S4363 You Are Your Patient's Best Advocate: A Case of Acute Dysphagia

Introduction: Acute dysphagia in hospitalized patients is often due to stroke or post-extubation. Less common causes include pill-induced esophagitis, severe gastroesophageal reflux disease, or anaphylaxis. Here, we present a case of an elderly man with Parkinson’s disease who developed acute dysphagia likely triggered by physiological stress and anemia, further complicated by difficulty administering his medications. Case Description/Methods: An 88-year-old man with type 2 diabetes and Parkinson’s disease, residing in a nursing facility, was admitted with a gastrointestinal bleed. Gastroenterology recommended bowel prep and colonoscopy. On the same day, he developed dysphagia while eating. Speech therapy performed an urgent modified barium swallow, which showed frank esophageal regurgitation and aspiration. NG tube placement attempts failed, requiring esophagogastroduodenoscopy-guided placement. A cricopharyngeal bar was noted but not believed to be the cause. As he had no focal neurological deficits, head imaging was not pursued. Colonoscopy later revealed colonic AVMs, which were clipped. Despite this, dysphagia persisted, and a repeat swallow study showed worsening aspiration. Speech therapy and palliative care advised a goals-of-care discussion, noting that aspiration risk would remain even with NG or percutaneous endoscopic gastrostomy tube feeding. However, considering the acute onset, we suspected a potentially reversible cause. Neurology was consulted and noted that up to 80% of patients with Parkinson’s disease can develop dysphagia during acute illness or stress. They recommended increasing the dosage of Parkinsonian medications. Discussion: Remarkably, the patient’s swallowing improved within two days of dose escalation. While he had been adherent to his medications before admission and continued to receive them via NG tube, improvement occurred only after the dosage increase. This case highlights that while dysphagia is common in Parkinson’s disease, it may be under-recognized as an acute, reversible complication during hospitalization. Difficult NG tube placement, the presence of a cricopharyngeal bar, and stress from anemia contributed to complexity, but individualized care led to recovery. It reinforces the value of reassessing assumptions and consulting specialists when common explanations fall short.