Conclusion What Does the Future Hold?

Abstract

Diagnosis and therapy must proceed hand in hand. At present practitioners in the field believe that we are affecting the outcome of our patients’ illness, but is that indeed true? We need carefully controlled randomized clinical trials to study outcome measures in patients with dysphagia. End points of disease must be expanded. For example, the prevention of or development of aspiration pneumonia would seem to be too extreme an outcome measure for aspiration-related disease. Perhaps measures such as change in total lung capacity or in forced expiratory volume over time would predict a poor prognosis before the patient develops a full-blown aspiration pneumonia and perhaps dies. Prognostic factors need to be defined: for example, why do some patients aspirate only a small amount and die of pneumonia and others aspirate large volumes and live out a full life span without disease related to the copious aspiration?