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Causes of Dysphagia Cheat Sheet (DRAFT) by [deleted]

Causes of Dysphagia

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Questions to ask the patient

1) Do you ever choke or cough when eating solid foods or swallowing liquids?
2) Do you enjoy eating less than you used to?
3) Have you lost weight because you no longer enjoy eating?
4) Do you have difficulty swallowing medica­tions?
5) Do you have difficulty swallowing certain foods?
6) Do you ever have the feeling that food is sticking in your throat?
7) Do you have trouble clearing food from your mouth with one swallow?
8) Does it ever feel as if food is “going down the wrong pipe?”
9) Does your voice ever sound “gurgly” or wet when you are eating?
10) Do you have repeated episodes of pneumonia and/or other respir­atory illness?
Additional Questions recomm­ended by Gasior­owski & Fass include:
1) What is the duration of the dysphagia?
2) Is the onset of the dysphagia acute? Sudden onset with other neurologic signs may indicate that a stroke has occurred.
3) Can the patient localize the swallow dysfun­ction?
4) Are there any additional symptoms, such as heartburn, regurg­ita­tion, aspira­tion, weight loss and chest or abdominal pain

1) Dysphagia due to Neurologic Disorder

often result in dysphagia due to the loss of muscle function and coordi­nation. Neurologic disorders that may cause dysphagia may include:
a) Cerebral Palsy
b) Stroke
c) Brain Injury
d) Spinal Cord injury
e) Parkin­son’s Disease
f) Multiple Sclerosis
g) Amyotropic lateral sclerosis (ALS)
h) Muscular Dystrophy
i) Alzhei­mer’s Disease

2) Disorders of the Head, Neck or Esophagus

a) Cancer
b) Injury or surgery involving the head or neck
c) Decayed or Missing Teeth
d) Poorly Fitting Denture

3) Drug Induced Dysphagia

Medica­tions may cause difficulty swallowing by several different mechan­isms. In the list below, medica­tions are grouped by their mechanism for causing dsyphagia.
a) Medica­tions that affect smooth muscle function and coordi­nation of the esophagus: Antich­oli­nergic and antimu­sca­rinic agents
b) Cytotoxic injury to the esophageal muscles: anti-n­eop­lastic agents
c) Viral and fungal infections of the esophagus: prolonged use of immuno­sup­pre­ssants
d) Esophageal muscle wasting: High dose cortic­ost­eroids
e) Blockage of Dopami­nergic Transm­ission resulting in an extra- pyramidal syndrome similar to Parkin­son’s disease: Antips­ychotic Medica­tions (Neuro­lep­tics) such as Thorazine (Chlor­pro­maz­ine), Haldol (Halop­eridol) or Risperdal (Rispe­rid­one).
f) Medica­tions that cause dry mouth (Xeros­tomia) which impairs food transport:
 ­ ­  i) ACE (Angio­tensin Converting Enzyme) Inhibitors
 ­ ­  ii) Anti-a­rry­thmics
 ­ ­  iii) Calcium Channel Blockers iv) Diuretics
 ­ ­  v) Anti-e­metics
 ­ ­  vi) Anti-h­ist­amines & Decong­estants
 ­ ­  vii) Selective Seroto­nergic Re-uptake Inhibitors such as Prozac (Fluox­etine) or Zoloft (Sertr­aline) viii) Tricyclic Anti-d­epr­essants such as Imipramine (Tofranil) or Elavil (Amitr­ypt­yline)
g) Medica­tions that CNS depres­sion, leading to drowsi­ness, confusion and decreased voluntary mucle control:
 ­ ­  i) Benzod­iaz­epines, such as Valium (Diazepam) and Xanax (Alpra­zolam)
 ­ ­  ii) Narcotics
 ­ ­  iii) Skeletal Muscle Relaxants
h) Medica­tions that local irritation of esophageal mucosa:
 ­ ­ i) Aspirin
 ­ ­  ii) Non-st­eroidal anti-i­nfl­amm­atory drugs (NSAIDS)
 ­ ­  iii) Antibi­otics
 ­ ­  iv) Iron containing products
 ­ ­  v) Vitamin C
 ­ ­  vi) Anti-a­rry­thmics vii) Potassium supple­ments
Note: Tardive dyskin­esia, an irreve­rsible condition that may caused by neurol­eptics can result in an orofacial and lingual muscle syndrome that may progress until the patient cannot chew or swallow