Screening of Oropharyngeal Dysphagia in Patients with Diabetes Mellitus
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
Background: Diabetes mellitus is a systemic endocrinal disease that results either from deficiency of insulin hormone (type 1) or from insulin resistance or both (type 2). Literature is scarce related to dysphagia with diabetes. This complaint is expressed by some patients and needs to be explored. A-EAT-10 is a questionnaire that explores the presence of dysphagia symptoms among patients. Aim: The aim of this work is to screen Egyptian diabetic patients (type 1 and type 2) in El-Demerdash hospital for oropharyngeal dysphagia using the validated Arabic version of Eating Assessment Tool (A-EAT-10) questionnaire to explore the degree of such symptom among them. Study design: This was a cross-sectional study conducted to screen the diabetic patients (of both type 1 and type 2) in El-Demerdash hospital for oropharyngeal dysphagia. Patients and methods: 200 Egyptian adult diabetic patients, aged 18y.1m.1d – 59y.12m.31d, were included in this study. The participants were selected upon certain inclusion and exclusion criteria. The inclusion criteria were diabetic patients of type 1 and/or type 2. The exclusion criteria were any past or present history of disorders that might cause oropharyngeal dysphagia. Patients were asked to complete the Arabic version of the Eating Assessment Tool – 10 (A-EAT-10) questionnaire. It is formed of 10 questions, and used to detect the presence of dysphagia complaints among patients and how it affects them. Results: The increase in age and having a female gender were considered of high risk for dysphagia among diabetic patients participating in this study. The commonest symptom among diabetic patients who complained from dysphagia was “I cough when I eat”. There is no relation between the type or duration of diabetes mellitus and the presence of oropharyngeal dysphagia. Conclusion: The present study showed that diabetic patients may encounter swallowing problems. The A-EAT 10 is an easy method that can be used for screening of swallowing difficulty. Dysphagia is the medical term that is used to describe the difficulty of swallowing and the feeling of difficulty in passage of solids or semisolids or liquids from the mouth to the stomach [1- 2]. Dysphagia is not a disease, but rather a symptom that results from an underlying etiology or cause [3]. Dysphagia is classified in the clinical setting according to the extent of oral, pharyngeal or esophageal phase deficits into oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia describes the difficulty to start a swallow in one of its 3 phases; the oral preparatory, oral voluntary and the pharyngeal phases. This may cause food to enter the larynx and lead to choking, coughing, or even aspiration pneumonia. This is typically felt in the region of the back of the throat. While, esophageal dysphagia describes the feeling of food being stuck in neck or chest and this occurs with diseases that involve the esophagus [4]. There are systemic diseases that may cause dysphagia such as [5]: A. Connective tissue diseases such as scleroderma and systemic lupus erythematosus. B. Infectious diseases such as Chagas’ disease. C. Inflammatory diseases such as sarcoidosis. D. Endocrinal diseases such as diabetes mellitus. Dysphagia can have a huge impact on different aspects of a patient’s life and is associated with increased morbidity and mortality, and may lead to a variety of clinical complications including dehydration, malnutrition and aspiration pneumonia [6]. Although, there are many tools that developed for early detection of dysphagia in the clinical practice, few tools have been developed to assess the patient’s perception of his/her dysphagia-related problems in terms of quality of life, emotional and psychosocial effects. Some of these questionnaires are: A. Eating Assessment Tool (EAT-10) is a tool used to measure the swallowing problems. It is also validated in the Arabic language by Farahat and Mosallem [7] and called the validated Arabic version of Eating Assessment Tool (A-EAT-10) for Arab speaking patients with oropharyngeal dysphagia [7]. B. The swallowing related quality of life (SWAL-QOL): was developed by McHorney et al. [8] as a patient-based dysphagiaspecific tool to evaluate the impact of swallowing problems on the quality of life in patients with dysphagia. C. M.D. Anderson Dysphagia Inventory (MDADI) was the first validated questionnaire that was designed specifically to assess the effect of dysphagia on quality of life of patients with head/neck cancer [9]. D. Dysphagia Handicap Index (DHI) is a validated and standardized English questionnaire that describes the handicapping effect of dysphagia on emotional, functional, and physical aspects of individual’s lives [10]. Diabetes mellitus is a systemic endocrinal disease that results either from deficiency of insulin hormone (type 1) or from insulin resistance or both (type 2) [11]. Dysphagia could be a complication of diabetes mellitus and it is observed that all phases of swallowing are affected in diabetes mellitus especially the oropharyngeal phase. Although, the pathophysiology of the oropharyngeal dysphagia in diabetics is still not completely clear, the autonomic neuropathy associated with long term hyperglycemia is claimed to be the cause [12]. Restivo et al. [12] reported that oropharyngeal dysphagia in DM may occur due to impaired coordination between the inferior constrictor (IC) muscle and the cricopharyngeus (CP) muscle of the upper esophageal sphincter (UES) with hyperactivity of the cricopharyngeus (CP) muscle during the swallowing process. Questions arise about oropharyngeal dysphagia in diabetes; its prevalence, whether it is related more to diabetes type 1 or type 2, or duration of diabetes. Literature is scared related to dysphagia with diabetes; however, this complaint is expressed by some patients and needs to be explored
Authors and Affiliations
Marwa M Saleh, Meram M Bekhet, Mona S Khodeir, Donia A Zakaria, Samia E Bassiouny
Keywords
Related Articles
- EP ID EP567439
- DOI 10.26717/BJSTR.2017.01.000206
- Views 176
- Downloads 0
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