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What is it? A ventricular septal defect is an opening between the left and right ventricles. It is a common congenital malformation. This ventricular septal defect allows oxygenated blood to mix with “deoxygenated” blood. The consequence is an increased workload for the ventricles and therefore heart failure. Symptoms Shortness of breath or fatigue on exertion, palpitations... (symptoms of heart failure). Affected infants are more prone to respiratory infections. Treatments The ventricular septal defect will be closed surgically. Diuretics, digitalis, sodium restriction and treatment of respiratory infections while awaiting surgery if the situation is stable.

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The functional medical unit for adult epileptology provides multidisciplinary care for adult patients with epilepsy of any type and severity.

Neuromuscular diseases account for a significant proportion of acquired or genetic neurological disorders. They encompass all diseases affecting the peripheral nervous system.From an anatomical perspective, they include diseases of the peripheral nerves in the broadest sense (motor neurons, spinal ganglia, myelin sheath, small peripheral nerve fibres, sensory or motor nerve fibres, the autonomic nervous system, etc.), diseases of the neuromuscular junction (myasthenia gravis, Lambert–Eaton syndrome) and diseases of the muscle (myopathies). Most of these diseases are rare and are generally characterised by a chronic course. Professional and psychosocial impactIn most patients, neuromuscular diseases regularly result in the development of a disability that may have a significant professional and psychosocial impact. They may be associated with an acute, subacute or progressive risk to life, primarily affecting the respiratory and cardiac systems. They regularly require end-of-life care, with all the ethical issues that arise during these difficult times. Their management requires specific expertise at every stage of the disease, including the diagnostic phase. The need to centralise the care of patients with neuromuscular diseases is well established. This approach is implemented in many European countries. To this end, Neuromuscular Reference Centres (CRNMs) have been developed. Extended multidisciplinary careThe Neuromuscular Reference Centre (CRNM) brings together a team of medical and paramedical experts in the field of neuromuscular diseases. It is intended to organise multidisciplinary consultations in coordination with the treating doctors and paramedical professionals. For many chronic diseases, centralising care in a specialised centre improves outcomes in terms of morbidity and mortality. Some of the objectives are to preserve autonomy and prevent complications. These two factors have an impact on the direct and indirect costs of the disease. Bringing together within a single entity all the expertise required for the diagnostic and therapeutic management of patients with rare, chronic and progressive diseases is therefore a rational approach. Patients are monitored by a specialised team dedicated to their condition. At the heart of treatment is an extended multidisciplinary approach bringing together adult and paediatric, medical and paramedical expertise in a wide range of fields, such as neurology, genetics, functional rehabilitation, anatomical pathology, cardiology, pulmonology, physiotherapy, occupational therapy, treatment of neuropathic pain, treatment of autoimmune diseases through immunomodulation, surgical treatments such as thymectomy in certain cases of myasthenia gravis, and scoliosis correction procedures for myopathies.At Erasme Hospital, Dr Gauthier Remiche is the medical director of the Neuromuscular Reference Centre (CRNM).

One in six people worldwide will experience a Cerebrovascular accident, and in Belgium, 52 people have a Cerebrovascular accident every day. Cerebrovascular accident is the leading cause of disability in Western countries, causing severe disabilities such as paralysis on one side of the body, speech, vision and walking difficulties, and more. To limit the after-effects, it is essential to go to the Emergency Department as quickly as possible, as soon as symptoms begin, because treatments are only effective during the first few hours.

Presentation of the department The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine disorder, that is, a condition affecting the secretion of a hormone (excessive or insufficient secretion) and/or the gland that secretes it. The department therefore manages conditions affecting the thyroid, parathyroid glands, adrenal glands, gonads (ovaries and testes) and pituitary gland.Since 2016, the Endocrinology Department of Erasme Hospital, in partnership with the Queen Fabiola Children’s University Hospital (HUDERF) for paediatric care, has been part of ENDO-ERN (European Reference Network for Rare Endocrine Conditions), the European Reference Network for rare endocrine diseases.The mission of this network is to improve access to high-quality care for patients with rare endocrine disorders. It supports clinical research and contributes to the creation of registries listing patients receiving follow-up for rare conditions, in order to promote the sharing of knowledge and the improvement of clinical practices. The management of rare endocrine diseases is multidisciplinary. Regular consultations are organised to discuss complex cases with numerous specialists within our institution, as well as through virtual consultations with recognised European experts via the ENDO-ERN network or during international multidisciplinary consultation meetings (France).Some endocrine diseases begin at birth or during childhood and require lifelong treatment and follow-up. Transition consultations have been provided for many years in collaboration with our paediatric colleagues at HUDERF, to ensure the smoothest possible transition from paediatric to adult care. What is Turner syndrome? Turner syndrome is a genetic condition associated with an abnormality of the sex chromosomes. It affects approximately 25 to 50 girls per 100,000. It is characterised by the presence of one normal X chromosome and the complete or partial absence of the second X chromosome. When all cells present this abnormality, it is referred to as X monosomy (45,X). In some people, only a proportion of cells is affected; this is known as mosaicism. The manifestations of the condition may be more or less pronounced depending on the type of chromosomal abnormality, although the karyotype does not always make it possible to predict the severity of the condition or the risk of long-term complications.The two main characteristics of Turner syndrome are:A short stature Premature ovarian insufficiency, resulting in delayed or absent puberty, amenorrhoea (absence of menstrual periods) and, most often, infertility.Turner syndrome may also be associated with other conditions requiring regular