Dysphagia, GERD, EoE and Silent Aspiration


Posted 2.17.11 | Mallory West

There has been a lot of talk about dysphagia lately so we wanted to repost our blog from a few months ago called “Dysphagia, GERD and Silent Aspiration”

Dysphagia, GERD and Silent Aspiration

We’ve talked about Gastroesophageal reflux disease (GERD) before, and today we wanted to talk about dysphagia and aspiration, two things that can be associated with GERD.

GERD

Dysphagia refers to the inability of food and/or liquids to pass easily from the mouth, into the throat, through the esophagus and into to the stomach during the process of swallowing.[1] In more simple terms, it means “difficulty swallowing.” Many medical conditions can cause dysphagia but in children, it is usually due to physical malformations, neurological conditions or digestive problems like GERD.

How can GERD cause dysphagia?

GERD is a condition where the muscles at the end of the esophagus do not close properly and allow stomach contents to leak back into the esophagus. The acidity of stomach contents can cause inflammation in the esophagus (esophagitis) and may lead to ulcers and scaring. The scarring can result in narrowing of the esophagus which may make swallowing more difficult. Patients with dysphagia may experience pain in the throat or chest, heartburn, regurgitation or the feeling that they have something stuck in their throat or chest.

Aspiration:

Both GERD and dysphagia are risk factors for aspiration, where foreign substances (food, liquid and/or stomach contents) are inhaled into the lungs. GERD can cause stomach contents to flow back into the esophagus and dysphagia can cause food and/or liquid to remain in the esophagus after swallowing. If these substances are inhaled and move into the lungs, it can lead to serious respiratory problems, such as aspiration pneumonia[2].

Silent Aspiration:

Silent aspiration describes aspiration without any obvious signs of swallowing difficulty, such as coughing or breathing difficulty[3]. Silent aspiration is especially common among children with dysphagia. In fact, an estimated 94% of children with dysphagia experience silent aspiration. This form can be especially dangerous because caregivers may not know that aspiration is occurring until the child becomes sick.

Because GERD and dysphagia are risk factors for aspiration and because children are more likely than adults to experience silent aspiration, you may want to do a swallow study if your child has these conditions to rule out aspiration. If it is detected, don’t worry! There are various ways to manage it so that respiratory problems don’t develop, such as altering the thickness of your child’s food and drinks.

 

*Update*

Eosinophilic Esophagitis

Our previous post focused on GERD as it relates to dysphagia and silent aspiration but in this post, I want to mention Eosinophilic Esophagitis (EoE), which is another condition that is linked to dysphagia and silent aspiration. Patients with EoE may have feeding problems, vomiting, dysphagia, abdominal pain or food impaction. In fact, a recent study urged professionals to screen for EoE when patients present with dysphagia. If your child has been diagnosed with EoE, you may want to discuss the possibility of silent aspiration with your health care provider since dysphagia is a risk factor for aspiration. Symptoms of EoE are often controlled by diet so dietary management may be sufficient to control dysphagia and the risk for silent aspiration. Feeding therapy and food thickeners may be considered as well.

Have any of your children with GERD or EE experienced dysphagia? How do you manage the dysphagia and the risk for silent aspiration?

-Mallory

[1] Dysphagia. Children’s Hospital Boston:
http://www.childrenshospital.org/az/Site815/mainpageS815P0.html.
[2]
Palmer & Drennan et al. Evaluation and Treatment of Swallowing Impairments. Am Fam Physician 2000;61:2453-62
[3]
Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006 Jul 17;3:14.

Read Comments (7)

  • 2011-07-20 | angela

    i wish i had known about this formula 2 yrs ago my son was diagnosed with aspiration when he was 4 months old and was in the hospital for a week and put on a feeding tube for a month could only drink formula with a thickner wich was the concistinty of honey now my newborn is haveing the same symptoms and my dr is telling me to look into necate. i hope it will work

  • 2012-08-02 | Kristine K

    My oldest has E.O.E wish I knew about this then so many tests and stress put on a little one.
    My second 20 months has E.O.E. with oral phase dysphagia severe we are doing feeding therapy. Again after being placed in the hospital with pneumonia and refusing to drink all liquids.  And doctor after doctor her gastro had her tested we are still doing night feeds to keep her weight stable she will drink then.
    We have been on Neocate 1 week old and E.O.E is under control.

  • 2012-08-08 | Rob McCandlish, RDN

    Hi Kristine,

    Yes, there certainly can be a lot of doctor visits with EoE. We’re so glad to hear that your youngest is doing well. Has the team mentioned Neocate Nutra? That’s been helpful in a lot of cases where feeding therapy is involved, since it is spoonable. We’re doing our best to help spread the word to allergists and gastroenterologists to make sure they’re all aware of how Neocate helps EoE!

    ~Rob

  • 2012-09-01 | Rebecca Prevost

    I can not put into words how greatful I am for neocate Jr. My son had multiple food allergies, gerd, dysphagia, a sever tongue tie, aspiration & failure to thrive (his whole body stopped growing feet, head included for a yr). He could only eat 1/2 jar of baby food at 2 yrs old. He went through feeding therapy and was in a growth and nutrition program. He was at risk for a feeding tube but my husband and I weren’t willing to give up the fight of him being able to eat normally. I ordered a sample of neocate jr I began adding it to the baby food I would feed him. Through the work of therapy and lots of prayers he would eat more. Eventually over time we taught him to drink out of a cup and would add neocate Jr to whatever he was drinking and would continue to add it into his baby food jars. Neocate Jr. helped him gain some weight, helped him increase his food intake and helped him not to need a g-tube. While he still has many of the same problems including aspiration He is now maintaining his weight on his own. I still have a can of neocate Jr in my closet in case he gets the flu or something. Neocate Jr helped my son grow and get healthier. If it wasn’t for this wonderful product we would be in a different situation. I am very greatful and thankful for neocate.

  • 2012-09-04 | Mallory

    Thanks so much for sharing your story, Rebecca. We are so glad to hear that Neocate Junior was helpful for your son! Best wishes to you both!
    -Mallory

  • 2013-03-25 | B Richards

    Neocate Junior has been a life saver for my son. I am truly grateful that there was something my son could take through his button that wouldn’t cause him more discomfort. I felt so guilty for not continuing to pump. Although, I wondered how long I would be able to keep up since he will have a button for at least 3 more years. Neocate took away that guilt. It provides nutrients and is hypoallergenic so my son’s body doesn’t have a horrible reaction to it. THANK YOU NEOCATE MAKERS!

    ps. Has the formula change in recent months?

  • 2013-03-28 | Mallory

    We are so happy to hear that Neocate Junior has been helpful for your family! There was a recent change in the levels of certain vitamins and minerals in the Neocate Junior. We update these levels every few years to stay current with the updated recommendations by the Institute of Medicine. You can read about the specific changes here: http://www.neocate.com/images/uploads/Files/neocate-junior-upgrade.pdf Hope .this helps!

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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.