A difficult bite: An overview of dysphagia
Main Article Content
Keywords
dysphagia, malnutrition, texture-modified diets
Abstract
Dysphagia describes the difficulty in swallowing during the passage of a bolus from the mouth to the stomach or the perception of obstruction during swallowing. It is a symptom of several oncological, neurological or neuromuscular pathologies. Dysphagia can also be found in sarcopenic patients, as a clinical feature of loss of strength and function of swallowing muscles.
Diagnosis can be challenging due to the non-specificity of symptoms and the heterogeneity of aetiology and requires a multidimensional approach, comprising screening tools and instrumental assessment. Dysphagia is an issue of nutritional interest since predisposes to malnutrition and dehydration. Dysphagic patients, indeed, are usually not able to cover their nutritional and fluid needs both because of the change in swallowing mechanics and because the nutritional value of texture-modified diets.
A well-structured nutrition plan needs a multidimensional approach developed by a multidisciplinary tea, who firstly define the nutritional needs, work on the adequate nutritional plan, then predispose a well-organized follow-up. Food fortification, in-between-meal nutritious snacks and oral nutritional supplements, artificial nutrition, preferably enteral nutrition through nasogastric tube or gastrostomy are the essential steps of nutritional management of dysphagic patients.
References
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3. Zhao WT, Yang M, Wu HM, Yang L, Zhang XM, Huang Y. Systematic Review and Meta-Analysis of the Association between Sarcopenia and Dysphagia. J Nutr Health Aging. 2018;22(8):1003-1009. doi: 10.1007/s12603-018-1055-z.
4. Madhavan A, LaGorio LA, Crary MA, Dahl WJ, Carnaby GD. Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review. J Nutr Health Aging. 2016;20(8):806-815
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6. Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia. 2023 Feb;38(1):76-121. doi: 10.1007/s00455-022-10465-x
7. Byun SE, Kwon KB, Kim SH, Lim SJ. The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea. BMC Geriatr. 2019 Dec 18;19(1):356. doi: 10.1186/s12877-019-1382-x.
8. Miller N, Patterson J. Dysphagia: implications for older people. Reviews in Clinical Gerontology. 2014;24(1):41-57. doi:10.1017/S095925981300021X
9. Altman KW, Yu G, Schaefer SD. Consequence of Dysphagia in the Hospitalized Patient: Impact on Prognosis and Hospital Resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–789. doi:10.1001/archoto.2010.129
10. Kuo P, Holloway RH, Nguyen NQ. Current and future techniques in the evaluation of dysphagia. J Gastroenterol Hepatol 2012;27(5):873–881
11. Carucci LR, Turner MA. Dysphagia revisited: common and unusual causes. Radiographics. 2015 Jan-Feb;35(1):105-22. doi: 10.1148/rg.351130150
12. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion: is the patient accurate? Dig Dis Sci 1995;40(10):2192–2196
13. Dylczyk-Sommer A. Dysphagia. Part 1: General issues. Anaesthesiol Intensive Ther. 2020;52(3):226-232. doi: 10.5114/ait.2020.98074
14. Clavé, P., Shaker, R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 12, 259–270 (2015). https://doi.org/10.1038/nrgastro.2015.49
15. Panebianco M, Marchese-Ragona R, Masiero S, Restivo DA. Dysphagia in neurological diseases: a literature review. Neurol Sci. 2020 Nov;41(11):3067-3073. doi: 10.1007/s10072-020-04495-2
16. Ricci Maccarini A, Filippini A, Padovani D, Limarzi M, Loffredo M, Casolino D. Clinical non-instrumental evaluation of dysphagia. Acta Otorhinolaryngol Ital. 2007 Dec;27(6):299-305
17. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia. 2008 Sep;23(3):244-50. doi: 10.1007/s00455-007-9127-y
18. Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope. 2011 Jul;121(7):1383-7. doi: 10.1002/lary.21839
19. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008 Dec;117(12):919-24. doi: 10.1177/000348940811701210
20. Nishimura K, Kagaya H, Shibata S, et al. Accuracy of dysphagia severity scale rating without using videoendoscopic evaluation of swallowing. Journal of Japanese Comprehensive Rehabilitation Science. 2015;6:124–8. doi: 10.11336/jjcrs.6.124.
