Simple Nursing Screen for infectious oesophagitis could save lives and reduce length of stay
Flowcharts and boxes in Leslie, Carding and Wilson’s excellent review
of chronic dysphagia1 omitted to mention infectious and traumatic
oesophagitis. Monilia (candida), cytomegalovirus, herpes virus or fungal
disease2; dyphagia lusoria3; and inflammation and infection arising from
trauma and foreign bodies4, can each interfere with effective swallow, as
highlighted in the ABC of the upper gastro-intestinal tract2 and its rapid
responses. Immuno-suppressed patients and those on prolonged antibiotics
all have higher risk, as signalled by Shetty5. Diagnosis and treatment is
simple but often overlooked, despite patient’s ‘nasty taste in the mouth’.
The Welsh Demonstration Project for Implementing Clinical
Effectiveness in Acute Stroke (North Wales) identified the need for
multidisciplinary screening and assessment for dysphagia in the acute
stage of stroke, and demonstrated expected improvement in outcomes from
service re-engineering6, broadly within existing resources. This supports
the authors’ recommendations for timely multidisciplinary dysphagia
management.
A simple nursing screen for infectious oesophagitis in clinical
pathways for AIDS, cancers, bacterial infection and aftercare of complex
surgery, e.g. transplants, serious trauma and coronary artery bypass
grafts, could be cost-effective in reducing length of stay and avoidable
premature mortality.
References
1. Leslie P, Carding PN, Wilson JA (2003). Investigation and management of
chronic dysphagia. BMJ;326:433-436
2. Owen W (2001). ABC of the upper gastrointestinal tract. BMJ
3. Holemans JA (2001). No mention of dysphagia lusoria. BMJ Rapid response
(17 October 2001)
4. Oko MO (2002). No “A” in the ABC of the upper gastrointestinal tract.
BMJ Rapid response (5 January 2002)
5. Shetty G (2003) Other Important common causes of dysphagia. bmj.com, 25
Feb 2003
6. Meara RJ and Westley S (1999). National Demonstration Project for
Clinical Effectiveness (North Wales). Stroke Assessment and
Multidisciplinary Working – Final report (Deliverable D15). North Wales
Health Authority, Mold and Welsh Office Clinical Effectiveness Initiative,
Cardiff.
Competing interests:
None declared
Competing interests:
No competing interests
27 February 2003
Simant G Westley
Public Health Scientist, North Wales Public Health Service
Institute of Medical and Social Care Research, Bangor, LL57 2UW
Rapid Response:
Simple Nursing Screen for infectious oesophagitis could save lives and reduce length of stay
Flowcharts and boxes in Leslie, Carding and Wilson’s excellent review
of chronic dysphagia1 omitted to mention infectious and traumatic
oesophagitis. Monilia (candida), cytomegalovirus, herpes virus or fungal
disease2; dyphagia lusoria3; and inflammation and infection arising from
trauma and foreign bodies4, can each interfere with effective swallow, as
highlighted in the ABC of the upper gastro-intestinal tract2 and its rapid
responses. Immuno-suppressed patients and those on prolonged antibiotics
all have higher risk, as signalled by Shetty5. Diagnosis and treatment is
simple but often overlooked, despite patient’s ‘nasty taste in the mouth’.
The Welsh Demonstration Project for Implementing Clinical
Effectiveness in Acute Stroke (North Wales) identified the need for
multidisciplinary screening and assessment for dysphagia in the acute
stage of stroke, and demonstrated expected improvement in outcomes from
service re-engineering6, broadly within existing resources. This supports
the authors’ recommendations for timely multidisciplinary dysphagia
management.
A simple nursing screen for infectious oesophagitis in clinical
pathways for AIDS, cancers, bacterial infection and aftercare of complex
surgery, e.g. transplants, serious trauma and coronary artery bypass
grafts, could be cost-effective in reducing length of stay and avoidable
premature mortality.
References
1. Leslie P, Carding PN, Wilson JA (2003). Investigation and management of
chronic dysphagia. BMJ;326:433-436
2. Owen W (2001). ABC of the upper gastrointestinal tract. BMJ
3. Holemans JA (2001). No mention of dysphagia lusoria. BMJ Rapid response
(17 October 2001)
4. Oko MO (2002). No “A” in the ABC of the upper gastrointestinal tract.
BMJ Rapid response (5 January 2002)
5. Shetty G (2003) Other Important common causes of dysphagia. bmj.com, 25
Feb 2003
6. Meara RJ and Westley S (1999). National Demonstration Project for
Clinical Effectiveness (North Wales). Stroke Assessment and
Multidisciplinary Working – Final report (Deliverable D15). North Wales
Health Authority, Mold and Welsh Office Clinical Effectiveness Initiative,
Cardiff.
Competing interests:
None declared
Competing interests: No competing interests