**Abstract**

Neurogenic dysphagia is an increasingly common problem. This chapter describes current approaches to enteral nutrition in patients with neurogenic dysphagia. We have shown the possibilities and our experience of using diet with a measured degree of density, specialized thickeners for drinks and food, readymade enteral mixtures. We also identified patients who need a nasogastric tube or gastrostomy.

**Keywords:** neurogenic dysphagia, diet, nasogastric tube, gastrostomy tube, thickeners, dense enteral feeding mixtures

## **1. Introduction**

The term "dysphagia" means difficulty in swallowing that a person experiences either during the primary phases of swallowing (usually described as" oropharyngeal dysphagia") or when solid food or liquid is blocked or even passed through with difficulty during its passage from the mouth to the stomach (usually described as "esophageal dysphagia"). Thus, dysphagia is a feeling of an obstacle to the typical passage of ingested food.

The problem of dysphagia of various origins is widespread. The 2011 study in the United Kingdom shows a prevalence of dysphagia in 11% of the general population [1, 2]. Dysphagia develops in 40–70% of stroke patients, 60–80% of patients with neurodegenerative diseases, in almost 13% of adults aged over 65 years, and in more than 51% of elderly patients in nursing homes [3–6]. From a study in Russia, the incidence of dysphagia in hospitals reaches up to 33% and up to 30–40% at home care [5, 7]. Dysphagia is often a prominent condition in various neurological diseases.

The risk of this pathology lies in the high probability of developing formidable complications—malnutrition, dehydration, weight loss, airway obstruction, aspiration pneumonia. Malnutrition with dysphagia is detected during the first week after a stroke in 48.3% of cases, without dysphagia in 13.6% (several authors stated that this complication occurs in 75% of cases). Malnutrition resulting from dysphagia complicates the course of the underlying disease due to the activation of catabolic processes. Among patients requiring long-term rehabilitation, malnutrition can be as high as 50% [1, 8, 9]. Malnutrition syndrome increases susceptibility to

oropharyngeal flora, increases the risk of developing septic complications, leads to suppression of the immune status, reduces the strength of the cough push, reduces the level of wakefulness, impedes the implementation of rehabilitation measures. Aspiration is one of the most severe complications of dysphagia, leading to airway obstruction, aspiration pneumonia [10–12].

Dysphagia—it is a frequent and sometimes even life-threatening complication in patients with central nervous system injury. In patients with a low level of consciousness, dysphagia can cause severe destructive pneumonia, respiratory failure, and death. Nevertheless, even with a preserved level of consciousness, the fact that the presence of dysphagia carries a potential risk of aspiration and asphyxia and this fear of aspiration makes patients with speech disorders avoid taking liquid diet, which leads to dehydration of the body, which is diagnosed by doctors quite late [13, 14].

In addition to such severe complications as aspiration, destructive pneumonia, patients with dysphagia have a high risk of developing protein-energy malnutrition (PEM) due to a reduction in substrate supply. In turn, this problem worsens the quality of life and complicates the course of infectious processes, complicates wound healing, and significantly reduces physical activity [15–19]. In combination with dysphagia (moderate and severe), protein-energy malnutrition is a significant problem in patients with pressure sores. At the same time, the risk of developing pressure ulcers increases in the presence of severe concomitant pathology (spastic paresis, diabetes mellitus, destructive pneumonia), which often accompanies patients with severe brain damage. If the patient is in a chronic critical illness (CCI), the rate of pressure ulcers can reach 80%, despite ongoing preventive measures [20–23].

There are several approaches to nutritional support for neurological patients in the clinic, depending on the severity of dysphagia.
