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[Dysphagia] Food and barium
Bronwyn Jones advocates using solid boluses (bread, bagel soaked in barium;
barium paste on a cookie or a pill) to evaluate dysphagia for solids ("A
solid bolus should be given if a subtle stricture, or solid-induced spasm,
is suspected, or if a patient with symptoms of solid food dysphagia has a
normal study with liquid barium. A solid bolus, however, should be given
with caution to the patient with pharyngeal decompensation, especially if
pharyngeal retention indicating pharyngeal weakness is seen with liquids."
Chapter 3, page 45.) (Normal and abnormal swallowing: Imaging in diagnosis
and therapy (2nd Edition), 2003, Bronwyn Jones, (Ed), Springer, New York.
If some patients have dysphagia for solids only, barium + water won't give
us the clinical information we need, surely?
Claire
----- Original Message -----
From: "Irene Campbell-Taylor" <eripley@yahoo.com>
To: <dysphagia@b9.com>
Sent: Saturday, March 12, 2005 3:49 AM
Subject: [Dysphagia] Food and barium
>
> I continue my search for a reason for mixing food with barium for VFSS.
Barium alone, if aspirated is innocuous but, if, as is unfortunately too
often the case, VFSS is performed to look for aspiration which is,
logically, at least potential in the clinician's mind, why risk the
aspiration of a harmful substance i.e. food, when barium alone is sufficient
and harmless as well as being the substance used in all available research
on swallowing? Please see the following:
>
> Sutton, D,1980 A textbook of Radiology & Imaging, Churchill Livingstone,
London
>
> A barium sulphate suspension in water is the universal contrast medium
used for examination of the upper gastrointestinal tract. A simple barium
sulphate/water mixture has several undesirable properties such as a tendency
to sediment and unpalatability. Consequently many commercial barium meal
preparations have been developed to obviate these unfavourable features.
>
> Aspiration - Aspiration of small volumes of barium sulfate suspension is
usually incidental. The barium is eliminated by coughing and the
mucocilliary apparatus. The remainder of the barium is removed by
macrophages and may accumulate in the tracheobronchial lymph nodes which
will then appear opaque. Aspiration of large volumes of barium can cause
suffocation and suction may be necessary to remove the barium. If gastric
contents or other material is aspirated, then pneumonia may result. Often,
this is treatable with antibiotics. Aspiration of nonionic, iodinated
contrast material may lead to pulmonary edema.
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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