21. Langmore SE. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia. 2017;32(1):27–38
22. Dziewas, R., auf dem Brinke, M., Birkmann, U. et al. Safety and clinical impact of FEES – results of the FEES-registry. Neurol. Res. Pract. 1, 16 (2019). doi: 10.1186/s42466-019-0021-5
23. Ramsey D, Smithard D, Kalra L. Silent aspiration: what do we know? Dysphagia. 2005 Summer;20(3):218-25. doi: 10.1007/s00455-005-0018-9
24. Fattori B, Grosso M, Bongioanni P, et al. Assessment of swallowing by oropharyngoesophageal scintigraphy in patients with amyotrophic lateral sclerosis. Dysphagia 2006; 21: 280-286. doi: 10.1007/s00455-006-9052-5
25. Moloney J, Regan J, Walshe M. Patient Reported Outcome Measures in Dysphagia Research Following Stroke: A Scoping Review and Qualitative Analysis. Dysphagia. 2023 Feb;38(1):181-190. doi: 10.1007/s00455-022-10448-y
26. Patel DA, Sharda R, Hovis KL, et al. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus. 2017;30:1–23
27. Smith R, Bryant L, Hemsley B. The true cost of dysphagia on quality of life: The views of adults with swallowing disability. Int J Lang Commun Disord. 2023 Mar;58(2):451-466. doi: 10.1111/1460-6984
28. Nielsen AH, Kaldan G, Nielsen BH, Kristensen GJ, Shiv L, Egerod I. Intensive care professionals' perspectives on dysphagia management: A focus group study. Aust Crit Care. 2023 Jul;36(4):528-535. doi: 10.1016/j.aucc.2022.04.004
29. Lazarus CL. History of the use and impact of compensatory strategies in management of swallowing disorders. Dysphagia. 2017;32(1):3–10. doi: 10.1007/s00455-016-9779-6
30. Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Dysphagia. 2016;31(2):232–249. doi: 10.1007/s00455-016-9696-8
31. Cheng I, Hamad A, Sasegbon A, Hamdy S. Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations. Neuropsychiatr Dis Treat. 2022 Oct 14;18:2251-2263. doi: 10.2147/NDT.S371624
32. Cichero JA, Lam P, Steele CM, et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia. 2017 Apr;32(2):293-314. doi: 10.1007/s00455-016-9758-y
33. International Dysphagia Diet Standardisation Initiative: https://www.iddsi.org/ (2022). Accessed 11 January 2024
34. Silva LML, Lima CR, Cunha DA, Orange LG. Dysphagia and its relation with nutritional status and calorie/protein intake in the elderly Rev CEFAC. 2019;21(3):e15618. Doi:10.1590/19820216/201921315618
35. Saleedaeng P, Korwanich N, Muangpaisan W, Korwanich K. Effect of Dysphagia on the Older Adults' Nutritional Status and Meal Pattern. J Prim Care Community Health. 2023 Jan-Dec;14:21501319231158280. doi: 10.1177/21501319231158280
36. O'Keeffe M, Kelly M, O'Herlihy E, et al. Potentially modifiable determinants of malnutrition in older adults: A systematic review. Clin Nutr. 2019 Dec;38(6):2477-2498. doi: 10.1016/j.clnu.2018.12.007.
37. Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel). 2021 May 24;9(6):624. doi: 10.3390/healthcare9060624
38. Ahlinder A, Hoglund E, Ohgren C, Milijkovic A, Stading M. Towards attractive texture-modified foods with increased fiber content for dysphagia via 3D printing and 3D scanning. Front Food Sci Technol. 2023;2:105864. doi: 10.3389/frfst.2022.105864
39. Ott A, Senger M, Lötzbeyer T, Gefeller O, Sieber CC, Volkert D. Effects of a Texture-Modified, Enriched, and Reshaped Diet on Dietary Intake and Body Weight of Nursing Home Residents with Chewing and/or Swallowing Problems: An Enable Study. J Nutr Gerontol Geriatr. 2019 Oct-Dec;38(4):361-376. doi: 10.1080/21551197.2019.1628158.
40. Ueshima J, Shimizu A, Maeda K, et al. Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People. J Am Med Dir Assoc. 2022 Oct;23(10):1676-1682. doi: 10.1016/j.jamda.2022.07.009.
