[Dysphagia] Response to Jonathan Bennett 3.

[eripley at yahoo.com (Irene Campbell-Taylor)]

  Dr Beach made reference to issues that appeared in the early days ?dysphagiology?  or what I prefer to call ?deglutology?. The mistakes were even worse than identified since the supposed lethal effects of aspiration were based on early work of Bartlett, Zuidema and others who were describing aspiration of stomach contents, not oropharyngeal secretions/food/liquid. Still, the clear occurrence of pneumonitis due to reflux, followed in a few days by secondary bacterial pneumonia is constantly overlooked.  The certainty             Marik, P. E. N Engl J Med 2001;344:665-671

with which physicians and others diagnose ?aspiration pneumonia? is staggering in its arrogance given the extreme difficulty of making such a diagnosis  See: Paul E. Marik Aspiration Pneumonitis and Aspiration Pneumonia NEJM 344:665-671: 2001 and 
  Tom?s Franquet, MD, Ana Gim?nez, MD, Nuria Ros?n, MD, Sof?a Torrubia, MD, Jos? M. Sabat?, MD and Carmen P?rez, MD Aspiration Diseases: Findings, Pitfalls, and Differential Diagnosis Radiographics. 2000;20:673-685.
  As Dr Beach states, aspiration itself is not the problem. The ?true? diagnostic abilities for predicting pneumonia are known, insofar as anything in medicine can be certain. The variables are these: What is being aspirated, how much, over how long a period and, most importantly, what is the patient?s resistance to infection? Accurate answers to these will provide high probability answers to, ?What is the risk of pneumonia?? probability being the best possible as certainty always eludes prediction.. These variables appear again and again in articles on the nature and risks of aspiration pneumonia and aspiration pneumonitis.
   
   



Dr I Campbell-Taylor
Clinical Neuroscientist
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