medical follow-up, including:Cardiovascular abnormalities (heart valve abnormalities, aortic involvement, high blood pressure);Abnormalities in the shape of the kidneysOverweight, obesity and/or diabetesAutoimmune diseases such as autoimmune thyroiditis Recurrent ear infections with residual hearing lossSome patients also have difficulties with certain types of learning and visuospatial difficulties.The manifestations of the syndrome vary considerably from one person to another. Some patients have few clinical signs and therefore require less intensive medical follow-up, whereas others require multidisciplinary follow-up throughout their lives. Diagnosis The diagnosis may be made at different stages of life, depending on the clinical manifestations. It may be suspected before birth, during an ultrasound scan showing certain suggestive abnormalities, or through non-invasive prenatal testing (NIPT). The diagnosis is then confirmed by chromosomal analysis performed on a chorionic villus sample or by amniocentesis.After birth, the diagnosis is most often suspected in the presence of:A reduced growth rate or short stature during childhood;An absence of or delayed puberty during adolescence; Amenorrhoea or infertility during adolescence or adulthood.Certain physical characteristics may suggest the diagnosis, such as the position of the ears, hairline, the presence of a shorter finger, and the shape of the eyes and neck. However, these signs are inconsistent and are often less suggestive than abnormalities of growth and pubertal development.Recurrent ear infections, hearing loss, learning difficulties or the discovery of a heart abnormality may also lead to suspicion of the diagnosis.The diagnosis is confirmed by a karyotype performed on a blood sample, which reveals the complete or partial absence of an X chromosome. A hormonal assessment is also performed to evaluate ovarian function, particularly by measuring oestradiol and other hormones related to ovarian function. Care management Care is multidisciplinary and individualised. It includes, in particular, growth hormone treatment to improve final height, hormone replacement therapy to induce and then maintain puberty, as well as regular monitoring of cardiovascular, endocrine, metabolic, hearing and bone-related complications. If they wish to have children, patients are referred to the fertility clinic to discuss the various options available to them and receive appropriate support.Psychological, neuropsychological and/or speech therapy support may also be offered according to each patient’s needs.Management of Turner syndrome is based on an individualised, person-centred approach. It includes:Specialised diagnostic assessment (clinical, hormonal and genetic) Screening for, prevention and treatment of associated complications Clear information provided to the patient and her familyMedical, psychological and social support throughout life, when necessaryDepending on each patient’s needs, medical monitoring and treatment may include:Hormone replacement therapy (oestrogen-progestogen therapy from puberty until the usual age of menopause)Growth hormone treatment during childhood and adolescenceThyroid hormone treatment in the event of hypothyroidismSurgical procedures when necessary (particularly in cardiology or ENT) Fertility preservation procedures when indicated Regular monitoring of bone, metabolic and cardiovascular healthAppropriate treatment of complications that may arise during follow-up, such as obesity, diabetes, high blood pressure or osteoporosis.The aim is to support each patient in understanding her condition and treatment, in order to promote her long-term quality of life. Multidisciplinary team – Erasme Hospital – H.U.BManagement of Turner syndrome is based on close collaboration between several specialists:Paediatric endocrinologists (from HUDERF, as part of the transition to adult care) and adult endocrinologists (Erasme Hospital);Geneticists: Dr Isabelle Vandernoot, Dr Isabelle Migeotte Gynaecologists specialising in fertility: Prof. Anne Delbaere, Dr Mélodie Vander Borght, Dr Ozlem Okutman Cardiologist: Prof. Antoine Bondue ENT specialist: Dr Maxime Niesen Psychologist and neuropsychologist: Marianne Rotsaert, Dr Hichem Slama Psychiatrist: Prof. Oswald Pierre, Social services: Denis StormeSince 2015, a Turner Platform has been organised at Erasme Hospital. It enables patients to meet, during a single day, various specialists from the multidisciplinary team (endocrinologist, gynaecologist from the fertility clinic, cardiologist, ENT specialist and geneticist). This organisation facilitates coordinated, personalised and comprehensive care during a single visit. Patient advice Good adherence to treatment and regular medical follow-up are essential. It is important to comply with recommendations concerning treatments, screening examinations and monitoring for any complications.Adopting a balanced diet and engaging in regular physical activity help reduce the risk of cardiovascular and metabolic complications.A health passport, specifically designed for patients with Turner syndrome, is made available to them. It includes follow-up recommendations adapted to the different stages of life (childhood, adolescence and adulthood) and facilitates coordination of care.If you have any questions or difficulties, the medical team remains your primary point of contact to adapt your care. Transition to adulthood During adolescence, a gradual preparation for the transition to adult care is organised. This stage helps strengthen the young patient’s autonomy, ensure continuity of medical care and transfer all the necessary information to the specialised adult service. The transition is planned in collaboration with the patient, their family, and the paediatric and adult care teams. Focus: Expertise Patients are treated by a certified adult endocrinologist. Hormone assays and genetic tests are performed in a specialised laboratory. An on-call service is available 24 hours a day. Our centre is actively committed to improving knowledge and care for patients with rare endocrine diseases. A local registry has been established. The centre actively contributes to an international database (International Turner Syndrome Registry) dedicated to Turner syndrome. The aim is to gain a better understanding of the disease, optimise follow-up practices, and compare management approaches between different specialised centres. The team receives ongoing training, participates in congresses and seminars, initiates and collaborates on studies, and publishes in the field of gonadal disorders. It also provides training and teaching for students and doctors in training. Our specialists