41. Bannerman E, McDermott K. Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: the role of snacks. J Am Med Dir Assoc. 2011 Mar;12(3):234-9. doi: 10.1016/j.jamda.2010.06.001.
42. Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10e47
43. Todorovic V. Evidence-based strategies for the use of oral nutritional supplements. Br J Community Nurs. 2005 Apr;10(4):158, 160, 162-4. doi: 10.12968/bjcn.2005.10.4.17954.
44. Wu XS, Yousif L, Miles A, Braakhuis A. A Comparison of Dietary Intake and Nutritional Status between Aged Care Residents Consuming Texture-Modified Diets with and without Oral Nutritional Supplements. Nutrients. 2022 Feb 5;14(3):669. doi: 10.3390/nu14030669.
45. Ley D, Austin K, Wilson KA, Saha S. Tutorial on adult enteral tube feeding: Indications, placement, removal, complications, and ethics. JPEN J Parenter Enteral Nutr. 2023 Jul;47(5):677-685. doi: 10.1002/jpen.2510
46. Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020 Jan;39(1):5-22. doi: 10.1016/j.clnu.2019.04.022
47. Jéquier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010 Feb;64(2):115-23. doi: 10.1038/ejcn.2009.111.
48. Li S, Xiao X, Zhang X. Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients. 2023 Jun 2;15(11):2609. doi: 10.3390/nu15112609.
49. Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis. 2016 Jan;23(1):19-28. doi: 10.1053/j.ackd.2015.08.004.
50. Puga AM, Lopez-Oliva S, Trives C, Partearroyo T, Varela-Moreiras G. Effects of Drugs and Excipients on Hydration Status. Nutrients. 2019 Mar 20;11(3):669. doi: 10.3390/nu11030669
51. Steele CM, Alsanei WA, Ayanikalath S, et al . The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015 Feb;30(1):2-26. doi: 10.1007/s00455-014-9578-x. Epub 2014 Oct 25. Erratum in: Dysphagia. 2015 Apr;30(2):272-3. doi: 10.1007/s00455-015-9603-8.
52. Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin. Nutr. 2001;20:423–428. doi: 10.1054/clnu.2001.0467
53. Adapted from “Harrison’s Principles of Internal Medicine”
2. Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases. 2023 Apr 16;11(11):2363-2373. doi: 10.12998/wjcc.v11.i11.2363
3. Zhao WT, Yang M, Wu HM, Yang L, Zhang XM, Huang Y. Systematic Review and Meta-Analysis of the Association between Sarcopenia and Dysphagia. J Nutr Health Aging. 2018;22(8):1003-1009. doi: 10.1007/s12603-018-1055-z.
4. Madhavan A, LaGorio LA, Crary MA, Dahl WJ, Carnaby GD. Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review. J Nutr Health Aging. 2016;20(8):806-815
5. Takizawa C, Gemmell E, Kenworthy J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson's Disease, Alzheimer's Disease, Head Injury, and Pneumonia. Dysphagia. 2016 Jun;31(3):434-41. doi: 10.1007/s00455-016-9695-9.
6. Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia. 2023 Feb;38(1):76-121. doi: 10.1007/s00455-022-10465-x
7. Byun SE, Kwon KB, Kim SH, Lim SJ. The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea. BMC Geriatr. 2019 Dec 18;19(1):356. doi: 10.1186/s12877-019-1382-x.
