ABSTRACT
OBJECTIVE: Oropharyngeal dysphagia (OPD) refers to difficulty swallowing food or a liquid bolus from the oral and pharyngeal cavities into the esophagus and increases the risk of possibly life-threatening pneumonia. Little has been reported on OPD in adults with anorexia nervosa (AN). This study includes a description of OPD in severe AN and discusses potentially effective clinical management. METHOD: Two hundred and six adults with severe AN, admitted over a five-year period to a national referral center specializing in the multidisciplinary medical stabilization of this population, were retrospectively evaluated by electronic database query and manual chart review. All patients whose initial medical assessment triggered a speech-language pathology (SLP) consultation, due to concerns for OPD, were reviewed in detail. RESULTS: Of the 206 total patients, 42 presented with symptoms of OPD and received SLP consultation. In the OPD cohort, 37 (88%) were women, with median age 32 years old, and mean admission weights of 57% ideal body weight (IBW) and body mass index (BMI) of 12 kg/m(2). Compared with those who did not have OPD, OPD patients had significantly lower BMI on admission (12 kg/m(2) vs. 13.1 kg/m(2), p < 0.001), longer stay (21 days vs. 14 days, p < 0.001), and were more medically compromised, including a greater incidence of refeeding hypophosphatemia (60.9% vs. 29.7%, p < 0.004). DISCUSSION: Clinical awareness of OPD may reduce the incidence of aspiration pneumonia and promote life-saving oral nutrition in patients with severe AN. Proper, timely evaluation and intervention may improve clinical outcomes.
Subject(s)
Anorexia Nervosa/complications , Deglutition Disorders/epidemiology , Deglutition Disorders/psychology , Adult , Anorexia Nervosa/physiopathology , Body Mass Index , Body Weight , Deglutition Disorders/complications , Female , Hospitalization , Humans , Hypophosphatemia/etiology , Length of Stay , Male , Middle Aged , Prevalence , Referral and Consultation , Retrospective Studies , Young AdultABSTRACT
OBJECTIVES: In severe anorexia nervosa, there are a litany of medical complications that affect virtually every body system, and severe weakness is a typical characteristic. To our knowledge, aspiration risk, dysphagia recognition, and dysphagia management and intervention have not been well described in the literature in regard to severe anorexia nervosa. The purpose of this case series is to increase awareness among clinicians of possible oropharyngeal dysphagia symptoms that may present in patients with severe anorexia nervosa. METHODS: We describe the cases of 3 patients with severe anorexia nervosa who presented with symptoms of dysphagia. The speech-language pathology team administered dysphagia therapy to the 3 patients utilizing neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy tasks that included strengthening exercises and compensatory strategies. RESULTS: After the course of dysphagia treatment intervention, the 3 patients were able to tolerate an oral diet with improved swallowing function and no ongoing aspiration. CONCLUSIONS: The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.
Subject(s)
Anorexia Nervosa/complications , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Electric Stimulation Therapy , Speech Therapy/methods , Adult , Deglutition Disorders/physiopathology , Female , Humans , Muscle Weakness/etiology , Muscle Weakness/physiopathology , Muscle Weakness/therapy , Pharyngeal Muscles/physiopathology , Respiratory Aspiration/etiology , Respiratory Aspiration/prevention & control , Severity of Illness Index , Young AdultABSTRACT
OBJECTIVE: The purpose of this case report is to increase awareness among clinicians that oropharyngeal dysphagia occurs in patients with severe anorexia nervosa, placing them at risk for aspiration and impeding nutritional rehabilitation. METHOD: We describe a patient with severe anorexia nervosa who manifested symptoms of dysphagia, with resultant aspiration pneumonia, at the time of her admission for medical stabilization. RESULTS: The speech pathology team administered dysphagia therapy, using neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy. Following the course of dysphagia treatment intervention, the patient was able to tolerate an oral diet with improved swallowing function and no ongoing aspiration. DISCUSSION: Patients with severe anorexia nervosa should be screened for possible dysphagia. NMES in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeds and prolonged hospitalization.
