[Dysphagia] Food and barium

[eripley at yahoo.com (Irene Campbell-Taylor)]

Chris and Claire Langdon <chris_claire@bigpond.com> wrote:
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."

*** The above refers to patients with gastroesophageal problems - gastroenterologists have used marshmallows, bagel "pills" etc for decades to identify esophageal obstruction and that's what the above is all about. Yes, caution should be used with solids i.e. bread pellets etc. in the patient with oropharyngeal problems because of the risk of asphyxia. If the problem is with solids only - it is gastroesophageal.

I am talking about the VFSS of the patient with oropharyngeal dysfunction who is given various foods mixed with barium that, among other things bears no resemblance to the food alone. Also, as has been stated many times by Groher among others, VFSS does not reflect the reality of eating a meal and to give food mixed with barium removes it even further from real life. VFSS is intended to examine the dynamics of the swallow and to determine whether various compensatory interventions might be helpful - in real life.




Dr I Campbell-Taylor
Clinical Neuroscientist
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