The Management of Dysphagia: A Clinical and Ethical View (pp. 1-26)
Authors: (David G. Smithard, Kent Community Health Trust, Kent, United Kingdom)
Abstract: The ability to swallow is essential for independent living, that is the ability
not to take food supplements via non oral means. Swallowing difficulties
(dysphagia) can occur with numerous conditions, some of which are
permanent, some reversible and some progressive. The underlying aetiology
can be neurological, muscular, or mechanical/ obstructive.
Dysphagia is not only determined by its aetiology but also by the site
affected. Swallowing can be compromised by pathological processes within
the oral cavity, pharynx, oesophagus and stomach. Other conditions can affect
swallowing as a secondary effect eg severe lung disease, poor conscious level,
and cognitive problems.
The aetiology and prognosis associated with dysphagia poses several
problems. When to feed, who to feed and how to feed. What is the role of
enteral feeding, does it help recovery in those reversible conditions eg stroke
or does it just prolong life needlessly or is it appropriate in the general
management of malignant conditions eg cancer, AIDS.