Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: A randomized controlled crossover trial

Abstract

Background & Aims:The presence of a nasogastric tube (NGT) affects swallowing physiology but not function in healthy young adults. The swallowing mechanism changes with increasing age, therefore the impact of a NGT on swallowing in elderly individuals is likely to be different but is not yet known. The aims of this study were to determine the effects of NGTs of different diameter on (1) airway penetration-aspiration, (2) pharyngeal residue, and (3) pharyngeal transit, in older healthy subjects. Methods:Randomized controlled crossover design. Healthy elderly volunteers underwent 3 modified barium swallow studies in which multiple diet and fluid consistencies were swallowed under the following conditions: (A) no NGT (control), (B) fine bore NGT, and (C) wide bore NGT. The control condition was assessed first to establish baseline swallowing function, then NGT order was randomly allocated. Results:Of the 15 volunteers (median age 65 years, range 60-81) complete data sets were obtained for 9 (4 with allocation order ABC; 5 with ACB). Wide bore NGT data could not be obtained for 6 volunteers mainly due to tube intolerance. The presence of a NGT was associated with: (i) an increase in airway penetration-aspiration (fine bore NGT with serial liquid swallows and puree) (p<0.01); (ii) increased pharyngeal residue (p<0.05) in the pyriform sinus (fine bore NGT with puree); and in the valleculae (both fine and wide bore NGT with soft solids); and (iii) an increase in pharyngeal transit duration regardless of consistency (p<0.01), with longest swallowing durations with the widest tube. Conclusions:NGT presence increases airway penetration-aspiration, pharyngeal residue and prolongs transit through the pharynx in older healthy individuals. Consideration of NGT impact on swallowing during concurrent oral and enteral feeding is recommended, with 4 further systematic investigation required in elderly patients recovering from critical illness.

Dispelling Myths and Unfounded Practices About Enteral Nutrition

“…A more recent trial in older healthy subjects concluded that the presence of an NGT increases airway penetration‐aspiration and pharyngeal residue and prolongs transit through the pharynx in older healthy individuals. Consideration of the impact of an NGT on swallowing during concurrent oral and enteral feeding is recommended, with further systematic investigation required in elderly patients recovering from critical illness .…”

Novel Visual Nasogastric Tube Insertion System: A Feasibility and Efficiency Study in a Manikin

“…Tubes often bend and coil in the pyriform sinus and arytenoid cartilage during insertion [17, 18]. In addition, physiological or pathological variations of a patient's functional anatomy can predispose to prolonged procedure or misplacement [19–21].…”

Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube–fed patients

“…The incidence of aspiration pneumonia in tube‐fed patients is reported between 7% and 62%, with a mortality rate of 17% to 62% . Among various tube‐feeding techniques, nasogastric tube (NGT) feeding has the added disadvantage of disturbing the protective mechanism of the lower esophageal sphincter (LES) and upper esophageal sphincter (UES) against reflux …”

“…17 Among various tube-feeding techniques, nasogastric tube (NGT) feeding has the added disadvantage of disturbing the protective mechanism of the lower esophageal sphincter (LES) and upper esophageal sphincter (UES) against reflux. [18][19][20] The main mechanism of gastroesophageal reflux in this patient population is likely related to the increased number of inappropriate transient lower esophageal sphincter relaxations in the setting of increased gastric volume/content. After entry of gastric content into the esophagus, there remain two mechanisms for containing the refluxate in the esophagus and preventing its entrance into the pharynx, which is a prerequisite for aspiration.…”