Effect of intermittent oro-esophageal tube feeding on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy

Objective To investigate the effect of intermittent oro-esophageal tube feeding (IOE) on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy. Methods From May 2016 to December 2018, patients with acute stroke complicated with bulbar or pseudobulbar palsy admitted to the Department of Neurology, Ninghe District Hospital of Tianjin were enrolled retrospectively. They were divided into IOE group and nasogastric gavage tube (NGT) group. The baseline clinical data, swallowing function and nutritional indicators before and after treatment, and the incidence of aspiration pneumonia were collected and compared. Kubota's water swallow test was used to evaluate the swallowing function, and Grade ≥3 was defined as poor swallowing function after 30 days of treatment. Multivariate logistic regression analysis was used to determine the independent influencing factors of poor outcomes of swallowing function. Results A total of 92 patients were enrolled, 58 were males (63%), and aged 64.3±11.2 years; the National Institutes of Health Stroke Scale (NIHSS) score 5.98±2.29; 76 patients (82.6%) had cerebral infarction, 16 (17.4%) had cerebral hemorrhage; 16 (17.4%) had bulbar palsy, and 76 (82.6%) had pseudobulbar palsy. There were 46 cases in each of the IOE group and the NGT group. The improvement of swallowing function and nutritional status at 30 d in the IOE group were significantly better than those in the NGT group (all P<0.01), while the incidence of aspiration pneumonia was significantly lower than that in the NGT group (19.6% vs. 39.1%; χ2=4.246, P=0.039). The dysphagia of 70 patients (76.1%) had good outcomes, and that of 22 (23.9%) had poor outcomes. Multivariate logistic regression analysis showed that the NIHSS score on admission (odds ratio [OR] 1.225, 95% confidence interval [CI] 1.221-1.445; P=0.030), bulbar palsy (OR 1.428, 95% CI 1.327-1.545; P<0.001), and left lesions (OR 1.424, 95% CI 1.352-1.565; P<0.001) were independently associated with the poor outcomes of swallowing function, while IOE (OR 0.351, 95% CI 0.075-0.643; P<0.001) was independently associated with the good outcomes of swallowing function. Conclusion IOE can improve the swallowing function of stroke patients with bulbar or pseudobulbar palsy, and reduce the incidence of aspiration pneumonia while providing good nutritional support. Key words: Stroke; Deglutition disorders; Bulbar palsy, progressive; Pseudobulbar palsy; Enteral nutrition; Esophagus; Treatment outcome