European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

Abstract

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.

Keywords: Dysphagia; dysphagia; flexible endoscopic evaluation of swallowing; impaired deglutition; neurostimulation; screening; stroke; swallowing; videofluoroscopic swallowing study.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RD reports non-financial support from Phagenesis, other from Phagenesis, personal fees from Nestle Healthcare, grants from Olympus, personal fees from Sanofi, personal fees from Pfizer, personal fees from Daiichi Sankyo, outside the submitted work; EM has nothing to disclose; MTG reports personal fees from Phagenesis, outside the submitted work; AL has nothing to disclose; MA reports personal fees from Kabi Fresenius, personal fees from Nutricia, personal fees from Kocak Pharma, personal fees from Sanofi, personal fees from Bayer Healthcare, personal fees from Daichi Sankyo, personal fees from Pfizer, personal fees from Abbott, grants from TUBITAK, outside the submitted work; PMB reports personal fees from Phagenesis Ltd, grants from MRC (Medical Research Council, UK), personal fees from DiaMedica Inc, personal fees from Moleac, outside the submitted work; PC reports grants and contracts from Nutricia Advanced Medical Nutrition, Fresenius Kabi Deutschland GmbH, Nestle Health Science, Nestle Research, DJO Global, Phagenesis, Sanofi Research; consulting fees from Nestle Health Science, Nestle Research; honoraria for lectures from Nutricia Advanced Medical Nutrition; Support for attending meetings and/or travel from Nutricia Advanced Medical Nutrition, Sanofi Research; Participation on a Data Safety Monitoring Board or Advisory Board from Nutricia Advanced Medical Nutrition, Fresenius Kabi Deutschland GmbH, Nestle Health Science, Nestle Research, DJO Global, Sanofi Research, outside the submitted work. JG has nothing to disclose; SH reports other from Phagenesis Ltd, grants from MRC (Medical Research Council, UK), outside the submitted work; SP has nothing to disclose; AS has nothing to disclose; MS has nothing to disclose; DW reports personal fees from Desitin Pharma, outside the submitted work; RW has nothing to disclose; EV has nothing to disclose.

© European Stroke Organisation 2021.