Asymptomatic dysphagia causing recurrent aspiration pneumoni
The present case has been reported in BMJ. A 52-year-old male patient with known bipolar disorder and innate cerebral palsy causing widespread spasticity problems. Treated for 2 years with antidepressants and electroconvulsive therapy. He repeatedly presented with-and was treated for-pneumonia resulting in more than 20 episodes of hospital admission.

He underwent numerous examinations until a diagnosis of dysphagia was established using video fluoroscopic swallowing examination (modified barium swallow). Eventually, as all other treatment regimens had proven effortless, percutaneous gastrostomy feeding tube was inserted and intensive training with a specialised occupational therapist was started.

This treatment regimen caused the recurrent episodes of pneumonia to vanish. It is important to acknowledge that otherwise silent dysphagia may cause recurrent pneumonia.

Learning points
• Aspiration in patients with recurrent episodes of pneumonia should be considered.

• Numerous conditions can lead to aspiration, including a variety of different medications.

• Aspiration can be silent and thus easily overlooked.

• Silent aspiration can be devastating as well as life-threatening.

• A rather simple solution such as a feeding tube should not be ignored and should be considered early on as a treatment solution in relevant patients.

• Specialist training by an occupational therapist of the swallowing function and the muscle strength in the tongue and throat can be pivotal.

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