Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding

Abstract

Background In clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. However, its impact on the swallowing function remains largely unknown. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients. Methods The participants of this study were 30 elderly post-stroke patients who had been using an NGT for more than 2 months. A videofluoroscopic swallowing study (VFSS) was performed before and 5 h after removal of the NGT. The following parameters were analyzed and compared, the functional dysphagia scale (FDS), residue in the valleculae, residue in the pyriform sinuses, and the penetration-aspiration scale (PAS). In addition, prior to the VFSS, the pharynx and larynx were examined using a fiberoptic laryngoscope. Results Significant differences were observed between the total scores of the FDS, pharyngeal transit times (PTTs), the residue in the valleculae, and the residue in the pyriform sinuses before and after the NGT removal, suggesting an improved swallowing function following the removal of the NGT. A significantly lower penetration-aspiration degree was found after removing the NGT compared with that before its removal. In addition, examinations using the fiberoptic laryngoscope showed that laryngopharyngeal edema was present in three quarters of the patients. Conclusions Our results demonstrate that prolonged placement of the NGT had a negative impact on the swallowing function of elderly post-stroke dysphagia patients, mainly on the pharyngeal phase.

Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission

“…The development of aspiration pneumonia depends on the cough reflex, volume and pH level of aspirated material, and the integrity of the immune system [27]. NGT that passes through the gastroesophageal sphincter may increase gastroesophageal reflux [31] and NGT that passes through the upper esophageal sphincter may interfere with the protective cough reflexes, thereby increasing the risk of aspiration [32][33][34].…”

Dispelling Myths and Unfounded Practices About Enteral Nutrition

“…22 In a recently published study, in similar patients with dysphagia post-stroke, it was found that the NGT has a negative effect on swallowing function, and it was recommended that once the patient is able to swallow, the tube should be removed. 23 This is also dependent on the amount the patient is able to ingest. Summary/Recommendations: Patients with a nasogastric feeding tube who are able to safely swallow and meet nutrition needs orally should do so as a transition to having the NGT removed.…”

Percutaneous endoscopic gastrostomy feeding effects in patients with neurogenic dysphagia and recurrent pneumonia

“…Long-term NGT placement could lead to sensory disorders, such as sensory deficits or desensitization in the laryngopharyngeal structures. 37 As a result, secretion accumulation in the pyriform sinus or a leak into the laryngeal vestibule could result in aspiration in these patients. 38 Therefore, it is important when selecting patients for PEG to be aware that certain conditions respond more favorably in terms of preventing pneumonia.…”