Dysphagia In Patients Research Articles

Pyridostygmine, A Potential Therapy for Dysphagia Secondary to Ineffective Esophageal Motility

Purpose: Clinical Presentation: A 47-year-old white woman with GERD initially presented 7 years ago for possible anti-reflux surgery evaluation due to heartburn and severe dysphagia of solids and liquids. She was previously treated with multiple antireflux regimens and endoscopic dilations without improvement. Esophageal impedance manometry testing confirmed the diagnosis of severe ineffective esophageal motility (IEM). Over the next 4 years, acid control therapy was continually altered and a prolonged trial of bethanechol yielded little improvement. Repeat testing continued to reveal severe IEM, normal number of reflux episodes and esophageal acid exposure, and negative symptom association. She was then started on Mestinon 30 mg BID based on recent studies showing increased esophageal contraction amplitudes. Within the next 3 months the patient's dysphagia drastically improved as evidenced by a 15 lb weight gain. Although repeat esophageal impedance manometry continued to show severe IEM, distal contraction amplitudes improved and the patient's dose of Mestinon was increased to 60 mg BID. Most recently the patient still struggled with heartburn but her dysphagia has disappeared, and her biggest health concern currently is obesity having since gained >60 lb since initiation of Mestinon! Discussion: IEM was redefined by the presence of greater than or equal to 50% liquid swallows with contraction amplitude <30 mm Hg in one of the two distal sites in the lower esophagus. Although antireflux therapy has been the mainstay of IEM treatment, restoration of esophageal smooth muscle contractility by the muscarinic receptor agonist, bethanechol, improved esophageal contraction pressures as well as bolus transit. Recent comparison of oral pyridostygmine (Mestinon), buspirone, and bethanechol was undertaken after short-acting acetylcholinesterase inhibitors were shown to increase esophageal contraction amplitude and duration. After our patient failed to improve with antireflux therapy and a trial of bethanechol, addition of Mestinon was attempted. Although the addition of Mestinon did not change her diagnosis of severe IEM, it did increase distal contraction amplitudes and overall bolus transit of both solids and liquids, but more importantly completely cured the symptom of dysphagia as evidenced by the patient's drastic weight gain over the follow 3 years. Conclusion: The addition of pyridostygmine greatly improved the distal esophageal contraction amplitudes and bolus transit in this patient. Although the degree of improvement was not enough to change her diagnosis of severe IEM, the therapeutic benefit has proven to dramatically improve this woman's quality of life and cure her dysphagia.

A Novel Treatment for Pseudoachalasia Secondary to Malignant Mesothelioma Using Botulinum Toxin

Purpose: Background: Secondary achalasia due to mesothelioma is a rare event that carries a poor prognosis. Most patients with mesothelioma will not respond to its primary treatment and may require palliative therapy. We present the first case, to our knowledge, of a patient with secondary achalasia due to mesothelioma treated successfully with botulinum toxin injections into the lower esophageal sphincter (LES). Case Description: A 66 year-old male recently diagnosed with malignant mesothelioma and being treated with chemotherapy, presented with progressive dysphagia to solids and liquids. His past history was remarkable for gastroesophageal reflux being treated with omeprazole twice daily. The patient had previously worked as a plumber. The physical exam was normal except for decreased breath sounds in the left lung. A CT scan of the chest revealed extensive soft tissue prominence from the level of the thoracic inlet with involvement of the mediastium, but sparing the distal esophagus. A double contrast esophagram showed a smoothly tapering stricture of the distal esophagus without associated mucosal abnormality. There were diffuse esophageal tertiary contractions, and decreased esophageal peristalsis. The patient refused esophageal manometry. Esophagogastroduodenoscopy (EGD) was performed, revealing a mildly dilated esophagus with uncoordinated contractions, no appreciable esophageal peristalsis, and a hypertonic LES, which was easily traversed with the endoscope. The mucosa was normal and the rest of the EGD was unremarkable. Botulinum toxin was injected directly into the four quadrants of the LES using 20 units of toxin per injection. The patient's dysphagia improved following this treatment and maintained symptomatic response during a 3-month follow-up. Discussion: Dysphagia is a rare preterminal event associated with mesothelioma. Postmortem examinations in cases of mesothelioma have shown the esophagus to be involved rarely or not at all. There have been several cases describing pseudoachalasia secondary to mesothelioma. The prognosis is poor, and the goal with these patients is to improve their quality of life. In previous cases that have addressed dysphagia secondary to mesothelioma, treatments included tumor resection, local myotomy, or pallative stents. To our knowledge this is the first reported case of a patient with pseudoachalasia secondary to mesothelioma treated successfully with botulinum toxin injections. In conclusion, just as in primary achalasia where botulinum toxin is an option primarily used for high-risk surgical candidates; we see that its use can be extended to include patients with pseudoachalasia secondary to mesothelioma.

