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[Dysphagia] Thick mucus



Thanks everyone for your responses. Glad I'm not missing anything too crucial. I think the amount of reflux in the DD population is really surprising, but what is more surprising is many medics overlooking it. I often feel like I'm going to be teaching 'granny to suck eggs' as we say in the UK when I politely asking a medic to consider treating a rampant reflux which to me is as plain as the nose on my face, but seems not to register with medics. They also seem not to consider helicobacter in this population, but again this is fairly rampant. As you say Rene, the reflux is really common, but I do seem to get all the patients with the full whammy, the chronic reflux, the chronic synptomatic oral and pharyngeal dysphagia, the poor oral hygiene, and everything that goes with it. I often describe my input as 'one slice of a piece of pie' (food analogies always useful!) and I often find myself tinkering about in lots of areas other than just trying to improve the eating experience. Usually really interesting, sometimes uplifting, occasionally really really sad but always rewarding!
 
Happy weekend everyone
 
 
Hannah Crawford
Consultant Speech & Language Therapist
Tees, Esk & Wear Valleys NHS Trust
 
RCSLT Professional Advisor (ALD Dysphagia)
 
Admin Block
Bankfields Court
Flatts Lane
Middlesbrough
TS6 0NP
 
07824 461422
01642 283716
 

________________________________

From: rene taylor [mailto:thepariah101 at gmail.com]
Sent: Thu 10/09/2009 16:31
To: hannah.crawford
Cc: dysphagia
Subject: Re: [Dysphagia] Thick mucus


This is usually the result of GERD, the prevalence of which is very high in the DD population. The mucosa of the esophagus contain mucous glands that are expressed as foodstuffs distend the  esophagus allowing mucus to be secreted and aid in lubrication. When this mucous tissue is bathed in acid per reflux, the mucus produced, joined with mucus required for lubrication, gathers above the LES and can rise as far as the pharynx. Persons with moderate GERD report throat clearing after a meal to clear mucus ( they usually call it phlegm) or waking in the night because of constant throat clearing. The incidence of pneumonia in the DD population is related to the high incidence of reflux, commonly during sleep, rather than to oropharyngeal aspiration. If the mucus is particularly thick, it can be a sign of dehydration.



On Thu, Sep 10, 2009 at 12:00 PM, hannah.crawford <hannah.crawford at northumbria.ac.uk> wrote:


	I have a question that I would be interested to hear the list's members opinion on. I am an SLT working with adults with mental retardation in the UK, but I'm sure this presentation is not confined to them.
	
	What do people make of patients who produce copious thick, tenuous white bubbly phlegm. It often comes up after coughing at mealtimes. Sometimes this phlegm is so thick and copious that staff can 'pull' it out, or patients have been known to have serious choking episodes on it. Obviously as an SLT I have tended to worry about this, but over time, have become fairly sure that it isn't coming from the chest at all. Clinically I have found a startling correlation between its presence and the presence of Helicobacter Pylori, but I have wondered whether this is the answer, and if so, if anyone has any robust evidence that discusses this. I have also wondered if anyone has any other competing theories. I have heard other SLTs who are interested in this gastro oesophageal area propose that it may be the mucus that coats the oesophagus, that gets 'caught' and builds up above a stricture or achalasia.
	
	I would be really interested and grateful to hear anyone else's opinion or experiences.
	
	Kind regards
	
	Hannah Crawford
	Consultant Speech & Language Therapist
	Tees, Esk & Wear Valleys NHS Trust
	
	RCSLT Professional Advisor (ALD Dysphagia)
	
	Admin Block
	Bankfields Court
	Flatts Lane
	Middlesbrough
	TS6 0NP
	
	07824 461422
	01642 283716
	
	
	
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