Could prolonged nasogastric (NG) tube placement contribute to failed swallow tests and absence of reflux in a patient with Herpes Simplex Virus-1 (HSV-1) Encephalitis and autoimmune diseases, recently diagnosed with pneumonia?

From the Guidelines

Prolonged nasogastric (NG) tube placement can contribute to failed swallow tests and absence of reflux in a patient with Herpes Simplex Virus-1 (HSV-1) Encephalitis and autoimmune diseases, recently diagnosed with pneumonia. The presence of a nasogastric tube for an extended period can lead to mechanical irritation of the pharynx and esophagus, causing inflammation and disrupting normal swallowing reflexes 1. This, combined with the neurological damage from HSV-1 encephalitis and the effects of autoimmune conditions, can further compromise swallowing function.

Key Considerations

• The absence of reflux may indicate severe dysmotility, which can increase the risk of aspiration pneumonia 1.
• Prolonged NG tube placement can result in muscle disuse atrophy of the swallowing muscles, making it challenging for patients to regain normal swallowing function.
• Alternative feeding methods, such as percutaneous endoscopic gastrostomy (PEG), should be considered if long-term enteral nutrition is needed, as they may reduce the risk of complications associated with NG tube placement 1.

Management Recommendations

• Aggressive pulmonary hygiene and intensive swallowing rehabilitation with a speech-language pathologist should be implemented once the patient is medically stable.
• The indication for artificial nutrition should be reassessed daily, and the placement of a nasogastric tube should be done by trained and technically experienced medical staff to minimize the risk of complications 1.
• A local standard for the assessment of correct tube placement should be developed in every hospital to ensure proper placement and reduce the risk of misplacement 1.

From the Research

Prolonged Nasogastric Tube Placement and Swallow Tests

• Prolonged nasogastric (NG) tube placement may contribute to failed swallow tests due to the potential for irritation and inflammation of the nasal and oral mucosa, as well as the risk of aspiration 2.
• However, there is limited direct evidence to support the specific relationship between NG tube placement and failed swallow tests in patients with Herpes Simplex Virus-1 (HSV-1) Encephalitis and autoimmune diseases.

Absence of Reflux in Patients with HSV-1 Encephalitis

• The absence of reflux in patients with HSV-1 Encephalitis may be related to the underlying neurological damage caused by the virus, which can affect the normal functioning of the gastrointestinal tract 3, 4.
• Additionally, the use of immunomodulatory therapy, such as glucocorticoids and intravenous immunoglobulin (IVIG), may also play a role in reducing inflammation and modulating the immune response, potentially contributing to the absence of reflux 2, 3.

Impact of Pneumonia on Swallow Tests and Reflux

• The recent diagnosis of pneumonia may also impact the results of swallow tests and the presence of reflux, as pneumonia can cause inflammation and irritation of the respiratory and gastrointestinal tracts 5.
• However, there is limited evidence to support the specific relationship between pneumonia and swallow tests or reflux in patients with HSV-1 Encephalitis and autoimmune diseases.

Autoimmune Diseases and Swallow Tests

• The presence of autoimmune diseases may also contribute to the failed swallow tests, as these conditions can affect the normal functioning of the nervous system and muscles involved in swallowing 3, 5.
• Further research is needed to fully understand the relationship between autoimmune diseases, HSV-1 Encephalitis, and swallow tests.