Uveitis: What is it? Uveitis encompasses inflammatory diseases affecting various structures of the eye, including the iris, ciliary bodies and choroid, and may affect one or both eyes. It may occur in isolation or be associated with a systemic, infectious or inflammatory disease. Its presentation and course are highly variable. Specialist care makes it possible to identify the form of uveitis, investigate its cause when necessary, and adapt follow-up and treatment in order to preserve vision and limit complications. The department also manages complex cases or situations requiring a multidisciplinary opinion. Assessment and diagnosis Management is based on a comprehensive and standardised ophthalmological assessment, making it possible to characterise the inflammation according to its location, activity and complications. The team relies in particular on the SUN classification and monitoring criteria, as well as on international recommendations from scientific societies specialising in uveitis. The aetiological assessment is guided by the clinical context and may combine laboratory tests, imaging and specialist consultations. Treatment is individualised and may include topical or systemic corticosteroid therapy, immunomodulatory or immunosuppressive treatments, as well as treatments targeting ocular complications. Management of complex cases is based on close collaboration with the relevant specialists, particularly in internal medicine, rheumatology or infectious diseases. Follow-up is adapted to disease activity and the response to treatment. Treatments and techniques Regular follow-up is important, even when symptoms are mild, because inflammation can sometimes progress without causing significant discomfort initially. It is recommended to comply with the treatment and follow-up appointments, and to report any decrease in visual acuity, significant eye pain, unusual redness, the appearance of floaters or marked photophobia. Rapid worsening of symptoms or a significant reduction in vision warrants prompt ophthalmological assessment. Treatments may be adjusted gradually according to the activity of the inflammation and their tolerability. If systemic treatment is used, follow-up may also require coordination with the relevant specialist. Care pathway Proposed care pathway for patients being followed for uveitis1. Referral to a specialist consultation in cases of suspected or known uveitis.2. Ophthalmological assessment and characterisation of the inflammation according to SUN criteria.3. Investigation of an associated cause when clinically indicated, with targeted additional tests.4. Multidisciplinary discussion when the uveitis is associated with a systemic, infectious or autoimmune disease, or in complex cases requiring corticosteroid-sparing treatment.5. Initiation and adjustment of treatment, with monitoring of inflammatory activity, vision and complications.6. Long-term follow-up and coordination between the various healthcare professionals involved. The care pathway may be adapted according to the patient’s age, aetiology, severity and disease progression. Transition to adulthood The transition to adulthood relies on coordination between paediatric and adult teams to ensure continuity of ophthalmological care and, where necessary, systemic follow-up. Particular attention is paid to understanding the disease, the young patient’s autonomy in managing their treatment, and the gradual transfer of medical information. Links with the relevant adult specialists can be arranged according to the aetiology and the patient’s needs. Focus / Research The centre is contributing to the development of a structured approach to quality of care and research in uveitis. A Belgian Uveitis Registry (BUR) is being developed, with a retrospective pilot phase conducted at Erasme involving several hundred patients (UVERA), and the aim of extending it nationwide via REDCap. This project aims, in particular, to standardise the collection of clinical data and patient follow-up. Patient care is based on the SUN criteria and international recommendations. The project is also part of an academic initiative to develop quality indicators for uveitis. Our specialists Associated department

Department overview The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine problem, i.e. a condition affecting the secretion of a hormone (excessive or insufficient secretion) and/or the gland that secretes it. The department manages conditions affecting the thyroid, parathyroid glands, adrenal glands, gonads (ovaries and testicles), and pituitary gland.Since 2016, the Erasme Hospital Endocrinology Department, together with the Queen Fabiola Children’s University Hospital (HUDERF) for paediatric care, has been part of the ENDO-ERN network (European Reference Network for Rare Endocrine Conditions), the European Reference Network for rare endocrine diseases.The mission of this network is to improve access to high-quality care for patients with rare endocrine disorders. It supports clinical research and contributes to the creation of registries listing patients receiving follow-up for rare conditions, in order to promote knowledge sharing and improve clinical practice.The management of rare endocrine diseases is multidisciplinary. Regular consultations are organised to discuss complex cases with numerous specialists within our institution, as well as through virtual consultations with recognised European experts via the ENDO-ERN network or during international multidisciplinary consultation meetings (France).Some endocrine diseases begin at birth or during childhood and require lifelong treatment and follow-up. Transition consultations have been provided for many years with our paediatric colleagues at HUDERF to ensure the smoothest possible transition from paediatric to adult care. What is pituitary insufficiency? The pituitary gland is a pea-sized gland located at the base of the brain, behind the nose. It acts as the conductor of most of the body’s other glands. It produces several hormones that regulate the secretion of hormones by other glands (the thyroid, ovaries or testes, and adrenal glands). It also produces growth hormone and releases prolactin, which plays an important role during pregnancy and breastfeeding, as well as vasopressin, a hormone involved in maintaining the body’s water balance.Some people have a pituitary gland that does not function, either partially or completely, and consequently have deficiencies in hormone secretion. Depending on which hormones are affected, their functions, and the age at which the insufficiency develops, the symptoms experienced by patients may vary: growth retardation and/or delayed puberty in children and adolescents, fatigue, hypoglycaemia, dizziness, a drop in blood pressure, abdominal pain, nausea, unexplained weight loss or gain, libido disorders, cessation of menstruation, etc. Vasopressin deficiency causes the kidneys to eliminate large amounts of water; patients urinate excessively both during the day and at night. As a result, they are very thirsty and drink a great deal to compensate.Pituitary diseases may be caused by congenital conditions (abnormal development of the gland) that are present from birth, but are most often related to conditions acquired later in life. These conditions may be tumours (most often benign), inflammatory, haemorrhagic or, more rarely, infectious. Pituitary hormone deficiencies may also occur following treatment of tumours located in this region, through surgery and/or radiotherapy.  