The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

Abstract

Purpose Dysphagia occurs as a component of a wide variety of diseases and conditions. When unrecognized or poorly managed, dysphagia can result in malnutrition, volume depletion, and reduced quality of life, as well as aspiration, pneumonia, and death. This document focuses specifically on oropharyngeal dysphagia. The modified barium swallow study (MBSS) is a fluoroscopic motion study used to evaluate oropharyngeal anatomy and swallowing physiology in real time. It is typically performed by a speech-language pathologist together with a radiologist and often assisted by a radiologic technologist. Because oropharyngeal dysphagia has such a varied presentation, the guidance to diagnose and treat oropharyngeal dysphagia in the United States falls under the purview of several professional societies and organizations. However, a thorough review of available practice guidelines and appropriateness criteria issued to date reveals a deficit of up-to-date, comprehensive, evidence-based information on the diagnosis and evaluation of oropharyngeal dysphagia. Specifically, a lack of quality guidance on the ordering, performance, and reporting of the MBSS has hindered efforts to improve standardization and ensure quality continuity of care. Method In 2019, a group with expertise in oropharyngeal dysphagia (speech-language pathologists, radiologists, and referring physicians) convened with the goal of specifying a core set of expert recommendations/best practices to achieve a high-quality MBSS. Results Here, we present the results of the participants' discussions and provide consensus recommendations regarding ordering, performing, and reporting an MBSS. Conclusion The overarching goal of this summary is to emphasize the need for and encourage the development of MBSS practice guidelines to support clinicians and patients.