrition

Publication History

Article published online:
28 December 2021

• Literatur

• 1 Wirth R, Dziewas R. Neurogenic dysphagia. Internist 2017; 58: 132-140
• 2 Martino R, Foley N, Bhogal S. et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763
• 3 Morgan AS, Mackay LE. Causes and complications associated with swallowing disorders in traumatic brain injury. J Head Trauma Rehabil 1999; 14: 454-461
• 4 Muller J, Wenning GK, Verny M. et al. Progression of dysarthria and dysphagia in postmortem-confirmed parkinsonian disorder. Arch Neurol 2001; 58: 259-264
• 5 Miller N, Noble E, Jones D. et al. Hard to swallow: dysphagia in Parkinson’s disease. Age Ageing 2006; 35: 614-618
• 6 Langmore SE, Olney RK, Lornen-Hoerth C. et al. Dysphagia in patients with frontotemporal lobar dementia. Arch Neurol 2007; 64: 58-62
• 7 Kühnlein P, Gdynia HJ, Sperfeld AD. et al. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol 2008; 4: 366-374
• 8 Grob D, Arsura L, Brunner NG. et al. The course of myasthenia gravis and therapies affecting outcome. Ann NY Acad Sci 1987; 505: 472-499
• 9 Mulcahy KP, Langdon PC, Mastaglia F. Dysphagia in inflammatory myopathy: self-report, incidence, and prevalence. Dysphagia 2012; 27: 64-69
• 10 Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 1996; 109: 167-172
• 11 Macht M, Wimbish T, Clark BJ. et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 2011; 15: R231
• 12 Turley R, Cohen S. Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg 2009; 140: 33-36
• 13 Lin LC, Wu SC, Chen HS. et al. Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc 2002; 50: 1118-1123
• 14 Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000–2007. Gerontology 2009; 55: 714-718
• 15 Serra-Prat M, Palomera M, Gomez C. et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing 2012; 41: 376-381
• 16 Suominen M, Muurinen S, Routasalo P. et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr 2005; 59: 578-583
• 17 Ney DM, Weiss JM, Kind AJ. et al. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract 2009; 24: 395-413
• 18 Warnecke T, Dziewas R. Neurogene Dysphagien. Diagnostik und Therapie. Stuttgart: Kohlhammer; 2013
• 19 Muhle P, Wirth R, Glahn J. et al. Age-related changes in swallowing. Physiology and pathophysiology. Nervenarzt 2015; 86: 440-451
• 20 Wirth R, Dziewas R, Jäger M. et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESEKES, der AKE, der DGN und der DGG: Klinische Ernährung in der Neurologie. Aktuel Ernahrungsmed 2013; 38: 257-282
• 21 Dziewas R, Glahn J, Helfer C. et al. FEES for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German Stroke Society. Nervenarzt 2014; 85: 1006-1015
• 22 Volkert D, Chourdakis M, Faxen-Irving G. et al. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34: 1052-1073
• 23 Volkert D, Berner YN, Berry E. et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clinical nutrition 2006; 25: 330-360
• 24 Loser C, Aschl G, Hebuterne X. et al. ESPEN guidelines on artificial enteral nutrition – percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
• 25 Beck AM, Kjaersgaard A, Hansen T. et al. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia – An updated clinical guideline. Clin Nutr 2017;
• 26 Burgos R, Breton I, Cereda E. et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37: 354-396
• 27 Hanson B. A review of diet standardization and bolus rheology in the management of dysphagia. Curr Opin Otolaryngol Head Neck Surg 2016; 24: 183-190
• 28 Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr 2001; 20: 423-428
• 29 Vivanti AP, Campbell KL, Suter MS. et al. Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 2009; 22: 148-155
• 30 Frey KL, Ramsberger G. Comparison of outcomes before and after implementation of a water protocol for patients with cerebrovascular accident and dysphagia. J Neurosci Nurs 2011; 43: 165-171
• 31 Karagiannis M, Karagiannis TC. Oropharyngeal dysphagia, free water protocol and quality of life: an update from a prospective clinical trial. Hell J Nucl Med 2014; 17 (Suppl. 01) 26-29
• 32 Druml C, Ballmer PE, Druml W. et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr 2016; 35: 545-556