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In this article, we will summarize the guidelines and recommendations about the initiation of enteral or tube feeding in a patient of acute stroke with dysphagia. Summary of Recommendations: When to start enteral feeding in a patient of stroke? Each patient of stroke should be evaluated for dysphagia as soon as possible. How to evaluate dysphagia in a patient of acute stroke? There are five ways of assessing dysphagia; Water swallowing test Multiple consistency test. Swallowing provocation test Videofluoroscopic swallowing study (VFSS) Fiberoptic endoscopic evaluation of swallowing (FEES) Videofluoroscopic swallowing study (VFSS) is the gold standard of swallowing evaluation.  Importance of starting early nutrition in a patient of acute stroke If a patient doesn't pass the swallowing evaluation. Then we should think about alternate modes of nutrition. As nutrition in a patient of stroke affects the outcome, decreases the risk of infections, bedsores, and also decrea...

A Patient who has a stroke commonly presents with altered sensorium, dysphagia, and weakness of a part or whole side of the body depending on the extent of infarct and area of the brain that is involved. If a patient has dysphagia or altered sensorium, then he is at risk of having aspiration. So in such situation, oral or enteral feeding shouldn't be allowed during the first 72 hours at least. Professor Dr. Rauf Niazi , explained during a teaching session at PIMS hospital, "A nasogastric tube should only be passed if needed as it may actually increase the risk of aspiration. In the presence of nasogastric tube the lower esophageal sphinctor (a valve at the lower end of esophagus which prevents reflux of stomach contents back to esophagus) can't close properly and food or gastric secretions may regurgitate back to esophagus, thus, increase the risk of aspiration. If patient is at risk of aspiration or is having recurrent aspiration, then you should pass NG tube ac...