A Rare Cause of Dysphagia: Malignant Pleural Mesothelioma in the Posterior Mediastinum

A 69-year-old man presented to the emergency room with dysphagia and vomiting. A computed tomographic scan revealed a posterior mediastinal mass surrounding the lower portion of the esophagus. Endoscopic examination demonstrated narrowing of the lower esophagus without malignant mucosal lesions. Thoracoscopic biopsies of the mediastinal mass failed to yield a pathologic diagnosis. The hyaluronic acid concentration in the left pleural effusion was remarkably high (755 mg/L), which is a finding strongly suggestive of malignant mesothelioma. Four months after the initial admission, a subcutaneous nodule was found in the left chest wall and a biopsy was taken. The histopathologic and immunohistochemical findings of the biopsy were consistent with the diagnosis of pleural malignant mesothelioma.

52-Year-Old Woman With Dysphagia

52-Year-Old Woman With Dysphagia

Systematic review: the epidemiology of eosinophilic oesophagitis in adults

The epidemiology of eosinophilic oesophagitis (EoE) in adults remains unclear. To estimate the prevalence and incidence of EoE through a systematic review of published literature. We conducted systematic literature searches in PubMed in September 2009. Studies were excluded if they contained any participants below 18 years of age, published in languages other than English, or had no exact reporting of prevalence or incidence rates. Nine studies fulfilled the criteria; one evaluated a population-based sample, one examined patients referred from a defined geographical region and seven studies examined the prevalence in a total of 6018 patients in clinic or hospital settings. The lowest prevalence was reported in population-based studies (4 and 0.23 per 1000), followed by studies of unselected patients (1.0%, 6.5%) and highest in the other five clinic/hospital based studies (2.2-48.2%). Men were more affected in seven of eight studies (64.5-100%). The sample size weighted average prevalence from the population-based studies was 0.03%. For studies evaluating symptomatic patients, it was 2.8%. The prevalence of EoE in adults varies considerably based on the study sampling frame: high in dysphagia patients, quite low in population-based studies and intermediate among unselected endoscopy patients.

A Review of the Management of Dysphagia

Dysphagia is an impairment of swallowing associated with neurological diseases, including stroke. Identification is vitally important but can be difficult because stroke patients with dysphagia rarely perceive that they have a swallowing problem. Assessments of swallowing are not consistently carried out by medical or nursing staff, and often, there are unclear lines of responsibility as to which patients should be referred to a speech-language pathologist. This study measured the prevalence, assessment, and management of dysphagia in three private rehabilitation clinics in South Africa. Findings indicated a prevalence of dysphagia in 56% of patients following stroke, a number far exceeding previously reported statistics. This number may have been inflated due to conservative swallowing assessments given the subjective measures commonly utilized in South Africa, a product of the often-limited availability of imaging technology. All three clinics evidenced a strong multidisciplinary approach in the care and management of dysphagia patients. These findings highlight the need for increased education of collaboration between speech-language pathologists and nursing staff and support the need for future research in the field of poststroke dysphagia.

