Modified Barium Swallow examination in dysphagic stroke patients

Aspiration in dysphagic stroke patients is common and causes significant morbidity and mortality. Bedside clinical assessment of aspiration risk is often unreliable, particularly in patients with silent aspiration. Twenty-five dysphagic stroke patients clinically assessed to have borderline risk of aspiration were studied using a Modified Barium Swallow (MBS) examination. MBS revealed definite aspiration of liquids in 6 patients (24%) and semisolids in 4 patients (16%). Combined clinical and MBS assessment revealed an additional 12 patients (48%) had problems swallowing liquids and 5 patients (20%) semisolids due to reasons other than aspiration. In total, oral feeding of liquids were contraindicated in 18 patients (72%) and semisolids in 9 patients (36%). (1) In dysphagic stroke patients assessed clinically to have borderline risk of aspiration, MBS can distinguish those who aspirate from those who do not. MBS can also identify patients with other swallowing problems which expose them to potential aspiration. (2) Aspiration risk with food of various consistencies can be clearly defined, thus guiding the choice of food consistency and safe feeding methods.