Diagnosis and management Pituitary disease is often investigated based on the patient’s symptoms (headaches, vomiting, hypoglycaemic episodes, abnormal weight gain or loss, menstrual disorders, reduced libido, etc.) or as part of an assessment of delayed growth or puberty in children. Hormonal deficiencies are systematically investigated after surgery or radiotherapy to the pituitary region. A simple blood test is usually sufficient to diagnose pituitary insufficiency. However, other tests, known as “dynamic” tests, may sometimes be required to confirm the diagnosis: a substance is administered by infusion to stimulate hormone secretion; in cases of insufficiency, the level of the hormone in question will not rise appropriately.These tests are performed on an outpatient basis, usually during one morning, with a specialist nurse, in a dedicated room in the Endocrinology consultation building.  A magnetic resonance scan of the pituitary gland completes the assessment to determine the cause of the insufficiency. In some cases, genetic testing is also offered, as well as other laboratory or radiological examinations depending on the suspected cause.Regardless of the cause of pituitary insufficiency, hormone replacement therapy is offered. The missing hormone is replaced by daily capsules and/or tablets, with a dose adjusted to each patient’s needs (thyroid hormone, adrenal hormone = cortisol, sex hormones). Some hormones are administered by injection, such as growth hormone or testosterone. Vasopressin can be taken orally or administered as a nasal spray. If the cause is a tumour, surgery is usually offered, particularly if the tumour is large and may cause other complications.  Advice for patients It is very important to take the thyroid hormone and adrenal hormone (cortisone) correctly every day. Cortisone is an essential hormone for feeling well and energetic, maintaining good blood pressure and having energy, but also for responding to situations that put the body under stress (infection, fever, gastroenteritis, surgery, anaesthesia, trauma). The doses are adjusted according to the blood test results, but also according to the patient’s own feelings and experience and the clinical examination, particularly in the case of cortisone (level of fatigue, weight, blood pressure, etc.). The cortisone dose must be increased in situations that put the body under stress. In the event of repeated vomiting preventing proper oral administration, cortisone may be administered intramuscularly by a family member or an on-call doctor.  In situations of major stress, such as surgery, anaesthesia or a serious infection, cortisone must be administered at a higher dose intravenously.  Patients with cortisol deficiency and their families are informed about situations requiring an increase in the doses. A nurse shows them how to inject cortisone intramuscularly when necessary. They all carry a card in their wallet indicating their cortisol deficiency and the need to increase the doses in the event of stress. They are encouraged to show this card to the doctors caring for them, particularly in the event of surgery or a visit to the Emergency Department. Growth hormone is administered every evening by daily subcutaneous injection, most often in the abdomen, using a pen that must be kept in the refrigerator. The dose is adjusted according to the blood test results and the child’s growth progression. In adults, it no longer plays a role in growth but may improve quality of life and have a beneficial effect on body composition (the ratio of fat to muscle).   Transition to adulthood During adolescence, a gradual preparation for the transition to adult care is organised. This step helps strengthen the young patient’s autonomy, ensure continuity of medical follow-up and transfer all the necessary information to the specialised adult service. The transition is planned in collaboration with the patient, their family, and the paediatric and adult teams. Focus: Expertise Patients are treated by a licensed adult endocrinologist. Hormone assays and genetic tests are performed in a specialised laboratory. We work closely with the radiology and neurosurgery departments. Magnetic resonance imaging is of high quality and can be supplemented by functional imaging (methionine PET, choline PET). The neurosurgeons are experts in pituitary surgery. Patients requiring additional treatment after surgery may benefit from a targeted radiotherapy technique, the gamma knife, which is available in only a few hospitals in Belgium.Complex pituitary cases are discussed during monthly multidisciplinary meetings with expert neurosurgeons and neuroradiologists. An on-call service is available 24 hours a day. Our centre is actively committed to improving knowledge and care for patients with rare endocrine diseases. A local registry has been established and feeds into a European ERN database dedicated to the pituitary gland. The aim is to optimise follow-up practices and compare the management of patients between different specialised centres.Particularly rare and/or complex cases are also discussed with international experts. The team receives ongoing training, participates in conferences and seminars, initiates and collaborates on studies, and publishes in the field of pituitary medicine. It also provides training and teaching for students and doctors in training.  Our specialists

What is dysphagia? Eating, drinking, swallowing saliva… actions we perform every day without thinking about them. Yet, for some people, swallowing becomes difficult, painful or even dangerous. Dysphagia refers to swallowing disorders, that is, difficulties in properly passing food, drinks or saliva from the mouth to the stomach. It can occur at any age and have many causes. It may be due to a neurological cause (neurodegenerative disease, neuromuscular disease, cerebrovascular accident), a surgical cause (ENT, respiratory or cardiac surgery), prolonged intubation, ageing, certain medications, etc.  Dysphagia should not be trivialised: it can lead to weight loss, dehydration, or food or liquids entering the airways. Appropriate care can reduce these risks and preserve, as much as possible, the pleasure of eating and drinking.  When the problem is located in the mouth or throat This is referred to as oropharyngeal dysphagia. For example, the person may have difficulty preparing food in their mouth, initiating swallowing, or moving food and drinks towards the oesophagus. When the problem is located lower down This is referred to as oesophageal dysphagia. The person may feel that food is stuck or moves down with difficulty between the throat and the stomach. Dysphagia may be temporary or long-lasting. Key point: dysphagia is not a single disease. It is a symptom or disorder that can have various causes.  