From the Guidelines
The prevalence of post-stroke dysphagia after 90 days is approximately 8.5-29% of stroke survivors, with most studies suggesting around 11-23% of patients continue to experience swallowing difficulties at this time point. This represents a significant improvement from the acute phase, where dysphagia affects up to 78% of stroke patients initially 1. The wide range in reported prevalence reflects differences in assessment methods, stroke severity, and definitions of dysphagia used across studies. Recovery typically follows a pattern of greatest improvement in the first few weeks post-stroke, with continued but slower recovery occurring up to 6 months. Persistent dysphagia at 90 days is associated with poorer long-term outcomes and increased risk of complications such as aspiration pneumonia, malnutrition, and dehydration. Factors that predict persistent dysphagia include initial stroke severity, location of the stroke (particularly brainstem strokes), bilateral hemispheric damage, older age, and pre-existing swallowing problems 1.
Some key points to consider in the management of post-stroke dysphagia include:
- Early enteral nutrition in patients anticipated to have swallowing difficulties for more than seven days 1
- The use of PEG tubes may be preferred over nasogastric tubes in certain cases, such as mechanically ventilated patients or those with prolonged artificial nutrition 1
- Dysphagia therapy should start as early as possible, in tube-fed as well as non-tube-fed patients 1
- Patients who still have dysphagia at 90 days should continue to receive specialized swallowing therapy and appropriate dietary modifications, as some may still show improvement beyond this timepoint, though complete resolution becomes less likely 1.
It is essential to note that the decision to use PEG tubes or nasogastric tubes should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances 1. Additionally, the placement of nasogastric tubes should be done by trained and technically experienced medical staff, and the correct position should be controlled before the application of tube feed 1.
From the Research
Prevalence of Post-Stroke Dysphagia
- The prevalence of persistent dysphagia in stroke patients is reported to be around 15% 2.
- Dysphagia affects the vast majority of acute stroke patients, although it improves within 2 weeks for most, some face longstanding swallowing problems 3.
- Predictors of prolonged dysphagia include stroke severity, dysphasia, and lesions of the frontal and insular cortex on brain imaging 4.
Duration of Dysphagia
- Dysphagia can last for more than 90 days in some patients, with one study reporting a median time between stroke and PEG insertion of 2 months 2.
- Prolonged dysphagia can necessitate prolonged enteral feeding, with early enteral feeding via percutaneous endoscopic gastrostomy (PEG) being both beneficial and safe 4.