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Dysphagia: State-of-the-Art Treatment

Contemporary Diagnosis and Treatment of Dysphagia
7:30 am, Today
Room 386/387

If you need a reason to attend a 7:30 am session on a Monday, Peter C. Belafsky, MD, PhD, MPH, has a good one: “Swallowing is awesome!” he jokes.

Dr. Belafsky and Daniel J. Cates, MD, have a specific goal for the “Contemporary Diagnosis and Treatment of Dysphagia” session: to help you become “gums-to-bums swallowologists.” What does that mean, exactly? A two-hour dive into contemporary approaches to the diagnosis of dysphagia and state-of-the-art treatment strategies.

Swallowing problems are extremely common and costly. Frequent causes include gastro-esophageal reflux, cricopharyngeus muscle dysfunction and Zenker’s diverticulum, esophageal webs, rings, and strictures, head and neck cancer, eosinophilic esophagitis, esophageal motility disorders, advancing age, and neurodegenerative disease.

Otolaryngologist-head and neck surgeons see many cases of dysphagia. Some, like esophagitis and vocal fold paralysis, are fairly routine.

The general otolaryngologist may stop at the neck, but swallowing problems are frequently caused by disease of the esophagus, the stomach, or even the small bowel,” Dr. Belafsky said. Given that reality, he and Dr. Cates encourage otolaryngologist-head and neck surgeons to be aware of and look beyond the current standard of practice.

Dr. Belafsky and Dr. Cates will provide an in-depth discussion of advanced diagnostic and treatment modalities such as:

  • Validated patient reported outcome measures (PROM)
  • Flexible endoscopic evaluation of swallowing (FEES)
  • Transnasal and peroral esophagoscopy and gastroduodenoscopy
  • Ambulatory pH and impedance testing
  • Swallowing fluoroscopy
  • High-resolution impedance manometry (HRIM)
  • Advanced dilation, endoscopic, and open myotomy and diverticulectomy techniques

Advanced use of botulinum toxin, hiatal hernia repair, and radio frequency delivery for endoscopic reflux management and treatment of intestinal metaplasia and dysplasia.

It is important for all otolaryngologist-head and neck surgeons to know these things, Dr. Belafsky said, for a number of reasons, but the most important: better patient care.

Currently, patients with swallowing difficulties often get tossed around between medical specialists trying to pinpoint the cause of the dysphagia and how best to treat it. “They may go to the ENT if there’s a problem with the throat. They may go to a GI if there’s a problem with the esophagus. They may go to a general surgeon if there’s a problem with the stomach. They may see a speech pathologist or a neurologist or a radiologist,” he said. If otolaryngologists are “gums-to-bums swallowologists,” however, they can provide patients with all the care and expertise they need without having to be bounced around to multiple practitioners.

Without a doubt, he said, the information he and Dr. Cates present during the session will change how you take care of your patients because it will better prepare you for the comprehensive care of both routine and complex swallowing problems.