Swallowing disorder

What is a swallowing disorder?

A swallowing disorder (dysphagia) is a disorder that affects the process of swallowing. It is a combination of disorders affecting the muscles involved in swallowing, reduced sensitivity and the decline of reflexes. It may cause a person to swallow the wrong way or choke. Food or drink can then enter the windpipe or even the lungs. In the general population, these disorders are primarily seen in the elderly, in people who have had a stroke (CVA), in people with multiple sclerosis (MS), in Parkinson's disease, in a motor nerve cell disease, in people with oral or throat cancer, in people with head or neck injuries and in people with a blockage of the throat (due to an infection, for example).

 

What are the complaints associated with a swallowing disorder?

The complaints are: drooling, food residues being left behind, saliva or food may exit the mouth or nose during eating, swallowing the wrong way, choking, coughing, swallowing takes longer than normal, repeated swallowing becomes necessary, the feeling of a lump in the throat (globus sensation), hoarseness, feeling a constant need to clear the throat, fatigue, weight loss.


People with intellectual disabilities sometimes find it impossible to communicate these symptoms. The people around them may then notice only a change in behaviour. It is important to be alert, particularly if there is a change in behaviour during meals. 271

 

How common are swallowing disorders in the general population?

Swallowing disorders are seen in between 0.11% 272 and 16-33% 273 of the population. Surveys including questions about swallowing and passage complaints such as the feeling that food remains gets stuck in the throat or chest have found an average prevalence of 16%. Women between the ages of 40 and 50 suffer most from this complaint. Swallowing problems probably occur more often in the elderly but they feel them less or are less bothered by them. Only 3-6% of people aged 70 and older report swallowing complaints. 273

 

How common are swallowing disorders in people with intellectual disabilities?

A study of 1373 people with intellectual disabilities found that 177 people with spasticity had significantly more dysphagia (6%) than people with intellectual disabilities but no spasticity (1%). The prevalence rate in this total study population was 1.6%. 274

 

Other research looking at people with intellectual disabilities referred for swallowing disorders found that people with spasticity, severe motor impairments and severe cognitive impairment were more likely to have dysphagia. The estimated prevalence in this study of dysphagia was 8.15%. 275 In children with spasticity and mental retardation, 99% suffer from dysphagia. 276


In a descriptive observational cross-sectional study of 128 clients aged 50 years and over (average age: 66 years) in an institution for people with intellectual disabilities in the Netherlands, swallowing was assessed with the Dysphagia Disorders Survey4 (DDS Part 2). Dysphagia was seen in 117 people (91%): mild in 32%, moderate to severe in 57% and very severe in 2%. Only 11 clients (9%) had no dysphagia. There was a significant correlation with wheelchair use but not with age or severity of intellectual disability. 277

 

The Dutch GOUD study of 1050 older people with intellectual disabilities found that 52% had moderate to severe swallowing problems. 548  

0.11% to 33% General population
>50% People with intellectual disabilities
99% Children with intellectual disabilities and severe spasticity

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De Winter CF, Jansen AAC, Evenhuis HM. Physical conditions and challenging behaviour in people with intellectual disability: a systematic review. J Intellect Disabil Res. 2011 Jul;55(7):675-98.

De Winter CF, Jansen AAC, Evenhuis HM. Physical conditions and challenging behaviour in people with intellectual disability: a systematic review. J Intellect Disabil Res. 2011 Jul;55(7):675-98.

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Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.

Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.

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Quartero AO, Bartelink ME. Slik- en passageklachten. Huisarts Wet 2012;55(8):360-3

Quartero AO, Bartelink ME. Slik- en passageklachten. Huisarts Wet 2012;55(8):360-3

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Quartero AO, Bartelink ME. Slik- en passageklachten. Huisarts Wet 2012;55(8):360-3

Quartero AO, Bartelink ME. Slik- en passageklachten. Huisarts Wet 2012;55(8):360-3

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Henderson CM, Rosasco M, Robinson LM, Meccarello J, Janicki MP, Turk MA, Davidson PW. Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy. J Intellect Disabil Res. 2009 Nov;53(11):887-97.

Henderson CM, Rosasco M, Robinson LM, Meccarello J, Janicki MP, Turk MA, Davidson PW. Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy. J Intellect Disabil Res. 2009 Nov;53(11):887-97.

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Chadwick DD, Jolliffe J. A descriptive investigation of dysphagia in adults with intellectual disabilities. J Iintell Disabil Res. 2009 Jan;53( pt 1): 29–43.

Chadwick DD, Jolliffe J. A descriptive investigation of dysphagia in adults with intellectual disabilities. J Iintell Disabil Res. 2009 Jan;53( pt 1): 29–43.

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Calis EA, Veugelers R, Sheppard JJ, Tibboel D, Evenhuis HM, Penning C. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev Med Child Neurol. 2008 Aug;50(8):625-30.

Calis EA, Veugelers R, Sheppard JJ, Tibboel D, Evenhuis HM, Penning C. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev Med Child Neurol. 2008 Aug;50(8):625-30.

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Egging M, Leeuwen van N, Evenhuis H, Penning C. Dysfagie bij ouderen met een verstandelijke beperking: signalering, prevalentie en risicofactoren. 

Egging M, Leeuwen van N, Evenhuis H, Penning C. Dysfagie bij ouderen met een verstandelijke beperking: signalering, prevalentie en risicofactoren. 

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Bastiaanse LP, Evenhuis HM, Echteld MA. Dysphagia in older adults with intellectual disabilities: results of the HA-ID study (submitted 2015)

Bastiaanse LP, Evenhuis HM, Echteld MA. Dysphagia in older adults with intellectual disabilities: results of the HA-ID study (submitted 2015)