What are the symptoms? The signs are not always the same from one person to another. They may include: Coughing or choking during or after eating or drinking;Regularly needing to clear one’s throat during meals;Having a “wet” or hoarse voice after swallowing;Feeling as though food is stuck in the throat or chest;Having difficulty chewing;Keeping food in the mouth for a long time before swallowing it;Needing much more time to finish a meal;Food or drinks escaping through the mouth or sometimes the nose;Experiencing pain when swallowing;Avoiding certain foods or drinks because they are difficult to swallow;Drinking or eating less than before;Losing weight unintentionally;Having repeated episodes of respiratory infection or pneumonia.  Warning: it is sometimes possible to “aspirate” WITHOUT coughing Aspiration occurs when food, a drink or saliva enters the airways instead of passing into the oesophagus. This can sometimes happen without coughing or any obvious sign. This is known as silent aspiration. This is one of the reasons why a medical assessment may be necessary when several signs suggest dysphagia. How common is dysphagia in Belgium? To date, there is no sufficiently robust national Belgian figure to determine precisely how many people have dysphagia in Belgium. This difficulty is not specific to Belgium: international studies produce very different results depending on the age of the people studied, their state of health and, above all, how dysphagia is screened for or diagnosed. European recommendations generally estimate its prevalence at 10 to 20%, while emphasising that the level of evidence is low and that estimates vary according to the populations and definitions used.  Nevertheless, the available data show that dysphagia is particularly common in certain populations: Among older people living at home, studies report highly variable estimates; a recent meta-analysis estimates the pooled prevalence at approximately 18%.Among older people living in a care home, the pooled prevalence is approximately 47% in a meta-analysis.Among hospitalised older people, it may reach approximately 38%, depending on the method used to detect it.After a cerebrovascular accident, studies report particularly high rates, with estimates varying considerably according to the populations and assessment methods. One meta-analysis reports a prevalence of 55.4% among people who have had a cerebrovascular accident.  These figures cannot be directly extrapolated to the Belgian population as a whole. They mainly help explain why dysphagia is an important problem, particularly among older people or those with certain diseases.  Main sources for the figures UEG/ESNM, 2025 clinical guidelines: general prevalence estimated at 10–20%, with substantial variability according to the definitions and populations. Zhao et al., Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults, meta-analysis: 18.39% among older people living in the community, 46.98% in institutions and 37.98% in hospital. Dziewas et al./systematic review of care settings: 36.5% in hospital, 42.5% in rehabilitation and 50.2% in care homes. Wang et al., global meta-analysis: substantial variability according to the populations; 55.4% among patients who had suffered a cerebrovascular accident in the included studies.  What are the causes of dysphagia? Dysphagia can have many causes. It may notably be associated with: A cerebrovascular accident;Parkinson’s disease or other neurological diseases;Multiple sclerosis;Certain neuromuscular diseases;Dementia;Cancer of the mouth, throat or oesophagus;Surgery or radiotherapy in the head and neck region;Certain abnormalities of the oesophagus;Significant frailty or loss of muscle strength related to ageing.  The cause must therefore be investigated on a case-by-case basis.  How is dysphagia diagnosed? The first step generally consists of listening to the difficulties experienced by the person and taking a complete medical history: which foods cause problems? When does the coughing occur? Are liquids more difficult to swallow than solid foods? Has there been any weight loss or respiratory infections? Has there been a loss of appetite? Etc.  A healthcare professional can then carry out a thorough motor examination of the orofacial sphere, observe the person while they are eating and perform various swallowing tests. Depending on the symptoms and the suspected cause, additional examinations may be necessary. A specialist assessment A speech therapist specialising in swallowing disorders can assess how the person chews and swallows and identify the difficulties they are experiencing. Other specialists may be involved depending on the cause: general practitioner, ENT specialist, gastroenterologist, neurologist, dietitian, physiotherapist, nurse or other healthcare professionals. More in-depth examinations In certain situations, it is necessary to directly observe what happens during swallowing. Two examinations may in particular be used: Videofluoroscopy: an X-ray examination performed while the person swallows different consistencies;Fiberoptic Endoscopic Evaluation of Swallowing (FEES): a small flexible camera is used to observe the throat during swallowing.  These examinations provide a better understanding of where and why swallowing is problematic and help tailor the care provided.   How is dysphagia treated? There is no single treatment. Management depends on the cause, the type of dysphagia and each person’s abilities. The aim is twofold: to make swallowing as safe and effective as possible and to enable the person to continue eating and drinking in the best possible conditions. Swallowing rehabilitation The speech and language therapist may suggest exercises and techniques designed to improve certain movements or stages of swallowing. They may also teach different strategies: modifying the position of the head, adapting how a bite or sip is taken, slowing the pace of the meal, implementing safe postures, adapting the patient’s food textures, … Adapting food and drinks In some cases, it is necessary to temporarily or permanently modify the texture of food or the consistency of drinks. For example, certain foods can be chopped, blended or made easier to chew. Drinks can also be thickened when indicated. These adaptations must be personalised: a texture suitable for one person may not necessarily be suitable for another. The IDDSI (International Dysphagia Diet Standardisation Initiative) system enables the use of a common international classification to describe food textures and drink consistencies.  Treating the cause Whenever possible, treating the disease or problem causing the dysphagia is also essential. Preventing malnutrition and dehydration If the person is no longer able to eat or drink enough, a dietitian can adapt their food intake and suggest solutions to maintain a sufficient intake of energy and fluids. In some situations, tube feeding may be considered. This decision is made on a case-by-case basis with the person and the medical team. Management is therefore often multidisciplinary, involving several professionals working together.   