Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Gómez, Juan José López; Ballesteros-Pomar, María D.; Torres-Torres, Beatriz; Maza, Begoña Pintor-de la; Penacho-Lázaro, M. Ángeles; Palacio-Mures, J.M.; Abreu-Padín, Cristina; Sanz-Gallego, Irene; Luis, Daniel Antonio de

doi:10.3390/nu13082765

Cited by 15 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Especially in patients with bulbar symptoms, early implementation of PEG can be necessary to counteract malnutrition and weight loss due to dysphagia. Lopez-Gomez et al could even show prolonged survival in ALS patients with PEG ( 56 ). Our Kaplan-Meier diagrams actually did show this tendency too, yet the group of patients with low ALB only contained 7 patients.…”

Section: Discussionmentioning

confidence: 98%

Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study

et al. 2022

View full text Add to dashboard Cite

ObjectiveAmyotrophic lateral sclerosis (ALS) pathogenesis is still unclear, its course is considerably variable, and prognosis is hard to determine. Despite much research, there is still a lack of easily accessible markers predicting prognosis. We investigated routine blood parameters in ALS patients regarding correlations with disease severity, progression rate, and survival. Additionally, we analyzed disease and patients' characteristics relating to baseline blood parameter levels.MethodsWe analyzed creatine kinase (CK), albumin (ALB), creatinine (CREA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG) levels around time of diagnosis in 1,084 ALS patients. We carried out linear regression analyses including disease and patients' characteristics with each blood parameter to detect correlations with them. Linear regression models were performed for ALSFRS-R at study entry, its retrospectively defined rate of decay and prospectively collected progression rate. Different survival analysis methods were used to examine associations between blood parameters and survival.ResultsWe found higher CK (p-value 0.001), ALB (p-value <0.001), CREA (p-value <0.001), and HDL levels (p-value 0.044) at time of diagnosis being associated with better functional status according to ALSFRS-R scores at study entry. Additionally, higher CREA levels were associated with lower risk of death (p-value 0.003).ConclusionsOur results indicate potential of CK, ALB, CREA, and HDL as disease severity or progression markers, and may also provide clues to ALS pathogenesis. However, these values are highly dependent on other variables, and further careful, longitudinal analyses will be necessary to prove the relevance of our findings.

show abstract

Section: Discussionmentioning

confidence: 98%

Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…However, early gastrostomy implantation prevents the development of disease complications and improves the quality of life of these patients [58] but has not clearly shown a benefit in patient survival [59]. However, patients who still maintain oral intake tend to be reluctant to place it early.…”

Section: Dysphagia -New Advancesmentioning

confidence: 99%

Dysphagia of Neurological Origin – Amyotrophic Lateral Sclerosis

Argente-Pla¹,

García‐Malpartida²,

Micó-García³

et al. 2022

Dysphagia - New Advances

View full text Add to dashboard Cite

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of unknown etiology that affects upper and lower motor neurons resulting in progressive atrophy of skeletal muscles. There are two forms of ALS: spinal motor neuron injury and bulbar paresis. Dysphagia is a highly prevalent severe and invalidating symptom in ALS: almost 80% of ALS patients with bulbar paresis will develop dysphagia. Also, dysphagia is one of the most common and serious complications, with respiratory insufficiency, in patients with ALS as it exposes them to malnutrition, dehydration and aspiration pneumonia. These conditions are reported to be associated with a minor survival in patients with ALS. Screening for dysphagia must be performed in all ALS patients at diagnosis and during the follow-up to approach dysphagia as soon as possible. This chapter includes the latest developments in the assessment and approach of dysphagia in ALS patients.

show abstract

“…Furthermore, clinicians recommend earlier PEG tube insertion in all patients with ALS with progressive dysphagia 17 . Despite these recommendations, patients and their families often express hesitancy regarding PEG tube insertion when oral intake is still possible 18 . Consequently, some patients inevitably experience aspiration pneumonia or malnutrition 10 , 19 .…”

Section: Introductionmentioning

confidence: 99%

Timing and impact of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis: a comprehensive analysis

Son,

Lee,

Ryu

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Dysphagia is common in amyotrophic lateral sclerosis (ALS) patients, often requiring percutaneous endoscopic gastrostomy (PEG) for enteral nutrition. We retrospectively analyzed data from 188 Korean patients with ALS who underwent PEG tube insertion at five-time points: symptom onset (t1), diagnosis (t2), recommended time for gastrostomy (t3), PEG insertion (t4), and one-year post-insertion (t5). The recommended time point for gastrostomy (T-rec for gastrostomy) was defined as the earlier time point between a weight loss of more than 10% and advanced dysphagia indicated by the ALSFRS-R swallowing subscore of 2 or less. The T-rec for gastrostomy was reached at 22 months after symptom onset, followed by PEG insertion at 30 months, resulting in an 8-month delay. During the delay, the ALSFRS-R declined most rapidly at 1.7 points/month, compared to 0.8 points/month from symptom onset to diagnosis, 0.7 points/month from diagnosis to T-rec for gastrostomy, and 0.6 points/month after the PEG insertion. It is crucial to discuss PEG insertion before significant weight loss or severe dysphagia occurs and minimize the delay between the recommended time for gastrostomy and the actual PEG insertion. A stratified and individualized multidisciplinary team approach with careful symptom monitoring and proactive management plans, including early PEG insertion, should be prioritized to improve patient outcomes.

show abstract

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Cited by 15 publications

References 29 publications

Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study

Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study

Dysphagia of Neurological Origin – Amyotrophic Lateral Sclerosis

Timing and impact of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis: a comprehensive analysis

Contact Info

Product

Resources

About