Self-expandable esophageal stents placement for the palliation of dysphagia as a result of lung cancer

We report our experience with self-expandable metallic stents for the palliation of malignant dysphagia and tracheoesophageal fistulae caused by lung cancer. Esophageal self-expandable metallic stents were deployed in 28 patients with malignant dysphagia as a result of lung cancer between August 2002 and January 2009. Mean age was 62.1 (42-77) with 26 male patients. Twenty-three patients received previous chemo-radiotherapy and two had pneumonectomy. Tracheoesophageal fistulae were coexisting in eight patients. Stents were inserted under fluoroscopic control over guide-wire with the patient under conscious sedation. One stent was used in all patients except one fistula patient with two stents. Immediate improvement after stent insertion was seen in all patients. Fistulae were sealed off in all. No complication was seen except transitional pain in 12 patients (42%). During the follow-up, all patients remained asymptomatic with no clinical appearance of dysphagia symptoms except one patient whom gastrostomy was applied. All patients with fistulae died with a mean survival of 15.4 weeks. Dysphagia patients without fistulae died with mean survival of 6 months except one patient with 1 month follow-up. Self-expandable esophageal metallic stent insertion can manage malignant dysphagia in lung cancer patients with significant survival period via nonsurgical approach.

Evaluation of Swallowing Using 320-Detector-Row Multislice CT. Part I: Single- and Multiphase Volume Scanning for Three-dimensional Morphological and Kinematic Analysis

A 320-detector-row multislice computed tomography (320-MSCT) scanner can acquire a volume data set covering a maximum range of 16 cm and can generate axial images 0.5-mm thick at 0.5-mm intervals. Three-dimensional (3D) images reconstructed from the thin axial slices include multiplanar reconstruction and 3D-CT. Single-phase 3D images are reconstructed from 0.175-s data, and multiphase 3D images are created in 29 phases at intervals of 0.1 s. Continuous replay of these 3D images produces four-dimensional moving images. In order to determine the feasibility of the morphologic and kinematic analyses of swallowing using 320-MSCT, single-phase volume scanning was performed on three patients and multiphase volume scanning was performed on one healthy volunteer. The single-phase 3D images clearly and accurately showed the structures involved in swallowing, and the multiphase 3D images were able to show the oral stage to the early esophageal stage of swallowing, allowing a kinematic analysis of swallowing. We developed a reclining chair that allows scanning to be performed with the subject in a semisitting position, which makes swallowing evaluation by 320-MSCT applicable not only to research on healthy swallowing but also to the clinical examination of dysphagia patients.

The Usefulness of Video Fluoroscopic Swallowing Study in Post-Stroke Dysphagia Patients

Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

The Influence of the Range of Motion of the Cervix for Dysphagia Patients

The Influence of the Range of Motion of the Cervix for Dysphagia Patients

Neural Mechanisms of Swallowing and Effects of Taste and Other Stimuli on Swallow Initiation

Swallowing involves several motor processes such as bolus formation and intraoral transport of a food bolus (oral stage) and a series of visceral events that occur in a relatively fixed timed sequence but are to some degree modifiable (pharyngeal stage or swallow reflex). Reflecting the progressive aging of society, patients with swallowing disorders (i.e., dysphagia) are increasing. Therefore, there is expanding social demand for the development of better rehabilitation treatment of dysphagic patients. To date, many dysphagia diets have been developed and are available commercially to help bring back the pleasure of mealtimes to dysphagia patients. Texture modification of food to make the food bolus easier to swallow with less risk of aspiration is one of the important elements in dysphagia diets from the viewpoint of safety assurance. However, for the further development of dysphagia diets, new attempts based on new concepts are needed. One of the possible approaches is to develop dysphagia diets that facilitate swallow initiation. For this approach, an understanding of the mechanisms of swallow initiation and identification of factors that facilitate or suppress swallow initiation are important. In this review, we first summarize the neural mechanisms of swallowing and effects of taste and other inputs on swallow initiation based on data mainly obtained from experimental animals. Then we introduce a recently established technique for eliciting swallowing using electrical stimulation in humans and our ongoing studies using this technique.

