Treatment for swallowing difficulties (dysphagia) in long-term, progressive muscle disease

Hill M, Hughes T, Milford C

Published Online:

October 8, 2008

People 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.

Abstract (click to read)

Background:

The management of dysphagia (difficulty in swallowing), a common complication of long-term progressive muscle disease in children and adults, is currently unclear.

Objectives:

Our objective was to determine the most appropriate intervention for dysphagia in people with chronic, untreatable, non-inflammatory muscle disease.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Trials Register (August 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2008), MEDLINE (from January 1966 to August 2007), EMBASE (from January 1980 to August 2007), AMED (from January 1985 to August 2007), LILACS (from January 1982 to August 2007) and CINAHL (from January 1982 to August 2007) and contacted authors of published studies and other experts.

Selection criteria:

We 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 analysis:

We 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:

No studies were found that fulfilled the inclusion criteria. Therefore it was not possible to determine the benefit or otherwise of surgical interventions such as cricopharyngeal myotomy or upper oesophageal dilatation for oculopharyngeal muscular dystrophy or other chronic progressive muscle diseases. The effect of dietary advice or enteral feeding for children with congenital myopathy has not been compared with no intervention or an alternative intervention.

Authors' conclusions:

There 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.

This record should be cited as:

Hill M, Hughes T, Milford C. Treatment for swallowing difficulties (dysphagia) in chronic muscle disease. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004303. DOI: 10.1002/14651858.CD004303.pub2

Assessed as up to date:

August 31, 2007

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Primary Review Group:

Neuromuscular Disease Group

Health topics:

Gastroenterology > Dysphagia

Neurology > Chronic muscle disease

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Independent high-quality evidence for health care decision making

Treatment for swallowing difficulties (dysphagia) in long-term, progressive muscle disease

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