Patients younger than 50 who have multiple sclerosis (MS) who receive a gastrostomy tube to enable home enteral feeding (HEF) live longer than those older than 50 years, according to a study published in Multiple Sclerosis Journal- Experimental, Translational, Clinical.
In this descriptive retrospective case note review, researchers evaluated medical records, HEF databases, and death certificates of patients with MS who received gastrostomy from 2005 to 2017 in Sheffield, England. Of the 53 patients included in the study, around 54% survived 2 or more years following gastrostomy. “This is the largest dataset on patients with MS on gastrostomy tube for HEF,” the researchers noted.
Dysphagia, or difficulty swallowing, is a common symptom of MS and around one-third of patients with the disease experience this symptom. However, insertion of a gastrostomy tube allows for the safe administration of nutrition and hydration in patients.
The median survival following gastrostomy was 21.73 months, and the researchers found younger patients had better survival rates. Patients who received the gastrostomy tube before age 50 had a median survival rate of 28.48 months while those who received the treatment after age 50 survived a median of 17.51 months (P = .04). The researchers also found being older than 50 years at tube insertion to be the only significant predictor of shorter survival compared with duration of MS, gender, mobility, and other factors.
From the data, researchers collected information on gastronomy tube placement, duration of hospital stay, Expanded Disability Status Scale functional score at the time of gastrostomy, tube placement, discharge location, date of death, and cause of death.
“More than 80% of patients with MS survived more than a year, and more than 50% survived 2 years after gastrostomy. HEF is likely to extend the survival of people with dysphagia due to MS,” they said. The most common cause of death among patients in the cohort was respiratory tract infection.
Specifically, researchers found the following survival rates:
- At 30 days: 100% (53/53)
- 3 months: 98.1% (52/53)
- 1 year: 81.1% (43/53)
- 2 years: 54.7% (29/53)
- 5 years: 22.4% (11/49)
- 10 years: 6.8% (3/44)
The data determined 50 years to be the cut-off age for poor survival in patients with MS. “This could be because, unlike other neurodegenerative conditions causing dysphagia, MS is predominately a disease of young working-age adults,” the researchers said.
They stress the study does not answer the question on whether gastrostomy can extend survival, improve nutrition, and prevent aspiration in patients with MS. A prospective study using patients who refuse gastrostomy, as a control, could be more beneficial to provide answers to these questions.
Grandidge L, Chotiyarnwong C, White S, Denning J, Nair KPS. Survival following the placement of gastrostomy tube in patients with multiple sclerosis. Mult Scler J Exp Transl Clin. 2020;6(1):2055217319900907. doi: 10.1177/2055217319900907.