MS Patients Needing Feeding Tubes May Live Longer if Given Before Age 50, Study Finds
These findings may help doctors and patients with decisions about feeding tube use, but more work is needed to better understand the benefits of this procedure, its researchers said.
About 30% of people with MS are estimated to have dysphagia, which raises the risk of malnutrition, dehydration, and the aspiration (breathing in) of food particles that could cause serious lung infections, including pneumonia. Dysphagia is also known to significantly lower patients’ quality of life, affecting their mental health, and their interest and joy in eating and drinking.
A gastrostomy (feeding) tube is inserted through the abdominal wall to allow for proper nutrition and hydration, and to lessen the likelihood of aspiration-associated lung infections. But data are limited on MS patient outcomes after feeding tube placement.
Researchers in the U.K. reviewed the medical records of people who underwent this procedure at Sheffield hospitals from 2005 through 2017.
A total of 53 patients (37 women and 16 men), with a mean age of 55.4, were identified. Most had secondary progressive MS (86.8%), with a mean 17.8 years since their disease was diagnosed, and were either using wheelchairs (52.8%) or were confined to a bed (41.5%).
Gastrostomy tubes were placed mostly due to swallowing difficulties (54.7%), and aspiration pneumonia or recurrent pneumonia (26.4%). Slightly more than half of these patients (52.8%) were discharged to their homes from a hospital, while others (47.2%) went to a nursing home.
Records showed a median hospital stay of 14 days after the procedure, and a median survival of nearly two years (21.73 months).
A clear majority (81.1%; 43 people) were alive one year after the procedure, and more than half (54.7%; 29 people) at two years. Eleven lived for five years after tube placement (22.4%), and three were alive at 10 years (6.8%).
Those who had a feeding tube placed before their 50s survived significantly longer (median of 28.48 months; more than two years), compared with patients undergoing the procedure at later ages (median of 17.51 months; nearly a year and a half), data showed.
Age (younger or older than 50) was the sole predictor of better survival with this procedure, the study reported. No other parameter — including type and duration of MS, disability level, mobility, gender, elective or emergency surgery, and place of residence after hospital discharge from hospital — was seen to predict survival.
“In these [previous] studies the cut-off age for poor survival after gastrostomy for neurogenic dysphagia was 75 years,” the researchers wrote. “Our data found that the cut-off age for poor survival in patients with MS was 50 years. This could be because, unlike other neurodegenerative conditions causing dysphagia, MS is predominately a disease of young working-age adults.”
They also reported that while use of a feeding tube “is likely to extend the survival of people with dysphagia due to MS” by better meeting their nutritional needs, “it may not prevent aspiration pneumonia.”
The most frequent cause of death in this patient group was respiratory tract infection (45.3%, 24 of 53 people), followed by MS or frailty (26.4%; 14 patients). Findings of death due to respiratory tract infections are consistent with data from a previous study on survival after feeding tube placement in people with dysphagia due to a neurologic disease.
Taken together, these findings “will help inform clinicians and patients with MS making decisions regarding gastrostomy tube placement,” the researchers concluded.
But more studies are needed, they emphasized.
“Our data do not answer the question ‘Can gastrostomy extend survival, improve nutrition and prevent aspiration in MS patients who have indication for gastrostomy insertion?,’ the team wrote. “A prospective study, with patients who refuse gastrostomy as control, may be helpful in answering these important questions.”