A Multimodal Assessment of Gastric Motility, reflux risk, and Clinical Efficacy: Intermittent Oro-Esophageal versus Nasogastric Tube Feeding for Post-Stroke Dysphagia in a Randomized Controlled Trial.
rct · Level II
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- Also identified by DOI 10.1016/j.apmr.2026.07.013.
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Abstract
To compare the efficacy of intermittent oro-esophageal tube feeding (IOE) versus nasogastric tube feeding (NG) in reducing reflux risk and supporting swallowing recovery in patients with post-stroke dysphagia (PSD). A prospective, single-center, randomized controlled trial with blinded outcome assessment. Department of Rehabilitation Medicine at a university-affiliated hospital in China. Fifty-four adults with PSD confirmed by videofluoroscopic swallowing study. Participants were randomized to receive enteral nutrition support via either intermittent oro-esophageal tube feeding (IOE group, n=27) or continuous nasogastric tube feeding (NG group, n=27) for 14 days, alongside standardized swallowing rehabilitation. The primary outcomes were gastric emptying rate (measured via ultrasonographic gastric antrum cross-sectional area) and immediate postprandial reflux-mediated aspiration risk (assessed by gastric volume-to-weight ratio). Secondary outcomes included tube feeding removal success and swallowing function (Kubota Water Swallowing Test and Functional Oral Intake Scale). No significant differences in gastric emptying rate or antrum cross-sectional area were observed between groups (evaluated at baseline and post-intervention, all p>0.05). The IOE group demonstrated a significantly lower immediate postprandial reflux-mediated aspiration risk (F=5.467, p=0.023), a higher tube feeding removal success (χ²=4.964, p=0.02), and greater improvement in swallowing function (p<0.001) compared to the NG group. Moderator analysis indicated that patients with more severe functional impairment (lower Longshi Scale scores) benefited more from IOE for both aspiration reduction (β=-0.36, p=0.004) and swallowing recovery (β=-1.40, p=0.02). For patients with PSD, IOE may offer a potential advantage over NG feeding in reducing immediate reflux risk and promoting swallowing recovery. The treatment benefit is more pronounced in patients with severe baseline functional impairment. IOE should be considered a first-line enteral strategy for this population.