Nutritional Support in Amyotrophic Lateral Sclerosis

Abstract

Background: Pyramidal tract neuronal death in ALS leads to impairment of voluntary movements including swallowing and respiration. Dysphagia is associated with fatal complications such as aspiration pneumonia, undernutrition and dehydration. Optimization of nutritional support in ALS patients is necessary. Studies assessing quality of life in ALS patients with dysphagia and gastrostomy risks and benefits are lacking. Objectives: To assess benefits and challenges of nutritional support especially gastrostomy in Russian ambulatory ALS patients. Methods: Dysphagia in ALS patients was evaluated clinically and in some cases by video-radioscopy. Mild dysphagia was managed through diet modifications. Patients with severe dysphagia underwent gastrostomy. Patients or carers were interviewed, 30 patients with gastrostomy were questioned 1 year after gastrostomy. Results: Percutaneous endoscopic gastrostomy (PEG) was performed in all patients with severe dysphagia except one (radiologic placement). Mean disease duration before gastrostomy was 849 days. Forced vital capacity (FVC) before gastrostomy was < 50% in 20 % of patients. 4 patients had short-term fever that reduced without treatment after gastrostomy. One patient had an anterior abdominal wall abscess which required replacement of the gastrostomy tube. 28 of 30 patients had a benefit from gastrostomy. Most of patients had weight stabilization; taking meals caused fewer difficulties and was less timeconsuming. Gastrostomy was more favourable than nasogastral tube feeding utilized in several patients before gastrostomy since it did not cause mucosal irritation and hypersecretion. Discussion and conclusion: PEG improves the quality of life of ALS patients with severe dysphagia, rarely causes major or long-term complications and should be used more frequently.