Mechanism of recovery of dysphagic patients caused by stroke:A fMRI study

Objective To study the recovery mechanism of dysphagic patients after stroke using functional magnetic resonanee imaging(fMRI). Methods Thirteen patients with dysphagia caused by unilateral cortical or subcortical lesions were recruited into a dysphagia group,and eight age-matched healthy volunteers were recruited as controls.Both grouDs performed experimental volitional swallowing tasks during fMRI studies.All patients of the dys-phagia group received rehabilitation treatment targeting dysphagia.Of the 13 dysphagia patients,7 reached almost complete recovery and were identified as recovered in follow-up fMRI studies.A 3.0 T MR scanner and echo planar imaging(EPI)T_2 WI sequence were employed to obtain the fMRI data.SPM2 software was used for post-processing of the fMRI data and displaying activated brain maps.Lateral index(LI)was calculated as LI:(C-1)/(C+I).Paired t tests were used to compare activated brain volume before and after complete recovery. Results Consistent activation of the bilateral primary sensorimotor cortex,anterior cingulated gyrus and the bilateral insular cortex were observed in the control group. Activation of the pons,medulla,left cerebellum,left prefrontal area,right occipital area and the left insular cortex were observed in the dysphagia group.Activation was observed in the bilateral primary sensorimotor cortex.bilateral prefrontal area,bilateral superior temporal gyrus,left insular cortex,bilateral frontal o-pereulum and anterior cingulated gyrus in the recovered patients.The total activated volume before recovery in the ip-silesional hemisDhere was significantly less compared with the contralesional hemisphere in the dysphagia group.In the recovered patients,both the activated brain volume of the ipsilesional hemisphere and value of LI were significant-ly larger than those at the initial examination.Conclusions Decreased activation in the sensorimotor cortex,the in-sular lobe and the cingulate gyms might be causes.of dysphagia.Compensation by the contralesional hemisphere in the early stages and then the restoration of the ipsilesional hemisphere after recovery may be mechanisms of dysphagia recovery in stroke patients. Key words: Stroke; Dysphagia; Functional magnetic resonance imaging; Rehabilitation; Neuronal plasticity

The Assessment of Oropharyngeal Dysphagia in Adults

The Assessment of Oropharyngeal Dysphagia in Adults

Gastric Carcinoma Concealed by Paraesophageal Hernia: A Rare Manifestation of a Common Disease

Purpose: Paraesophageal hernias (PH) are relatively common and, in themselves, do not usually cause symptoms. Endoscopic evaluation of the content of a large PH can be challenging based on their location. In a thorough review of literature, we were able to identify only two reported cases of symptomatic patients with PH due to an underlying malignancy. Here we present a patient with dysphagia due to PH that was harboring gastric carcinoma. A previously healthy 83-year-old man, was referred to our center for further evaluation of progressive dysphagia and weight loss. Patient's dysphagia started three months before this admission and gradually progressed from solids to liquids. He reported a sixty pound weight loss during this period secondary to worsening dysphagia. Since the start of his symptoms, the patient had been hospitalized two times for severe dehydration and evaluation of his symptoms. During the previous hospitalizations, the patient had three EGDs. These EGDs showed an area of friable and inflamed mucosa at gastroesophagus (GE) junction with a significant stricture at this site, which required balloon dilation in order to traverse the scope to the stomach. The stomach was reported to be normal except for a small portion of stomach cardia that projected out, indicative of PH. Multiple biopsies from the esophagus and stomach during all these occasions were significant for acute and chronic inflammation. At our facility, patient had an EGD for dilation in preparation for EUS examination. After the initial pneumatic balloon dilation and despite an additional dilation with a 42F savory dilator, the EUS scope was not able to be advanced through the stenosis. At this point, the patient underwent surgical repair of the paraesophageal hernia as the possible culprit cause for his dysphagia. During the surgery, the mucosa of the reduced hernia sac was found to be thickened and infiltrated to the perigastric fat, which is highly suggestive of gastric carcinoma. Furthermore, numerous areas of peritoneal implants that are suggestive of peritoneal carcinomatosis were noted during the surgery. Biopsy results of all of the obtained tissues during the surgery confirmed the diagnosis of moderately differentiated adenocarcinoma. Cooper et al. reported a case of pseudoachalasia in a patient that was found to have paraesophageal hernia harboring a gastric carcinoma. Carr et al. reported a patient with progressive dysphagia that was found to have paraesophageal hernia withholding an esophageal adenocarcinoma. To our knowledge, this is the only other reported case of isolated gastric cancer contained in a paraesophageal hernia.

