You can use your existing Medical Independent, MediLearning or PharmacistCPD account to log in. is Ireland's only investigative medical news website for doctors, healthcare professionals and anyone with an interest in health issues.

Established in 2010, along with its sister publication The Medical Independent, our stated aim is to investigate and analyse the major issues affecting healthcare and the medical profession in Ireland. The Medical Independent has won a number of awards for its investigative journalism, and its stories are frequently picked up by national digital, broadcast and print media. The Medical Independent is published by GreenCross Publishing.

Address: Top Floor, 111 Rathmines Road Lr, Dublin 6

Tel: 353 (01) 441 0024

GreenCross Publishing is owned by Graham Cooke.

The benefits of registering: only registered users:
  • receive the ecCopy two days prior to the printed edition.
  • have automatic access to our free CPD sites.
  • can partake in our online MCQs.
  • can enter our online sports quiz.

Sign up now for ease of access to The Medical Independent, Ireland’s most frequently published medical newspaper, delivering award-winning news and investigative reporting.

Download the new Mindo app for both IOS & Android.

  • Get notified when a story goes live
  • Access Premium Content
  • Read Offline
[the_ad_placement id="main-ldb-public"]
[the_ad_placement id="main-ldb-mobile-public"]

You are reading 1 of 2 free-access articles allowed for 30 days

A focus on dysphagia

By Dermot - 30th Aug 2018 | 8 views

Dysphagia is one of the many complications of stroke and approximately 10,000 people in Ireland have a stroke-related event annually. Furthermore, an estimated 30,000 people are living in the community with disabilities as a result of a stroke.

It is also a frequent symptom in frail, older people or in individuals with any impairment of oral structure, or their respiratory or neurological systems, and is observed in a large proportion of people with dementia. It can also occur in patients with Chronic Obstructive Pulmonary Disease (COPD) and those with head and neck cancers.

Dysphagia refers to the sensation of not being able to swallow, food ‘sticking’ or not passing, choking episodes, or aspiration of food and/or liquids. It can also affect a patient’s ability to take medication and therefore can result in practices such as crushing and/or mixing, which can adversely affect the pharmacodynamics of the drug.

Dysphagia is also a strong predictor of malnutrition risk and dysphagic stroke patients are 2.4 times more likely to be malnourished compared with those who have normal swallowing function.

<h3 class=”subheadMIstyles”>Stroke</h3>

According to the Irish Heart Foundation, one-in-five people will have a stroke at some time in their life and approximately 50 per cent of people who have a stroke have swallowing problems. Other figures put the prevalence at up to 60 per cent, “which may rise to 100 per cent if minor deficits such as minor tongue weakness are accepted as evidence of dysphagia”, according to a 2016 paper in the journal <em>Current Physical Medicine and Rehabilitation Reports</em> (‘Dysphagia Management and Stroke Units,’ Dr David G Smithard).

“In many cases, dysphagia resolves fairly quickly, but in others, the swallow will vary in function,” states the same paper. “Management, at present, is based around texture modification of food/liquids and swallowing manoeuvres. Rehabilitation of swallowing remains in its infancy, but there is a lot of promising research with neurostimulation, medication and devices to strengthen muscles involved in swallowing.”

The HSE’s National Clinical Programme for Stroke has produced a <em>National Guideline for Swallow Screening in Stroke </em>(2017), which aims to support all acute stroke services in the development of a swallow screening service for stroke patients within their organisation.

<h3 class=”subheadMIstyles”>Consequences</h3>

Worryingly, where dysphagia is not identified and managed, it can severely impact on a patient’s health, with consequences ranging from unintended medication non-adherence, to choking, aspiration pneumonia and even death.

However, many healthcare professionals are unaware when patients may be having difficulties with swallowing their medicines. Furthermore, patients living in the community may not report dysphagia to their GP or pharmacist.

The Society of Hospital Pharmacists of Australia has stated that, where possible, dose alteration should be avoided and alternate dose forms or routes of administration should be found. Likewise, the National Institute for Health and Care Excellence (NICE), UK, recommended for patients with dysphagia that fluids and food should be administered in a form that can be swallowed without aspiration.

Gloup is an OTC swallowing gel for oral medication and it may be able to help patients maintain their treatment regimen. It facilitates the intake of medication in solid form, including tablets and capsules. It works by moistening the mucous membranes in the mouth and throat cavity and allowing the tablets to pass smoothly via the oesophagus to the stomach.

Some preliminary work from The University of Queensland, Australia, has assessed the effect of Gloup on drug dissolution (Crino L, Manrique YJ, Cichero JA, Steadman KJ, eds. Characterisation of Gloup: is it suitable for medication delivery in dysphagic patients? APSA-ASCEPT, 2015).

The authors concluded that Gloup had no effect on drug dissolution, unlike some gum-based thickeners designed to ensure safe fluid delivery in dysphagia.

<div style=”background: #e8edf0; padding: 10px 15px; margin-bottom: 15px;”> <p class=”subheadMIstyles”><strong>Symptoms of dysphagia</strong>

<p class=”listBULLETLISTTEXTMIstyles”>Odynophagia.

<p class=”listBULLETLISTTEXTMIstyles”>Being unable to swallow.

<p class=”listBULLETLISTTEXTMIstyles”>Recurrent chest infections.

<p class=”listBULLETLISTTEXTMIstyles”>Patient having the sensation of food getting stuck in their throat or chest or sternum.

<p class=”listBULLETLISTTEXTMIstyles”>Drooling.

<p class=”listBULLETLISTTEXTMIstyles”>Hoarse or wet mouth.

<p class=”listBULLETLISTTEXTMIstyles”>Nasal regurgitation.

<p class=”listBULLETLISTTEXTMIstyles”>Frequent heartburn.

<p class=”listBULLETLISTTEXTMIstyles”>Unexpected weight loss.

<p class=”listBULLETLISTTEXTMIstyles”>Coughing or gagging when swallowing.

Taking longer than usual to finish a meal.


Leave a Reply

[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]
Latest Issue
The Medical Independent – 24 June 2021

You need to be logged in to access this content. Please login or sign up using the links below.

[the_ad_placement id="main-mpu-public"]
Most Read
[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]