Swallowing Problems Lower Multiple Sclerosis Patients’ Quality of Life

Jose Marques Lopes, PhD avatar

by Jose Marques Lopes, PhD |

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Dysphagia, or problems with swallowing, is common in patients with multiple sclerosis and significantly reduces their quality of life, according to a new Australian study. Symptoms such as coughing and choking, and mental health issues related to eating or drinking, are common in this patient population, the data show.

The research, “The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires,” was published in the journal Multiple Sclerosis and Related Disorders.

Studies estimate that dysphagia may affect 30-40% of MS patients, but its exact frequency is unknown.

Serious complications such as dehydration, malnutrition and aspiration may occur as a consequence of dysphagia, potentially leading to breathing difficulties, fatigue and pneumonia, respectively. Dysphagia also may affect patients’ quality of life, their pleasure in engaging in social events, and their relationships with family and friends.

Despite its relevance, no studies have addressed suggestive symptoms of dysphagia in MS patients, as well as its affect on quality of life.

Aiming to address these questions, a research team at The University of Sydney, Australia, determined the frequency of dysphagia in adults with MS using the 10-item Eating Assessment Tool (EAT-10) and the swallowing quality of life questionnaire (SWALQOL) to assess how swallowing problems affect patients’ quality of life.

EAT-10 is a self-assessment tool to identify the risk of dysphagia, providing information on function, emotional impact, and physical symptoms. Each of the 10 items is ranked from 0 (no problem) to 4 (severe problem). A score of three or higher suggests dysphagia.

In turn, SWALQOL includes 44 questions on 10 quality of life concepts, including burden, symptoms and frequency of dysphagia, eating duration, food selection, mental health, fear related to eating, and social concerns related to swallowing difficulties.

Participants also completed questionnaires focusing on demographic data, medical history, type of MS, disability — as assessed with the Expanded Disability Status Scale (EDSS) — and other existing comorbidities.

A total of 103 adult MS patients (mean age 47 years) met the inclusion criteria for the study, 81 were women (78.6%) and 22 men (21.4%). Eighty-two participants had relapsing-remitting MS (79.6%), 11 primary progressive MS (PPMS) (10.7%), and 10 secondary progressive MS (SPMS) (9.7%).

Mean disease duration was 9.6 years, and mean EDSS score was 2.5, which corresponds to mild or minimal disability.

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The link between dysphagia and EDSS implies that swallowing difficulties increase with advanced stages of disability, the team noted. “Therefore, it is necessary to assess the presence of patient reported dysphagia in the earliest stages of the disease,” they wrote. “This would allow healthcare professionals to implement preventive interventions and reduce the risk of physical and social complications.”

Results of EAT-10 showed that 38% of patients reported swallowing problems, which is in line with previous reports.

As for specific symptoms, 66% of patients reported coughing during or after food and/or liquid intake; 63% complained of a sensation of food sticking in the throat; 61% of throat clearing after consuming food and/or liquids; 58% had thick saliva; 57% and 50% complained of choking on liquid and food, respectively; 47% coughed food and/or liquid out; 40% gagged; and 34% reported drooling and food sticking in the mouth.

The data also revealed that patients with dysphagia scored significantly lower across all SWALQOL domains than those without swallowing problems. The most marked difference was in the burden of dysphagia, as 60% of participants with dysphagia reported that impaired swallowing is a major distraction and that dealing with it is very difficult.

Nearly 50% of MS patients with dysphagia complained of mental health implications, such as feeling frustrated, discouraged, depressed and annoyed. Fear of choking and worry about getting pneumonia were reported by almost half of participants with swallowing problems. This led to reduced interest and enjoyment in eating and drinking in almost 45% of patients with dysphagia.

Also, nearly one-third of individuals with swallowing difficulties reported taking a long time to finish meals, particularly compared to healthy adults. Dysphagia also affected social life and work.

Of note, no correlations between dysphagia frequency or symptoms and MS types were found, which the authors attributed to the reduced number of PPMS and SPMS patients in their study.

“Adults with MS-related dysphagia had reduced scores across all domains of swallowing-related quality of life. These findings support referral to speech-language pathologists for management of dysphagia from the early stages of the disease,” the researchers concluded.

Nonetheless, “further work is required to determine whether early intervention for dysphagia can sustain or improve swallowing function as well as swallowing-related quality of life domains,” they added.

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