Steps to More Accurately Diagnose Oropharyngeal Dysphagia, with Daniel Duncan, MD

Infants who appear to have reflux may actually have oropharyngeal dysphasia with aspiration, and treating these patients with acid suppression is not only the wrong treatment approach but increases repeat hospital visits. The study found evaluating oropharyngeal dysphagia in infants with a brief resolved unexplained event (BRUE) with videofluoroscopic swallow studies (VFSS) and treating it appropriately reduced the risk of repeat hospital visits.

The multicenter retrospective cohort study of 17,558 infants was presented at the 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024. At the meeting, HCPLive spoke with Daniel Duncan, MD, MPH, from Boston Children’s Hospital, to discuss the main takeaways of the research.

“We're hoping that our findings can identify the subset of kids who are at higher risk for persistent symptoms or coming back into the hospital,” Duncan said.

Between July 1, 2016, and December 31, 2021, infants with BRUE were admitted to 49 hospitals included in the Pediatric Health Information System database. A third of infants (33%) were diagnosed with gastroesophageal reflux disease (GERD), 0.6% with oropharyngeal dysphagia, and 0.8% with both. In total, 12% were treated with acid suppression, and 2.4% underwent VFSS.

About 10% to 15% of infants had repeat hospitalizations, largely driven by a diagnosis of reflux (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.48 – 1.86; P < .001), oropharyngeal dysphagia with aspiration (OR, 2.13; 95% CI, 1.55 – 2.91; P < .001), and treatment with acid suppression.

Duncan pointed out infants with reflux or oropharyngeal dysphagia with aspiration have overlapping symptoms. This can make it trickier for patients with oropharyngeal dysphagia to get the right treatment path.

“Essentially, the symptoms look exactly the same,” Duncan said. “So, if pediatricians are managing these patients in the hospital, there's really no way to differentiate at the bedside, watching the babies, hearing their history, whether they might have reflux or might have aspiration because aspiration potentially requires more intensive testing and treatment. Our suggestion would be, if you're thinking about reflux as a diagnosis and the symptoms overlap, you should also think about aspiration as a diagnosis.”

Duncan added that if aspiration may be the diagnosis, you should keep in mind the high rate of silent aspiration and consider obtaining a swallow study to diagnose the aspiration accurately.

Already, Duncan published papers on the greater risks of aspiration in infants with BRUE, and how symptoms often improve if pediatricians treat for aspiration. Still, more research is needed in multiple settings.

“Knowing exactly which patients we need to worry about and which patients we need to perform swallow studies in is still an open question, and that's what we're trying to figure out,” Duncan said.

References

^{Duncan, D, Golden, C, Rosen, R. OUTCOMES FOR INFANTS WITH BRIEF RESOLVED UNEXPLAINED EVENT (BRUE) DIAGNOSED WITH OROPHARYNGEAL DYSPHAGIA OR GASTROESOPHAGEAL REFLUX: A MULTICENTER STUDY FROM THE PEDIATRIC HEALTH INFORMATION SYSTEM (PHIS) DATABASE. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}