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Post-Stroke Dysphagia – Oral vs Tube Feeding — SCE Neurology MCQ

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EasyNeurorehabilitationPost-Stroke Dysphagia – Oral vs Tube FeedingSCE Neurology

A 60-year-old man with a recent ischaemic stroke has persistent dysphagia requiring thickened fluids and a modified texture diet. He is 4 weeks post-stroke. His SLT is providing therapy but he is not making progress with thin fluid trials. What is the recommended approach to oral feeding vs tube feeding?

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Correct answer: E — Oral feeding should be maintained where safe (even with modified textures/thickened fluids) — this maintains oral musculature function and quality of life; PEG should only be considered if oral intake is insufficient to meet nutritional needs or if aspiration risk is unacceptably high despite modifications

NICE CG162 and RCP guidelines recommend maintaining oral feeding where safe, using appropriate texture modification and thickened fluids. PEG insertion is considered when: (1) oral intake is nutritionally insufficient despite modification, (2) aspiration risk remains unacceptably high despite best SLT management, or (3) prolonged nasogastric feeding is needed (>4 weeks). Oral feeding maintains oropharyngeal musculature function, provides pleasure, and supports quality of life. Many stroke patients recover swallowing function over time with therapy. A: PEG is not automatically needed. C: Oral feeding with modifications can be safe. D: Oral feeding is often appropriate. E: Many stroke patients can eat safely with modifications.

Reference: NICE CG162; RCP Stroke Guidelines