The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST, graded from 0–4) was developed as a tool for clinicians to grade dysphagia from modified barium swallow studies (MBSS). The purpose is to provide a common terminology for adverse events of pharyngeal swallowing based on swallowing safety (laryngeal penetration / aspiration) and swallowing efficiency (degree of pharyngeal residue). The authors of this study investigated the relationship between this standardised measure and the swallowing strategies used by patients to manage dysphagia. They hypothesised that as the DIGEST score increased, clinicians would recommend a greater number of and more complex swallowing strategies. They conducted a retrospective data review of all adult oncology patients referred to the MD Anderson Cancer Center between 2016 and 2021 for an MBSS, achieving a sample of 4570. Clinicians had selected and recommended strategies based on swallowing physiology and extent of dysfunction. These strategies included: recline, chin tuck, head turn, head tilt, throat clear / re-swallow, supraglottic swallow, effortful swallow, multiple swallows, liquid wash and other postural strategies. All were noted for both liquids and solid foods. More than half of the sample (54%, 2486) showed pharyngeal dysphagia with a DIGEST score greater than 0. Moderate dysphagia (DIGEST>2) was observed in about a third of patients. There was a statistically significant linear relationship between DIGEST score and swallow strategy recommendations (r=0.76, p<0.0001). Where the DIGEST score was 0, clinicians recommended an oral diet with no strategies in 92% of cases. When the score was 3, 59% were recommended an oral diet with multiple strategies and where the score was 4, 66% were placed nil by mouth and 24% were recommended oral intake with multiple swallow strategies. The authors provide further granular detail of results around safety and efficiency scores, and corresponding strategy use which they report as good efficacy evidence for the use of DIGEST in practice. This is a useful paper that highlights the clinical utility of the DIGEST score, particularly in oncology practice and research.
Swallow toxicity score (DIGEST) and its clinical utility in oncology practice
Reviewed by Roganie Govender
Compensatory Swallowing Strategies Recommended in Oncology Practice: Practice Patterns and Relationship to Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Grades.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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