What is Dysphagia?
Difficulty swallowing is referred to as dysphagia. It can be caused by a variety of conditions including neurological disorders (e.g., Parkinson’s), dementia, stroke, learning disability, general ageing, and general acute illness.
If you or your relative has dysphagia, there may be a risk of food, drinks, or saliva “going down the wrong way” and entering the windpipe or lungs. This is known as aspiration.
Aspiration can be uncomfortable for you or your relative and can result in coughing when eating and drinking. Sometimes aspiration can occur with no immediate or obvious signs or symptoms. This is known as silent aspiration.
Frequent aspiration can lead to an infection in the lungs called aspiration pneumonia. In some cases, severe pneumonia can be fatal.
Speech and Language Therapists specialise in the assessment and treatment of swallowing problems by helping to identifying the cause of dysphagia and consider ways to reduce the risk of aspiration. They often suggest modified foods and fluids or strategies to promote safer swallowing.
For some people, the use of compensatory strategies cannot prevent the risk of aspiration when eating and drinking.
What happens next?
When swallowing is unsafe, Nil by Mouth with non-oral nutrition and hydration is sometimes an option to reduce the risk of choking or developing aspiration pneumonia.
This means not having any food or drinks by mouth. Instead, a feeding tube can be inserted directly into the stomach (Percutaneous Endoscopic Gastrostomy – PEG) or via the nose (Nasogastric Tube – NGT).
A Nasogastric (NGT) or Nasojejunal Tube is inserted through the nose, down the oesophagus (food pipe) and into the stomach. They are typically used for short-term feeding of less than 4 weeks.
A Percutaneous Endoscopic Gastrostomy (PEG) is directly inserted into the stomach through a small hole made through the skin. They are used for long-term feeding of more than 4 weeks.
About Tube Feeding
What are the benefits of Tube Feeding?
- Increased energy and strength, as tube feeding allows consistent delivery of a nutritional liquid feed.
- Improved hydration as water flushes can be given down the tube to help you stay hydrated.
- Medications can be given via the tube.
- Could reduce the risk of coughing, choking and chest infections.
- Prevention of weight loss.
- Strengthening the immune system.
- Decreasing swallow related anxiety. It may help to improve enjoyment and quality of life.
What are the risks of Tube Feeding?
- Tube complications. The feeding tube can sometimes become blocked, fall out or leak. The skin around the tube can become infected and sore.
- Discomfort. Feeding can sometimes cause diarrhoea, constipation, stomach pain, wind, and bloating.
- Aspiration. This may happen if you are unable to maintain an upright (45 degree) position after feeding.
- Returning home. You might not always be able to return to your own home with a PEG or NGT.
Frequently Asked Questions
How will I care for the tube?
Nutrition nurses will help teach you to use the tube independently. If you require additional support, family members/carers/care home staff can be trained.
Will I be stuck indoors?
Your healthcare team will work with you to create the most appropriate feeding pattern. You may be fed the liquid feed via a pump over a certain number of hours (i.e., continuous feeding). Otherwise, you may be fed larger quantities of the liquid feed a few times a day (i.e., bolus feeding).
Will I have to live somewhere else?
If you or your family are unable to care for the tube, trained carers may be able to visit regularly to do this.
Where will I receive professional support from?
- Nutrition nurses and Dietitians
- Nutricia helpline – 03457 623253
- Written information
What if I still want to eat and drink?
Some people choose to have oral tasters for pleasure alongside the longer-term feeding tubes. Your Speech and Language Therapist and doctor can discuss the options with you to reduce the risk.
For more information, please contact:
Nutrition and Dietetics Service
Queen Elizabeth Hospital
Gateshead Health NHS Foundation Trust
Sheriff Hill,
Gateshead,
NE9 6SX
Speech and Language Therapy
Queen Elizabeth Hospital
Gateshead Health NHS Foundation Trust
Sheriff Hill,
Gateshead,
NE9 6SX