Therapy for dysphagia (difficulty swallowing) depends on the cause. In Parkinson’s disease-related dysphagia, studies demonstrate response to L-dopa in some patients. If dysphagia persists, complete or partial replacement of nutrition via percutaneous endoscopic gastrostomy (PEG; endoscopically placed artificial access from the outside through the abdominal wall into the stomach) may be required.
General measures
- Strive to maintain normal weight! Determine BMI (body mass index) or body composition using electrical impedance analysis.
- Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
Conventional non-surgical therapy methods
- Pharyngeal electrical stimulation (PES; electrical stimulation to a specific area of the pharynx’/throat) for apoplexy-related (stroke-related) dysphagia; led in one study to the removal of the tracheal cannula (tubes inserted into a tracheostoma/opening of the trachea to the outside to keep it open) in significantly more patients immediately after stimulation therapy (49 versus 9 percent); furthermore, the hospital stay of patients who responded to PES treatment was on average 22 days shorter than in patients who showed no response to therapy.
Regular checkups
- Regular medical checkups
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grain products).
- In cases of dysphagia, functional measures can reduce the risk of solid or liquid food entering the airways below the glottis level (vocal fold apparatus with associated actuating cartilages, with associated glottis). In this process, the following posture contributes to lowering pressure on the upper esophageal sphincter (esophageal sphincter): Head flexion and flexion (bending) of the neck.
- Observance of the following special dietary recommendations (needs-covering aspiration-free diet):
- The food must be well chewed.
- Puree solid foods with a blender, possibly adding a light sauce. To puree cooked vegetables, it is recommended to use milk instead of a broth. By adding cooked potatoes, the pureed meal can be varied in firmness. The pureed meal can be supplemented with protein-rich foods such as egg, grated or soft cheese, tofu, pureed chicken or pureed fish and finished with cream or a little butter.
- Prefer mushy and liquid food such as soups, mashed potatoes and vegetable purees.
- Frequently drink small amounts (peppermint tea, herbal tea, mineral water, buttermilk or kefir) Note: peppermint tea can increase reflux (reflux of acid gastric juice and other gastric contents into the esophagus (esophagus)).
- If necessary, optimization of the tube feed
- If necessary, costadaptation: consultation and joint preparation of special dysphagia food.
- Other special dietary recommendations depending on the cause of dysphagia (dysphagia).
- Selection of appropriate food based on the nutritional analysis.
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
Complementary treatment methods
- Logopedics – with the aim of improving swallowing behavior (logopedic swallowing therapy).
- Respiratory therapy (reflexive respiratory therapy).
Literature:
- Warnecke T, Oelenberg S, Teismann I et al : Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy.Mov Disord 2010 Jul 15;25(9):1239-45. doi: 10.1002/mds.23060
- Matsubara K et al : Effect of Three Different Chin-Down Maneuvers on Swallowing Pressure in Healthy Young Adults. Laryngoscope 2015, online August 12; doi: 10.1002/lary.25552
- Dziewas R et al : Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol Published:August 28, 2018 doi:https://doi.org/10.1016/S1474-4422(18)30255-2
