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Treatment for swallowing difficulties (dysphagia) in chronic muscle diseaseHill M, Hughes T, Milford C
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SummaryMore research is needed to show which interventions are most effective in managing swallowing difficulties (dysphagia) in long-term, progressive muscle diseasePeople with long-lasting, progressive muscle disease often develop swallowing difficulties (dysphagia), normally as a result of muscle weakness. This can lead to weight loss or inability to gain weight, breathing problems due to food inhalation into the airways or social problems resulting from embarrassment about coughing or spluttering while eating. The main treatment options for dysphagia are dietary manipulation (altering the consistency of food and adding supplements), adopting safe swallowing techniques, surgical interventions and feeding through the stomach (enteral feeding). No randomised controlled trials of the effectiveness of treatments for dysphagia in muscle disease were identified. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 19. 2004 AbstractBackgroundThe management of dysphagia (difficulty in swallowing), a common complication of long-term progressive muscle disease in children and adults, is currently unclear. ObjectivesOur objective was to determine the most appropriate intervention for dysphagia in people with chronic, untreatable, non-inflammatory muscle disease. Search strategyWe searched the Cochrane Neuromuscular Disease Group trials register, Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2003), MEDLINE (from January 1966 to Week 2 June 2003), EMBASE (from January 1980 to Week 2 June 2003), AMED (from January 1985 to Week 2 June 2003), LILACS (from January 1982 to June 21 2003) and CINAHL (from January 1982 to Week 2 June 2003) and contacted authors of published studies and other experts. Selection criteriaWe included randomised and quasi-randomised controlled trials of adults and children with chronic untreatable non-inflammatory muscle disease. The interventions under review included dietary modification, swallowing manoeuvres, a range of surgical interventions and enteral feeding. Our primary outcome was stabilisation of previously documented progressive weight loss not attributable to any other cause or weight gain of at least 5 kg in adults or increase in weight to at least the 10th centile in children, maintained for at least six months following the intervention. Secondary outcomes were: reduction in laryngeal penetration of bolus and/or aspiration observed on videofluoroscopy (modified barium swallow), reduction in chest infections attributable to aspiration over a six-month period, improvement in quality of life using a validated rating scale, the proportion of subjects who refused the intervention, the proportion of carers who refused the intervention, and serious adverse events related to the intervention within the first twelve months after intervention. Data collection and analysisWe identified no randomised controlled trials. We identified seven case series reporting the results of surgical intervention for moderate to severe dysphagia, and one reporting on the outcome of feeding advice and enteral feeding in children with a congenital myopathy. Main results
Authors' conclusionsThere are no trials that have adequately evaluated treatments in the management of dysphagia for chronic muscle disease. It is therefore not possible to decide on the most appropriate treatment for a given individual based on current evidence. |