Primary Care for the Developmentally Disabled Adult


	GI issues are common. Constipation may be avoided or respond to careful attention to fluid intake and exercise. However it may require the use of medications and even the use of drugs from multiple classes (osmotic agents, stimulants). Caution should be exercised when considering use of medications with anti-cholinergic effects (e.g. many antidepressants and incontinence agents) or other agents which may worsen or cause constipation. Dysmotility can also occur in the upper gut. The onset and progression of dysphagia can be subtle and surprising such as when it occurs in an otherwise physically able patient. Patient, family and care staff should be questioned about post prandial (or mealtime) cough as well as lengthening of mealtimes. Other signs of potential problems are recurrent URIs including otitis media and sinusitis, unexplained worsening of seizure control, weight loss, FUOs, or signs of marginal hydration. Any person who has been diagnosed or treated for “asthma” or “allergies” should be evaluated to rule out dysphagia with our without aspiration. Modified barium swallows should be interpreted by skilled speech pathologists. Delay in oral transit or pooling in sinuses are important risk factors even when frank aspiration is not seen.
	GERD is frequently encountered and can result in occult or apparent aspiration as well as esophagitis. If the patient is unable to report symptoms and symptom relief, endoscopy may be indicated to assess mucosal damage. Consideration should also be given to surgical treatment particularly if there is any indication of aspiration or if medical treatment has failed.
	Finally, those individuals who have lived in congregate care settings, are at higher risk for Hepatitis B infection and should be checked to determine if they may have chronic active Hep B (positive e antigen). If so, follow-up should be provided including liver enzymes and alpha fetoprotein measurement.