8. Miller N, Patterson J. Dysphagia: implications for older people. Reviews in Clinical Gerontology. 2014;24(1):41-57. doi:10.1017/S095925981300021X
9. Altman KW, Yu G, Schaefer SD. Consequence of Dysphagia in the Hospitalized Patient: Impact on Prognosis and Hospital Resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–789. doi:10.1001/archoto.2010.129
10. Kuo P, Holloway RH, Nguyen NQ. Current and future techniques in the evaluation of dysphagia. J Gastroenterol Hepatol 2012;27(5):873–881
11. Carucci LR, Turner MA. Dysphagia revisited: common and unusual causes. Radiographics. 2015 Jan-Feb;35(1):105-22. doi: 10.1148/rg.351130150
12. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion: is the patient accurate? Dig Dis Sci 1995;40(10):2192–2196
13. Dylczyk-Sommer A. Dysphagia. Part 1: General issues. Anaesthesiol Intensive Ther. 2020;52(3):226-232. doi: 10.5114/ait.2020.98074
14. Clavé, P., Shaker, R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 12, 259–270 (2015). https://doi.org/10.1038/nrgastro.2015.49
15. Panebianco M, Marchese-Ragona R, Masiero S, Restivo DA. Dysphagia in neurological diseases: a literature review. Neurol Sci. 2020 Nov;41(11):3067-3073. doi: 10.1007/s10072-020-04495-2
16. Ricci Maccarini A, Filippini A, Padovani D, Limarzi M, Loffredo M, Casolino D. Clinical non-instrumental evaluation of dysphagia. Acta Otorhinolaryngol Ital. 2007 Dec;27(6):299-305
17. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia. 2008 Sep;23(3):244-50. doi: 10.1007/s00455-007-9127-y
18. Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope. 2011 Jul;121(7):1383-7. doi: 10.1002/lary.21839
19. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008 Dec;117(12):919-24. doi: 10.1177/000348940811701210
20. Nishimura K, Kagaya H, Shibata S, et al. Accuracy of dysphagia severity scale rating without using videoendoscopic evaluation of swallowing. Journal of Japanese Comprehensive Rehabilitation Science. 2015;6:124–8. doi: 10.11336/jjcrs.6.124.
21. Langmore SE. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia. 2017;32(1):27–38
22. Dziewas, R., auf dem Brinke, M., Birkmann, U. et al. Safety and clinical impact of FEES – results of the FEES-registry. Neurol. Res. Pract. 1, 16 (2019). doi: 10.1186/s42466-019-0021-5
23. Ramsey D, Smithard D, Kalra L. Silent aspiration: what do we know? Dysphagia. 2005 Summer;20(3):218-25. doi: 10.1007/s00455-005-0018-9
24. Fattori B, Grosso M, Bongioanni P, et al. Assessment of swallowing by oropharyngoesophageal scintigraphy in patients with amyotrophic lateral sclerosis. Dysphagia 2006; 21: 280-286. doi: 10.1007/s00455-006-9052-5
25. Moloney J, Regan J, Walshe M. Patient Reported Outcome Measures in Dysphagia Research Following Stroke: A Scoping Review and Qualitative Analysis. Dysphagia. 2023 Feb;38(1):181-190. doi: 10.1007/s00455-022-10448-y
26. Patel DA, Sharda R, Hovis KL, et al. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus. 2017;30:1–23
27. Smith R, Bryant L, Hemsley B. The true cost of dysphagia on quality of life: The views of adults with swallowing disability. Int J Lang Commun Disord. 2023 Mar;58(2):451-466. doi: 10.1111/1460-6984
28. Nielsen AH, Kaldan G, Nielsen BH, Kristensen GJ, Shiv L, Egerod I. Intensive care professionals' perspectives on dysphagia management: A focus group study. Aust Crit Care. 2023 Jul;36(4):528-535. doi: 10.1016/j.aucc.2022.04.004
29. Lazarus CL. History of the use and impact of compensatory strategies in management of swallowing disorders. Dysphagia. 2017;32(1):3–10. doi: 10.1007/s00455-016-9779-6
30. Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Dysphagia. 2016;31(2):232–249. doi: 10.1007/s00455-016-9696-8
31. Cheng I, Hamad A, Sasegbon A, Hamdy S. Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations. Neuropsychiatr Dis Treat. 2022 Oct 14;18:2251-2263. doi: 10.2147/NDT.S371624
32. Cichero JA, Lam P, Steele CM, et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia. 2017 Apr;32(2):293-314. doi: 10.1007/s00455-016-9758-y
33. International Dysphagia Diet Standardisation Initiative: https://www.iddsi.org/ (2022). Accessed 11 January 2024
34. Silva LML, Lima CR, Cunha DA, Orange LG. Dysphagia and its relation with nutritional status and calorie/protein intake in the elderly Rev CEFAC. 2019;21(3):e15618. Doi:10.1590/19820216/201921315618
35. Saleedaeng P, Korwanich N, Muangpaisan W, Korwanich K. Effect of Dysphagia on the Older Adults' Nutritional Status and Meal Pattern. J Prim Care Community Health. 2023 Jan-Dec;14:21501319231158280. doi: 10.1177/21501319231158280
36. O'Keeffe M, Kelly M, O'Herlihy E, et al. Potentially modifiable determinants of malnutrition in older adults: A systematic review. Clin Nutr. 2019 Dec;38(6):2477-2498. doi: 10.1016/j.clnu.2018.12.007.
37. Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel). 2021 May 24;9(6):624. doi: 10.3390/healthcare9060624
38. Ahlinder A, Hoglund E, Ohgren C, Milijkovic A, Stading M. Towards attractive texture-modified foods with increased fiber content for dysphagia via 3D printing and 3D scanning. Front Food Sci Technol. 2023;2:105864. doi: 10.3389/frfst.2022.105864
39. Ott A, Senger M, Lötzbeyer T, Gefeller O, Sieber CC, Volkert D. Effects of a Texture-Modified, Enriched, and Reshaped Diet on Dietary Intake and Body Weight of Nursing Home Residents with Chewing and/or Swallowing Problems: An Enable Study. J Nutr Gerontol Geriatr. 2019 Oct-Dec;38(4):361-376. doi: 10.1080/21551197.2019.1628158.
40. Ueshima J, Shimizu A, Maeda K, et al. Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People. J Am Med Dir Assoc. 2022 Oct;23(10):1676-1682. doi: 10.1016/j.jamda.2022.07.009.
41. Bannerman E, McDermott K. Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: the role of snacks. J Am Med Dir Assoc. 2011 Mar;12(3):234-9. doi: 10.1016/j.jamda.2010.06.001.
42. Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10e47
43. Todorovic V. Evidence-based strategies for the use of oral nutritional supplements. Br J Community Nurs. 2005 Apr;10(4):158, 160, 162-4. doi: 10.12968/bjcn.2005.10.4.17954.
44. Wu XS, Yousif L, Miles A, Braakhuis A. A Comparison of Dietary Intake and Nutritional Status between Aged Care Residents Consuming Texture-Modified Diets with and without Oral Nutritional Supplements. Nutrients. 2022 Feb 5;14(3):669. doi: 10.3390/nu14030669.
45. Ley D, Austin K, Wilson KA, Saha S. Tutorial on adult enteral tube feeding: Indications, placement, removal, complications, and ethics. JPEN J Parenter Enteral Nutr. 2023 Jul;47(5):677-685. doi: 10.1002/jpen.2510
46. Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020 Jan;39(1):5-22. doi: 10.1016/j.clnu.2019.04.022
47. Jéquier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010 Feb;64(2):115-23. doi: 10.1038/ejcn.2009.111.
48. Li S, Xiao X, Zhang X. Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients. 2023 Jun 2;15(11):2609. doi: 10.3390/nu15112609.
49. Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis. 2016 Jan;23(1):19-28. doi: 10.1053/j.ackd.2015.08.004.
50. Puga AM, Lopez-Oliva S, Trives C, Partearroyo T, Varela-Moreiras G. Effects of Drugs and Excipients on Hydration Status. Nutrients. 2019 Mar 20;11(3):669. doi: 10.3390/nu11030669
51. Steele CM, Alsanei WA, Ayanikalath S, et al . The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015 Feb;30(1):2-26. doi: 10.1007/s00455-014-9578-x. Epub 2014 Oct 25. Erratum in: Dysphagia. 2015 Apr;30(2):272-3. doi: 10.1007/s00455-015-9603-8.
52. Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin. Nutr. 2001;20:423–428. doi: 10.1054/clnu.2001.0467
53. Adapted from “Harrison’s Principles of Internal Medicine”
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Mignini EV, Catani M, Ferrara M, Taus M. A difficult bite: An overview of dysphagia. Progr Nutr [Internet]. 2024 Dec. 19 [cited 2024 Dec. 19];26(3-4):e2024022. Available from: https://mattioli1885journals.com/index.php/progressinnutrition/article/view/15871
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How to Cite
1.
Mignini EV, Catani M, Ferrara M, Taus M. A difficult bite: An overview of dysphagia. Progr Nutr [Internet]. 2024 Dec. 19 [cited 2024 Dec. 19];26(3-4):e2024022. Available from: https://mattioli1885journals.com/index.php/progressinnutrition/article/view/15871
