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Neurogene Dysphagie

Neurogenic dysphagia

  • Schwerpunkt: Chronische Hirnerkrankungen
  • Published:
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Zusammenfassung

Etwa die Hälfte aller neurologischen und geriatrischen Krankenhauspatienten leidet an einer oropharyngealen Dysphagie. Diese führt häufig zu Pneumonie, Mangelernährung und Dehydratation. Häufig wird die zugrunde liegende Dysphagie jedoch nicht diagnostiziert und therapiert. Dies ist vor allem bei sogenannten stillen Aspirationen der Fall. Das Wissen um die Schluckphysiologie inklusive der zentralnervösen Steuerung des Schluckakts und die therapeutischen Möglichkeiten haben in den letzten Jahren erheblich zugenommen. Insbesondere die zunehmende Etablierung der flexiblen endoskopischen Evaluation des Schluckakts hat zu diesem Erkenntnisgewinn erheblich beigetragen. Sie bietet die Möglichkeit, das individuelle Muster der oropharyngealen Dysphagie zu erkennen. Basierend darauf können die adäquaten therapeutischen und kompensatorischen Strategien für den einzelnen Patienten ausgewählt werden. Die vielfältigen therapeutischen Möglichkeiten reichen von der Konsistenzmodifikation der Nahrung über die vielfältigen logopädischen Strategien und Stimulationstechniken bis hin zu interventionellen Verfahren.

Abstract

Approximately half of neurological and geriatric inpatients suffer from oropharyngeal dysphagia. This often leads to pneumonia, malnutrition and dehydration; however, the underlying dysphagia is frequently not diagnosed and treated. This is particularly the case for patients with so-called silent aspiration. Knowledge on the physiology of swallowing, including the central nervous system control of swallowing and the therapeutic options have achieved considerable progress in recent years. In particular, the increasing implementation of flexible endoscopic evaluation of swallowing (FEES) has significantly contributed to this knowledge. It provides the ability to identify the individual pattern of oropharyngeal dysphagia leading to a suitable selection of therapeutic and compensatory strategies for individual patients. The various therapeutic options range from modification of the consistency of the diet, over diverse logopedic strategies and stimulation techniques up to interventional procedures.

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Authors and Affiliations

  1. Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    R. Wirth

  2. Klinik für Allgemeine Neurologie, Universitätsklinik Münster, Münster, Deutschland

    R. Dziewas

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Correspondence to R. Wirth.

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R. Wirth und R. Dziewas geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Sieber, Nürnberg

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Wirth, R., Dziewas, R. Neurogene Dysphagie. Internist 58, 132–140 (2017). https://doi.org/10.1007/s00108-016-0178-8

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  • DOI: https://doi.org/10.1007/s00108-016-0178-8

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