Why should dysphagia be taken seriously? Unidentified or poorly managed dysphagia can have several consequences: Aspiration → respiratory infection Food or liquids may enter the airways and cause, in particular, aspiration pneumonia. Difficulty eating → malnutrition The person may gradually reduce the amount they eat or avoid certain foods. Difficulty drinking → dehydration Drinking may become difficult or tiring, which can lead to insufficient fluid intake. Difficult meals → loss of enjoyment Eating may become a source of worry, fatigue or social isolation.   When should you seek medical attention? Difficulty swallowing that recurs or persists should be discussed with a healthcare professional. It is particularly important to seek medical advice in the event of: Frequent coughing or choking during meals;A repeated sensation of food becoming stuck;Unexplained weight loss;A significant reduction in the amount of food or drink consumed;Repeated respiratory infections;A change in voice after swallowing;Difficulty that appears suddenly.  Sudden difficulty swallowing, particularly when accompanied by weakness on one side of the body, speech impairment or facial drooping, may be a sign of a cerebrovascular accident and constitutes a medical emergency.  Our specialists ENT Department: 02/555.37.75 ENT specialists in swallowing disorders:  Dr Nicolas ROPERDr Céline LAURENT  Speech and language therapists from the ENT Department:SNEL LorianaLE JEMTEL AlixNEEFS MathildeSEVERIN GéraldineSpeech and language therapists from the Neurology / Neurorehabilitation Department:MORALDO LauraEL OMARI RimGUERRY NathalieROLLO COLLURA CostanzaROBERT SophieSpeech and language therapists from the Neuromuscular Reference Centre:SNEL LorianaBARY PhilippineDECONDE JulieSpeech and language therapists from the Geriatrics Department:VAN DER MAREN Anne-SophieBARY PhilippineSpeech and language therapist from the Paediatrics Department:VAN DER MAREN Anne-Sophie Discover our ENT department FAQ on dysphagia 1. Does dysphagia mean that I will inevitably choke? No. Dysphagia can take different forms, and its severity varies from one person to another. It may simply cause a sensation of blockage, make certain foods difficult to swallow, or lead to aspiration. 2. Is it normal to have more difficulty swallowing as you get older? Ageing can alter certain functions involved in swallowing. However, regular difficulty swallowing should not be considered a normal consequence of ageing. An assessment can help identify a cause and suggest solutions. 3. Why do I cough when I drink water? Coughing during or immediately after drinking may be a sign that the liquid is not passing properly into the oesophagus. This does not necessarily mean that you have dysphagia, but if it happens frequently, it is best to discuss it with a healthcare professional.   4. Is it possible to have dysphagia without coughing? Yes. Some aspiration episodes can be silent, without coughing or any obvious signs. 5. Can dysphagia go away? Yes, in certain situations. It may be temporary, particularly when it is related to an acute condition or certain treatments. In other cases, it may last longer and require rehabilitation or adaptations.  6. Can you still eat normally with dysphagia? It depends on the situation. Where possible, the aim of care is to enable the person to continue eating and drinking by mouth under appropriate safety conditions. 7. Why do drinks sometimes need to be thickened when you have dysphagia? Some people have greater difficulty controlling very thin liquids. In these situations, an adapted consistency can facilitate control of the drink during swallowing. This adaptation should be recommended following an appropriate assessment.  8. Who should you consult for dysphagia? Several professionals may be involved: a doctor, speech therapist, dietitian, nurse, physiotherapist, ENT specialist, gastroenterologist, neurologist, and so on. The professional involved depends in particular on the cause and the difficulties encountered. 9. Can dysphagia lead to weight loss? Yes. Difficulties swallowing can lead to eating less, avoiding certain foods or considerably prolonging mealtimes. This can contribute to malnutrition.   10. What should I do if I think I have dysphagia? Talk to your doctor or another healthcare professional. Do not wait until the difficulties become significant, especially if you regularly cough while eating or drinking, lose weight, or experience recurrent respiratory infections.

What is a complication of haemodialysis? Haemodialysis is an essential treatment for patients with severe or end-stage kidney failure. Despite advances in dialysis techniques, it may be associated with acute or chronic complications, sometimes severe, which may require specialised care.These complications may be related to the dialysis session, vascular access, anticoagulant treatments, cardiovascular and metabolic disorders, or prolonged exposure to haemodialysis.Some complications are common, while others are rare and complex. Their diagnosis can be difficult in patients with multiple comorbidities and may sometimes require the involvement of several specialties. What are the main complications? Complications may occur during or after a dialysis session, or develop gradually over the course of follow-up.They include in particular:Hypotension and other haemodynamic complications during dialysis;Fluid, electrolyte and acid–base disorders;Cardiovascular complications;Reactions related to the dialyser or extracorporeal circuit;Haemorrhagic or thrombotic complications;Infections related to catheters or vascular access;Thrombosis, stenosis, aneurysms or other complications of arteriovenous fistulas;Mineral and bone disorders and vascular or valvular calcifications;Anaemia and malnutrition;Complications related to prolonged exposure to dialysis, particularly β2-microglobulin-related amyloidosis.Some of these complications may lead to repeated hospitalisations, loss of vascular access, a reduced quality of life or, in the most severe cases, be life-threatening. When should you seek medical advice? Specialist assessment is necessary, in particular, in the event of:Repeated or poorly tolerated hypotension during dialysis;Repeated difficulties in carrying out dialysis sessions;Prolonged or unusual bleeding after dialysis;Malfunction or thrombosis of a fistula or catheter;Signs of infection of the vascular access;Swelling, pain or changes in the appearance of the fistula;Cardiovascular or neurological disorders occurring during or after sessions;Persistent metabolic disorders despite treatment adjustment;Unexplained joint or bone pain in patients who have been on dialysis for a long time;Any unusual or difficult-to-explain complication. How is the diagnosis established? Diagnosis is based on a comprehensive clinical and