Modified Mondays: Esophagus, Revisited, Again
Updated: Dec 19, 2022
As a mobile provider, we have the luxury of weekly reminders of why scanning the esophagus can give critical information to the care of the patient. For SLPs that don’t get the chance to see it so often, here is yet another clip of an esophageal issue that could have easily been missed. Please forgive my sometime obsession on the topic of esophageal scans.
Hoping by now we have driven home how often esophageal issues can produce symptoms that are identical to symptoms of oropharyngeal dysphagia, including coughing post swallow, multiple swallows per bite/sip, poor PO intake, and complaints from the patient about food or pills “stuck”. Without a thorough instrumental, there is just no way to know the cause of the symptoms…and more importantly, implement an appropriate plan of care.
This particular patient is a great example of esophageal issues that clinically look just like oropharyngeal dysphagia. Patient not only had some inconsistent cough post swallow, but also the infamous recurrent right lower lobe pneumonia. (More on this in an upcoming post!!). Thankfully, this facility SLP knew the need for an instrumental assessment prior to implementing diet changes and/or strategies and therapy. We found a really beautiful swallow… and some very significant dysmotility in the esophagus. We were able to make the GI referral, which the patient was scheduled for shortly after.
In this case, all referrals happened just they way they needed to to ensure an appropriate plan for the patient. So often, we see a patient that will be seen for several weeks of needless therapy or have an unnecessary altered diet implemented, all while the real problem is unrecognized. This results in not only wasted time for the patient, but also wasted dollars for the facility and pay source.
When completing an MBS and finding a normal swallow, carefully consider whether the symptoms could indicate an esophageal component, it’s usually worth a look… and maybe another blog post. No promises that I am ready to leave this topic alone.
Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing - PubMed (nih.gov)
Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol - PubMed (nih.gov)