Table 7.3.1 Common causes of dysphagia
Mechanical
Neurological
Psychological
Oesophageal stricture
Oesophageal spasm
Cancers in the head, neck and
oesophageal areas
Cancer treatment including radiotherapy/
surgery to head and neck area
Pharyngeal pouch
Injury or surgery to the tongue, lips,
mouth or jaw
Severe infections of the mouth or throat,
e.g. oral thrush or ulcers
Postural problems, e.g. severe kyphosis
(curvature of the spine)
Stroke
Parkinson’s disease
Motor neurone disease
Head injury
Multiple sclerosis
Cerebral palsy
Dementia
Huntington’s disease
Drug induced (psychotropic drugs)
Globus hystericus
Severe anxiety
Severe depression
Table 7.3.2 Disruption of the normal swallowing process
Stage of the normal swallow
Affected by
Consequences
Preparatory stage
Reduced range of movement of facial muscles,
lips, tongue and jaw
Loss of sight, smell and/or taste
Reduced range of movement of facial muscles,
lips, tongue and jaw, and lack of saliva
Postural problems
Difficulty in getting food/liquid into the mouth
Difficulty in sealing the mouth
Reduced saliva production
Difficulty in mastication
Difficulty in forming a food bolus
Difficulty in controlling a food bolus
Difficulty in swallowing a food bolus
Inability to swallow safely
Food fails to move into the stomach
Aspiration after the swallow
Oral stage
Pharyngeal stage
Oesophageal phase
Absence of swallow reflex
Impaired peristalsis or obstruction
Manual of Dietetic Practice, Fifth Edition. Edited by Joan Gandy.
© 2014 The British Dietetic Association. Published 2014 by John Wiley & Sons, Ltd.
Companion Website: www.manualofdieteticpractice.com
Table 7.3.3 Prethickened commercial proprietary prescribable products
Product (manufacturer)
Thickened desserts
Thickened drinks
Ensure Plus Crème (Abbott Nutrition)
Forticreme Complete (Nutricia Advanced Medical Nutrition)
Fortisip Fruit Dessert (Nutricia Advanced Medical Nutrition)
Fresubin Creme (Fresenius Kabi Ltd)
Fresubin Thickened Stage 1 (Fresenius Kabi Ltd)
Fresubin Thickened Stage 2 (Fresenius Kabi Ltd)
Nutilis Complete Stage 1 (Nutricia Advanced Medical Nutrition)
Resource Thickened Drink (Nestles Healthcare Nutrition)
Resource Dessert Energy (Nestles Healthcare Nutrition)
Resource Dessert Fruit (Nestles Healthcare Nutrition)
Thick and Easy Thickened Juice Drink (Fresenius Kabi Ltd)
SLO Cold Juice Drinks, Hot Chocolate, White Coffee (SLO Drinks Ltd)
NB: The above products are not normally suitable for infants and young children.
Thickeners based on carob seed flour such as Carobel instant powder (Cow & Gate) are used to
thicken infant feeds for the treatment of recurrent vomiting. They are not suitable for the management of dysphagia.
Full composition details of these products and prescribing indications can be found in the British
National Formulary or the Monthly Index of Medical Specialties (MIMS) or obtained directly from the
manufacturers.
Table 7.3.4 High risk foods in dysphagia [modified from Joint Working Party of the British Dietetic Association and Royal College of
Speech and Language Therapists (2002, reviewed 2009) and Dietitians Association of Australia and The Speech Pathology Association
of Australia Ltd (2007)]
Food types
Examples
Chewy foods
Chewy sweets and toffees
Marshmallows
Chew bars, breakfast bars
Chewing gum
Chewy or crispy meat, e.g. crispy duck, bacon
Cooked hard cheese, e.g. cheddar
Bread crusts, pie crusts
Crumble
Dry biscuits/cakes
Toast
Flaky pastry
Dry biscuits
Crisps, popcorn
Lettuce, cucumber, uncooked spinach leaves
Boiled and hard sweets and toffees
Nuts and seeds
Raw vegetables
Sweetcorn
Granary bread, bread with grains and seeds
Cereals which do not blend with milk, such as muesli
Mince with thin gravy
Soup with lumps, e.g. minestrone
Pineapple, runner beans, celery, rhubarb
Steak
Broad, baked, soya and black eyed beans, peas, grapes, sweetcorn, apple with peel
Crumbly items
Crunchy foods
Floppy texture
Hard foods
Husk
Mixed consistency foods
Stringy, fibrous texture
Vegetable and fruit skins (including
bean skins)