Interventions for dysphagia in acute stroke (Review)

Bath, Philip M.W.; Bath-Hextall, F.J.; Smithard, D.G.

Abstract

Background
It is unclear how dysphagic patients should be fed and treated after acute stroke.
Objectives
The objective of this review was to assess the effect of different management strategies for dysphagic stroke patients, in particular how
and when to feed, whether to supplement nutritional intake, and how and whether to treat dysphagia.
Search strategy
We searched the Cochrane Stroke Group trials register, Medline, Embase, ISI, and existing review articles.We contacted researchers in
the field and equipment manufacturers. Date of the most recent searches: March 1999.
Selection criteria
Unconfounded truly or quasi randomised controlled trials in dysphagic patients with acute/subacute (within 3 months) stroke.
Data collection and analysis
Three reviewers independently applied the trial inclusion criteria. Two reviewers assessed trial quality and extracted the data.
Main results
Percutaneous endoscopic gastrostomy (PEG) versus nasogastric tube (NGT) feeding: two trials (49 patients) suggest that PEG reduces
end-of-trial case fatality (Peto Odds Ratio, OR 0.28, 95% CI 0.09 to 0.89) and treatment failures (OR 0.10, 95% CI 0.02 to 0.52),
and improves nutritional status, assessed as weight (Weighted Men Difference, WMD +4.1 kg, 95% CI -4.3 to +12.5), mid-arm
circumference (WMD +2.2 cm, 95% CI -0.5 to +4.9) or serum albumin (WMD + 7.0 g/l, 95% CI +4.9 to +9.1) as compared with
NGT feeding; two larger studies are ongoing. Timing of feeding: no completed trials; one large study is ongoing. Swallowing therapy
for dysphagia: two trials (85 patients) suggest that formal swallowing therapy does not significantly reduce end-of-trial dysphagia rates
(OR 0.55, 95%CI 0.18 to 1.66). Drug therapy for dysphagia: one trial (17 patients); nifedipine did not alter end-of-trial case fatality or
the frequency of dysphagia. Nutritional supplementation: one trial (42 patients) found a non-significant trend to a lower case fatality,
and significantly increased energy and protein intake; one large trial is ongoing and data is awaited from two other studies. Fluid
supplementation: one trial (20 patients) found that supplementation did not alter the time to resolution of dysphagia.
Authors’ conclusions
Too few studies have been performed, and these have involved too few patients. PEG feeding may improve outcome and nutrition as
compared with NGT feeding. Further research is required to assess how and when patients are fed, and the effect of swallowing or drug
therapy on dysphagia.

Citation

Bath, P. M., Bath-Hextall, F., & Smithard, D. (2008). Interventions for dysphagia in acute stroke (Review). Cochrane Library, 2008(3), https://doi.org/10.1002/14651858.CD000323

• Journal Article Type: Article
• Publication Date: Jan 1, 2008
• Deposit Date: Jun 8, 2012
• Publicly Available Date: Jun 8, 2012
• Journal: Cochrane Library
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 2008
• Issue: 3
• DOI: https://doi.org/10.1002/14651858.CD000323
• Public URL: https://nottingham-repository.worktribe.com/output/1015524
• Publisher URL: http://dx.doi.org/10.1002/14651858.CD000323
• Additional Information: Originally published: Bath PMW, Bath-Hextall FJ, Smithard D. Interventions for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD000323. doi: 10.1002/14651858.CD000323. URL: http://dx.doi.org/10.1002/14651858.CD000323 This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 1999, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Reprinted in the Cochrane Library, 2008, issue 3.