Abstract
Dysphagia in patients with multiple sclerosis (MS) is associated with significant morbidity and has profound impact on the quality of life (QoL). This study aimed to analyze the dysphagia prevalence, attitudes, and dysphagia-related QoL in patients with MS, not at relapse. A prospective study of 108 consecutively recruited patients. The patients were asked to report dysphagia and completed a general dysphagia questionnaire (the Eating Assessment Tool-10, EAT-10), a disease-specific dysphagia questionnaire (the Dysphagia in Multiple Sclerosis, DYMUS), and a dysphagia-related QoL questionnaire (the Swallowing-Quality of Life). Twenty-six percent of the patients reported dysphagia. Many more were classified as dysphagic by the questionnaires (34.3% by EAT-10 and 44.4% by DYMUS). Overall, one out of four patients reported difficulties or choking while drinking fluids and eating food, cough related to eating, food sticking in the throat, need for food and drink segmentation, and repetitive swallows. The pleasure of eating was found to be moderately affected. The patients seem to cope well with the psychological and social impact of dysphagia. Serious consideration must be given to patients’ perceptions and attitudes towards dysphagia. Our patients reported very little fear associated with their swallowing difficulties and choking. Apparently, they do not perceive the severity of their symptoms as an actual danger, as they have developed coping strategies. Dysphagia is common in MS patients not at relapse, even with mild disease-related impairment. Swallowing should be systematically assessed with validated questionnaires in all patients with MS at the course of the disease.
Similar content being viewed by others
Data Availability
Professor Athanasia Printza had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
References
Calcagno P, Ruoppolo G, Grasso MG, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis—prevalence and prognostic factors. Acta Neurol Scand. 2002;105:40–3.
Guan X, Wang H, Huang H, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81.
Printza A, Kalaitzi M, Bakirtzis C, Nikolaidis I, Proios H, Grigoriadis N. Reliability and validity of the DYMUS Questionnaire for the assessment of dysphagia in multiple sclerosis (Greek version) and proposed modification. Mult Scler Relat Disord. 2018;23:62–8. https://doi.org/10.1016/j.msard.2018.05.004.
Fernandes A, Duprat AC, Eckley C, Silva L, Ferreira R, Tilbery C. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol. 2013;79(4):460–5.
Solaro C, Rezzani C, Trabucco E, Amato M, Zipoli V, Portaccio E, Giannini M, Patti F, D'Amico E, Frau J, Lorefice L, Bonavita S, Della, Corte M, Grasso M, Finamore L, Ghezzi A, Annovazzi P, Rottoli M, Gasperini C, Restivo D, Maimone D, Rossi P, Stromillo M, Bergamaschi R (2013) Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci 15 331(1–2):94–97. doi: 10.1016/j.jns.2013.05.020.
Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.
Belafsky P, Mouadeb D, Rees C, Pryor J, Postma G, Allen J, Leonard R. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919–24.
Macqueen C, Taubert S, Cotter D, Stevens S, Frost G. Which commercial thickening agent do patients prefer? Dysphagia. 2003;18:46–52.
Printza Α, Kyrgidis Α, Pavlidou E, Triaridis S, Constantinidis J. Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer related oropharyngeal dysphagia. Eur Arch Otorhinolaryngol. 2018;275(7):1861–8. https://doi.org/10.1007/s00405-018-5001-9.
Bergamaschi R, Rezzani C, Minguzzi S, Amato M, Patti F, et al. DMS Group Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. Funct Neurol. 2009;24(3):159–62.
McHorney CA, Robbins J, Lomax K, et al. The SWALQOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III Documentation of reliability and validity. Dysphagia. 2002;17:97–114.
Georgopoulos V, Perdikogianni M, Mouskenteri M, Psychogiou L, Oikonomou M, Malandraki G. Cross-cultural adaptation and validation of the SWAL-QoL questionnaire in Greek. Dysphagia. 2018;33(1):91–9. https://doi.org/10.1007/s00455-017-9837-8.
Schindler A, Mozzanica F, Monzani A, Ceriani E, Atac M, Jukic-Peladic N, et al. Reliability and validity of the Italian eating assessment tool. Ann Otol Rhinol Laryngol. 2011;122:717–24.
Alali D, Ballard K, Vucic S, Bogaardt H. Dysphagia in multiple sclerosis: evaluation and validation of the DYMUS questionnaire. Dysphagia. 2018;33(3):273–81. https://doi.org/10.1007/s00455-017-9864-5.
Kurtzke J. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–522.
Rosenbek J, Robbins J, Roecker E, Coyle J, Wood J. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.
Neubauer P, Rademaker A, Leder S. The Yale pharyngeal residue severity rating scale: an anatomically defined and image based tool. Dysphagia. 2015;30:521–8.
Alfonsi E, Bergamaschi R, Cosentino G, Ponzio M, Montomoli C, Restivo D, Brighina F, Ravaglia S, Prunetti P, Bertino G, Benazzo M, Fontana D, Moglia A. Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin Neurophysiol. 2013;124(8):1638–45. https://doi.org/10.1016/j.clinph.2013.03.003.
Tenekeci E, Kara B, Cetiz A, Demirkaya S, Demir N, Acikel C. Validity and reliability of the Turkish version of the questionnaire for the assessment of dysphagia in multiple sclerosis. Noro Psikiyatr ARS. 2016;55(3):243–7. https://doi.org/10.5152/npa.2016.18105.
Sales D, Alvarenga R, Vasconcelos C, Silva R, Thuler L. Translation, cross-cultural adaptation and validation of the Portuguese version of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. SpringerPlus. 2013;2:332.
Alali D, Ballard K, Bogaardt H. The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires. Mult Scler Relat Disord. 2018;25:227–31. https://doi.org/10.1016/j.msard.2018.08.003.
Rommer P, Eichstädt K, Ellenberger D, Flachenecker P, Friede T, Haas J, Kleinschnitz C, Pöhlau D, Rienhoff O, Stahmann A, Zettl U. Symptomatology and symptomatic treatment in multiple sclerosis: results from a nationwide MS registry. Mult Scler. 2018;19:1352458518799580. https://doi.org/10.1177/1352458518799580.
Cordier R, Joosten A, Clavé P, Schindler A, Bülow M, Demir N, Arslan SS, Speyer R. Evaluating the psychometric properties of the eating assessment tool (EAT-10) using Rasch analysis. Dysphagia. 2017;32(2):250–60. https://doi.org/10.1007/s00455-016-9754-2.
Bartlett RS, Moore JE, Thibeault SL. Temporal analysis of factors associated with EAT-10 in outpatients with oropharyngeal dysphagia from a tertiary care clinic. Dysphagia. 2018;33(4):457–67. https://doi.org/10.1007/s00455-018-9874-y.
Funding
This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors Athanasia Printza, MD, MSc, PhD; Stefanos Triaridis, MD, MSc, PhD; Maria Kalaitzi, MSc; Ioannis Nikolaidis, MD, PhD; Christos Bakirtzis, MD, PhD; Jannis Constantinidis, MD, PhD; and Nikolaos Grigoriadis, MD, PhD declare that there is no conflict of interest related to this paper.
Ethical Approval
This study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments and had Institutional review Board approval.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Printza, A., Triaridis, S., Kalaitzi, M. et al. Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis. Dysphagia 35, 677–684 (2020). https://doi.org/10.1007/s00455-019-10075-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-019-10075-0