The Impact of Nasogastric Tubes (NGTs) on Swallow Function in Adults with Post-stroke Dysphagia: A Systematic Review

Nasogastric Tubes (NGTs) are a first-line treatment for delivering short-term nutrition to stroke survivors with dysphagia. However, the impact of NGTs on swallowing function itself is not yet well understood, despite the clinical importance of understanding this relationship to guide NGT treatment decisions. This review examined current evidence on the effects of NGTs on swallowing function in this population, focusing on five outcomes of interest: overall swallowing function, penetration/aspiration, oral and pharyngeal transit times and pharyngeal residue. A systematic search of terms related to stroke, dysphagia and NGTs across four major databases identified 1099 records. Eight full-text articles met inclusion criteria, of which seven were a pre-post design and one was a randomised control trial. Sample sizes of included studies ranged from 21 to 147 participants and median ages were between 66.0 ± 8.5 to 73.2 ± 12.4 years. Other participant characteristics, such as time with NGT in situ, time since stroke and NGT type, were inconsistently reported. Six studies used an instrumental swallowing evaluation to evaluate change between conditions, however, significant methodological heterogeneity between studies was evident in the inclusion criteria and assessment methods reported. Data synthesis suggested the following trends when an NGT is present: greater overall dysphagia severity, longer pharyngeal transit times, increased severity of penetration/aspiration, higher rates of pneumonia and increased volume of pharyngeal residue. However, most studies had a moderate-high risk of bias (n = 7), limiting the strength of conclusions. More methodologically robust research is needed to clarify the impact of NGTs on swallowing physiology and inform clinical management of dysphagia in stroke survivors requiring an NGT.