laboratory assessment tailored to each situation.Depending on the suspected complication, investigations may include:Specialised clinical and laboratory assessment;Analysis of dialysis session parameters;Assessment of vascular access;Doppler ultrasound or specialised imaging;Cardiovascular examinations;Microbiological tests if an infection is suspected;Assessment of mineral, bone and nutritional parameters;Specialised investigations in the event of a rare or atypical complication.The aim is to rapidly identify the cause of the complication in order to initiate appropriate treatment and, whenever possible, prevent its recurrence. Our care at H.U.B. The management of complex haemodialysis complications at H.U.B. is based on close collaboration between the nephrology teams and the various specialties involved.Nephrological expertiseNephrologists assess and treat dialysis-related complications and adapt renal replacement therapy to each patient’s individual characteristics.Particular attention is paid to preventing complications and preserving vascular access in order to maintain the quality and continuity of haemodialysis treatment.Multidisciplinary careDepending on the clinical situation, care may involve:Nephrology;Vascular surgery;Interventional radiology;Cardiology;Infectious diseases;Anaesthesia;Intensive care;Nutrition;Internal medicine;Renal transplantation.This organisation enables rapid management of complications and facilitates access to specialised diagnostic and therapeutic techniques.Particular expertise in vascular accessVascular access is an essential component of haemodialysis treatment. Its preservation is therefore a priority.H.U.B. has established close collaboration between nephrologists, vascular surgeons and interventional radiologists, enabling the diagnosis and management of thromboses, stenoses, infections and other complications affecting arteriovenous fistulas and catheters.This approach aims to preserve vascular access and limit the need for catheters or the creation of new access sites.Paediatric–adult collaboration and transitionHaemodialysis complications also affect children and adolescents requiring renal replacement therapy.Within H.U.B., the paediatric nephrology teams at the Queen Fabiola Children’s University Hospital (HUDERF) and the adult nephrology team at Erasme Hospital collaborate to ensure continuity of care.Particular attention is paid to the transition from paediatric to adult care. This gradual transition ensures continuity of follow-up, the transfer of medical information and the young patient’s progressive development of autonomy.Research and innovation at H.U.B.H.U.B. contributes to advancing knowledge in the field of chronic kidney disease, dialysis and its complications.This activity helps improve the prevention, diagnosis and management of haemodialysis complications and, where relevant, enables patients to access clinical research projects or collaborations with specialised centres. Why choose H.U.B.? Specialist expertise in nephrology and renal replacement therapy;Management of common, rare and complex complications of haemodialysis;Close collaboration between nephrology, vascular surgery and interventional radiology;Access to specialised technical facilities;Multidisciplinary management of complex situations;Collaboration between paediatric and adult nephrology;Organisation of the transition of patients from paediatric to adult care;Collaboration with the renal transplantation centre;Opportunities to participate in research projects and expert networks. Our specialists Associated department

What is a complication after a kidney transplant? Kidney transplantation enables patients with end-stage kidney failure to regain kidney function and achieve a better quality of life. However, it requires long-term medical follow-up to preserve the function of the transplanted kidney and prevent or treat complications that may occur after transplantation.These complications may be related to the immune system, immunosuppressive treatments, infections, cardiovascular disease or the underlying kidney disease. Some complications may occur soon after transplantation, while others appear several years later.Specialised care makes it possible to detect abnormalities promptly, investigate their cause and adjust treatment in order to preserve the graft and the patient’s overall health. What are the main complications? Complications after kidney transplantation include, in particular:Acute or chronic rejection of the transplanted kidney;Infections, particularly opportunistic infections related to immunosuppression;Viral infections such as CMV or BK virus;Complications related to immunosuppressive medicines;Recurrence of the initial kidney disease in the graft;Cardiovascular and metabolic complications;High blood pressure, diabetes and lipid disorders;Haematological and bone complications;Cancers promoted by immunosuppression;Urological or surgical complications affecting the graft;Progressive deterioration of graft function, which may, in some cases, lead to transplant loss.The management of transplant patients therefore relies on a balance between sufficient immunosuppression to prevent rejection and limited immunosuppression to reduce the risk of infections, cancers and other complications. When should you consult a doctor? Specialist assessment is necessary, in particular in the event of:Increased creatinine levels or an unexplained decrease in graft function;New or increased proteinuria;Fever or signs of infection;Urinary symptoms or decreased urine output;Unexplained increase in blood pressure;Persistent digestive problems that may affect the absorption of medications;Adverse effects or suspected toxicity of immunosuppressive medications;Abnormal blood levels of anti-rejection medications;Detection of a viral infection such as CMV or BK virus;Appearance of a mass, skin lesion or other symptoms that may suggest a tumour-related complication.A change in the function of the transplanted kidney does not necessarily mean that rejection is occurring. Prompt investigation makes it possible to distinguish between the different possible causes and adjust the treatment. How is the diagnosis made? Diagnosis is based on regular monitoring and a specialised assessment of the graft function.Depending on the situation, the examinations may include:A blood test to assess kidney function;Testing for and quantification of proteinuria;Measurement of immunosuppressive drug levels;Testing for viral infections, particularly CMV and BK virus;An ultrasound scan of the graft and other imaging examinations;Testing for donor-specific antibodies (DSA);A biopsy of the transplanted kidney when necessary;Specialised microbiological, immunological or genetic tests, depending on the context.A graft biopsy can, in particular, help distinguish rejection from other causes of transplant dysfunction and guide treatment. Our care at H.U.B. The management of complications following kidney transplantation at