For people with dysphagia, eating is often fraught with pain or fear, says Johns Hopkins laryngologist Shumon Dhar. Because dysphagia can have detrimental long-term effects, he says, including significant weight loss, decreased nutrition, aspiration pneumonia and prolonged hospitalization, Dhar and a multidisciplinary team of colleagues work together to treat dysphagia using a variety of approaches.
“Swallowing starts at the mouth and ends at the stomach,” Dhar says, “so we need a diverse group of experts and tools at our disposal to effectively treat swallowing problems in a holistic way.”
As dysphagia is a symptom that can arise from many potential causes, he says, accurate diagnosis is key in getting patients relief. Johns Hopkins offers the most comprehensive diagnostic program in the mid-Atlantic region, using some methods and tools that aren’t widely available elsewhere.
An integral part of the workup is swallowing fluoroscopy or a barium swallow study performed by a radiologist, sometimes in conjunction with a speech language pathologist. These tests allow Dhar and his colleagues to identify anatomical and physiologic abnormalities in real time. Sometimes these studies can lend themselves to on-the-spot therapy, with patients receiving some relief from learning swallowing maneuvers and strategies taught during the tests.
Because one of the most common causes of dysphagia is gastroesophageal reflux disease, patients can benefit from objective pH testing using either a hardwired transnasal probe or a high-tech capsule attached to the esophagus during endoscopy. Motility problems (or problems of movement of the esophagus) are diagnosed with high-resolution manometry using a probe in the esophagus that records pressure generated during the swallowing process.
At the Johns Hopkins Health Care & Surgery Center – Green Spring Station, Dhar and his colleagues recently began offering transnasal esophagoscopy (TNE), a procedure unique to the region that allows doctors to thoroughly examine the esophagus and stomach through an ultrathin endoscope inserted through the nose. Not only do patients stay awake during this in-office procedure, avoiding potential side effects from anesthesia, but TNE can be combined with other diagnostic and therapeutic procedures, including biopsy of the larynx or esophagus, balloon dilation of the esophagus, therapeutic injections of botulinum toxin or steroids, or secondary tracheoesophageal prosthesis evaluation and placement.
Once patients have the correct diagnosis, many cases of dysphagia can be treated noninvasively with swallowing therapy delivered by Johns Hopkins’ team of speech language pathologists or with medication. Other disease processes may require sedated endoscopic management or surgery performed by Dhar or one of his colleagues. “We offer the whole gamut of options within our team,” he says.
Getting patients back to living life to the fullest extent possible is their ultimate goal, Dhar says. “It’s extremely gratifying as a physician when we hear that patients with the most profound swallowing difficulties can eat meals with their families again.”