Dziewas Rainer, Allescher Hans-Dieter, Aroyo Ilia, Bartolome Gudrun, Beilenhoff Ulrike, Bohlender Jörg, Breitbach-Snowdon Helga, Fheodoroff Klemens, Glahn Jörg, Heppner Hans-Jürgen, Hörmann Karl, Ledl Christian, Lücking Christoph, Pokieser Peter, Schefold Joerg C, Schröter-Morasch Heidrun, Schweikert Kathi, Sparing Roland, Trapl-Grundschober Michaela, Wallesch Claus, Warnecke Tobias, Werner Cornelius J, Weßling Johannes, Wirth Rainer, Pflug Christina
Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany.
Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
Neurol Res Pract. 2021 May 4;3(1):23. doi: 10.1186/s42466-021-00122-3.
Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies.
This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with.
The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online ( https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf ).
神经源性吞咽困难是指由中枢和周围神经系统疾病、神经肌肉传递障碍或肌肉疾病引起的吞咽障碍。神经源性吞咽困难是许多神经系统疾病中最常见且同时也是最危险的症状之一。其最重要的后遗症包括吸入性肺炎、营养不良和脱水，受影响的患者更常需要长期护理，且死亡率增加。基于对PubMed上有关神经源性吞咽困难诊断和治疗的相关原始论文、综述文章、国际指南及调查的系统研究，启动了一个共识制定过程，其中包括来自27个医学协会的吞咽困难专家。
本指南包含53条建议，第一部分涵盖了从吞咽困难特定病史、初始吞咽困难筛查和临床评估到更精细的仪器检查程序（如吞咽的柔性内镜评估、电视荧光吞咽造影检查和高分辨率测压）的整个诊断范围。此外，还涵盖了特定临床场景，包括鼻胃管和气管切开管患者的管理。本指南的第二部分致力于神经源性吞咽困难的治疗。除了饮食干预和行为吞咽治疗外，还涉及改善口腔卫生的干预措施、药物治疗选择、不同形式的神经刺激以及微创和手术治疗。
神经源性吞咽困难的诊断和治疗具有挑战性，需要不同医学专业的共同努力。虽然支持实施吞咽困难筛查的证据相当有说服力，但仍需要进一步试验以提高更精细的吞咽困难诊断方法，特别是神经源性吞咽困难不同治疗选择的证据质量。本文是最近在线发表的指南（https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf）的节略和翻译版本。