H.U.B. is based on close collaboration between the nephrology and transplantation teams and the various specialties required for patient follow-up.Nephrology and transplantation expertiseNephrologists provide long-term follow-up for transplant patients, monitor graft function and adjust immunosuppressive treatment.In the event of graft dysfunction, a rapid assessment is carried out to investigate the various possible causes, including rejection, infection, drug toxicity, recurrence of the original kidney disease or a urological complication.Multidisciplinary careDepending on the clinical situation, various specialists may be involved:Nephrology;Kidney transplantation team;Urological surgery;Infectious diseases;Immunology;Anatomical pathology;Radiology;Cardiology;Endocrinology;Haematology;Oncology;Dermatology;Medical genetics.This multidisciplinary approach ensures comprehensive management of complications that may occur in transplant patients.Rejection of the transplanted kidneyRejection is an immune system reaction by the patient against the transplanted kidney. It may occur early or several years after transplantation.There are different mechanisms of rejection, and distinguishing between them is essential for selecting the appropriate treatment.Diagnosis is based on analysis of kidney function, testing for donor-specific antibodies, immunological assessment and, where indicated, a graft biopsy.Prompt management is essential to limit graft damage and preserve its function.Infections and complications related to immunosuppressionImmunosuppressive medicines reduce the immune response to prevent rejection, but they also increase the risk of infections.Specific monitoring is organised to detect certain viral infections, particularly CMV and BK virus, at an early stage. Early detection of BK virus replication makes it possible, in particular, to adjust immunosuppression and reduce the risk of graft involvement.Bacterial, viral, fungal or opportunistic infections may also require specialist management in collaboration with infectious disease specialists.Long-term complicationsFollow-up of transplant patients is not limited to monitoring the graft.Immunosuppression and chronic kidney disease may promote certain long-term complications, including cardiovascular diseases, metabolic disorders, bone complications and certain cancers.Preventive care is therefore put in place to reduce these risks and improve patient and graft survival.Recurrence of kidney disease in the graftSome kidney diseases may recur after transplantation and lead to a gradual decline in graft function.The risk of recurrence depends on the original kidney disease. Specific monitoring is organised for patients with a disease that may recur, allowing early diagnosis and appropriate management.Research and innovation at H.U.B.H.U.B. actively contributes to advancing knowledge in the field of kidney transplantation and its complications.The teams are involved in clinical and translational research projects focusing in particular on the mechanisms of rejection, the immune response, infections after transplantation and complications related to immunosuppressive treatments.This work helps improve understanding of post-transplantation complications and develop new diagnostic and therapeutic strategies.Paediatric–adult collaboration and transitionKidney transplantation can be performed in children and adolescents. Follow-up must then take into account specific issues relating to growth, development, schooling and the gradual acquisition of independence.Within H.U.B., the paediatric nephrology teams at the Queen Fabiola Children’s University Hospital (HUDERF) and the adult nephrology team at Erasme Hospital collaborate to ensure continuity of care.A transition pathway is organised for adolescents and young adults to gradually prepare them for transfer to adult teams, while maintaining appropriate monitoring of the graft and immunosuppressive treatment.This organisation ensures continuity of care and limits interruptions in follow-up during a particularly important period in the life of a transplant patient. Why choose H.U.B.? Specialised expertise in renal transplantation and long-term follow-up of transplant recipients;Management of common, rare and complex complications;Access to multidisciplinary expertise;Close collaboration between nephrology, transplantation, surgery and other specialties;Access to specialised immunological, virological, radiological and histopathological examinations;Management of rejection and complex graft dysfunction;Expertise in managing infections and complications related to immunosuppression;Management of patients experiencing recurrence of their kidney disease in the graft;Close collaboration between paediatric and adult nephrology;Organisation of the paediatric-to-adult transition pathway;Participation in clinical and translational research projects. Our specialists Associated department

What is idiopathic gastroparesis? Idiopathic gastroparesis is a chronic disorder characterised by delayed gastric emptying in the absence of a mechanical obstruction, the exact cause of which remains unknown. It causes disabling symptoms: nausea, vomiting, early satiety and bloating, and abdominal pain. Diabetes and surgery involving the oesophagus or stomach are common causes of gastroparesis, but 40% to 50% of cases are classified as idiopathic (with no identified cause), although they are often suspected to be post-viral in origin.Treatment aims to improve gastric emptying, manage symptoms and nutrition, and improve the patient’s quality of life.  Diagnosis The diagnosis is made by gastric emptying scintigraphy. Management begins with a consultation with a gastroenterologist to assess the severity of symptoms such as nausea, vomiting, early satiety and weight loss (GCSI clinical score), and to assess nutritional status.Gastroscopy, medical imaging (abdominal CT scan): to rule out a mechanical obstruction.Gastric emptying scintigraphy: Key examination for measuring the slowness of stomach digestion. Treatments Dietary and lifestyle measures: Eat smaller, more frequent meals and limit fatty foods and indigestible fibre.Prokinetic medicines: To stimulate stomach contractions and reduce nausea (e.g. domperidone).Nutritional support: Enteral nutrition (tube feeding) in cases of severe malnutrition. Endoscopic procedure: G-POEM (Gastric Per-Oral Endoscopic Myotomy) to relax the pyloric muscle and facilitate gastric emptying in cases of severe symptoms that do not respond to dietary measures and prokinetic medicines. Follow-up Follow-up involves several specialists as part of a multidisciplinary care pathway:Gastroenterologists (specialists in motility disorders).Nutritionists/Dietitians: To adapt the diet (a low-fibre, low-fat diet). Transition to adulthood Patients treated and followed in paediatrics transition to the gastroenterology outpatient clinic, where the follow-up required in adulthood is provided. Our specialists Associated department