title: Dysphagia in severe anorexia nervosa and potential therapeutic intervention: a case series.
abstract: OBJECTIVE
  In severe anorexia nervosa, there are a litany of medical complications that affect virtually every body system, and severe weakness is a typical characteristic. To our knowledge, aspiration risk, dysphagia recognition, and dysphagia management and intervention have not been well described in the literature in regard to severe anorexia nervosa. The purpose of this case series is to increase awareness among clinicians of possible oropharyngeal dysphagia symptoms that may present in patients with severe anorexia nervosa.
  
  
  METHODS
  We describe the cases of 3 patients with severe anorexia nervosa who presented with symptoms of dysphagia. The speech-language pathology team administered dysphagia therapy to the 3 patients utilizing neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy tasks that included strengthening exercises and compensatory strategies.
  
  
  RESULTS
  After the course of dysphagia treatment intervention, the 3 patients were able to tolerate an oral diet with improved swallowing function and no ongoing aspiration.
  
  
  CONCLUSIONS
  The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.
authors: ACUTE Center for Eating Disorders, Denver Health Medical Center, Denver, Colorado, USA.
authors: Samantha R M
authors: SR
authors: Holmes
authors: Tricia A
authors: TA
authors: Gudridge
authors: Jennifer L
authors: JL
authors: Gaudiani
authors: Philip S
authors: PS
authors: Mehler
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010609:Pharyngeal Muscles / Q000503:physiopathology; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control; D012720:Severity of Illness Index; D013070:Speech Therapy / Q000379:methods*; D055815:Young Adult