Early gastrostomy associated with speech therapy in patients with amyotrophic lateral sclerosis

Abstract

Amyotrophic Lateral Sclerosis (ALS) is a degenerative disease that occurs with the deterioration of motor neurons. The beginning of clinical impairment may be bulbar with the average life time, after the first symptoms, between 2 to 5 years, presenting serious swallowing, speech and breathing disorders. Deglutition disorders can lead to malnutrition, dehydration, aspiration, displeasure, and more serious complications such as aspiration pneumonia and death. With the evolution of the disease, the patient needs procedures that generate doubts in the professionals and family, as the correct moment of indication of the use of alternative long-term feeding routes called gastrostomies (GTT). The objective of this article is to analyze the impact of dysphagias and the most favorable moment for the placement of gastrostomies. Early GTT placement may help prevent the patient from clinically debilitating more quickly, respond better to multidisciplinary team therapeutics, and feel more comfortable.Key-words: dysphagia, enteral nutrition, gastrostomy, deglutition disorders, motor neuron disease, amyotrophic lateral sclerosis.

The Current State and Future Directions of Swallowing Care in Amyotrophic Lateral Sclerosis

“…The 2012 guidelines from the European Federation of the Neurological Sciences suggest that individuals with worsening respiratory status should consider percutaneous endoscopic gastrostomy tubes (PEG) even in the absence of dysphagia [54], as once dysphagia develops, it may be too late for placement. Benefits of early placement include potentially maximizing nutritional status and allowing for active patient participation in nutritional management interventions [33].…”