Photodynamic Therapy versus Radiofrequency Ablation Therapy in Barrettʼs Esophagus with Dysplasia

Purpose: Various endoscopic modalities for managing Barrett's dysplasia (BD) are available and no previous comparison of the photodynamic therapy (PDT) vs. radiofrequency ablation therapy (RFT) exists. The aim of this study is to compare these modalities with regard to endoscopic eradication (EE) of Barrett's metaplasia (BM) and BD, adverse events, and costs from a single institution. Methods: Prospectively collected data of consecutive patients were used to identify 88 patients with BM and BD who underwent PDT vs. RFT. All PDT patients had high grade dysplasia (HGD) and either refused surgery or were not considered surgical candidates. Eleven (18%) RFT patients had HGD while others had low grade dysplasia (LGD). Thirty-four patients with BD received PDT and 62 patients with BD underwent RFT with HALO-360 and −90 systems. Combined modalities were performed in 8 patients at different times (PDT prior to RFT in all cases). Results: Thirty-one PDT patients (91%) and 46 (74%) RFT patients were men. The mean age was 70.2±12.2 and 66.2±13; the mean length of BM was 5.7±3.3 cm & 5.4±3.1 cm for PDT and RFT patients, respectively. The EE of BD was (25/34) 73.5% with PDT vs. (55/62) 88.7% with RFT after the completion of first endoscopic ablation treatment (p=0.06). The EE of BM was present in (15/34) 44.1% of PDT vs. (42/62) 67.7% RFT patients, (p=0.03). These EE ratios were improved with subsequent additional ablation therapies. The EE of BD was (60/62) 96.8% with an additional HALO-90 touch-up. Post-PDT clinically significant dysphagia was seen in 9 patients and managed with multiple endoscopic dilatations and in 2 of those cases needed endoscopic temporary stent. Two of post-RFT dysphagia patients were managed by endoscopic dilatation easily and both had also Parkinson's disease. One patient with PDT had esophageal perforation who was managed with non-surgical measures and no perforation was seen in RFT patients. The subsquamous intestinal metaplasia was (4/34) 11.8% with PDT and (2/62) 3.1% with RFT treated patients. According to the calculated cost analysis in our institution, PDT was four times more costly than RFT. Conclusion: Both PDT and RFT can lead to satisfactory eradication of BD and BM. However, RFT management had less adverse events and less costly compared to PDT in patients with BD. Disclosure: Dr Ertan is receiving research grants, lecture & consultant fees from Abbott, Barrx Medical,Centocor, Eisai and UCB.

Functional Esophagogastric Junction Obstruction with Intact Peristalsis: A Heterogeneous Syndrome Sometimes Akin to Achalasia

BackgroundSome patients with suspected achalasia are found on manometry to have preserved peristalsis, thereby excluding that diagnosis. This study evaluated a series of such patients with functional esophagogastric junction (EGJ) obstruction. MethodsAmong 1,000 consecutive high-resolution manometry studies, 16 patients had functional EGJ obstruction characterized by impaired EGJ relaxation and intact peristalsis. Eight patients with post-fundoplication dysphagia and similarly impaired EGJ relaxation were studied as a comparator group with mechanical obstruction. Intrabolus pressure (IBP) was measured 1 cm proximal to the EGJ. Sixty-eight normal controls were used to define normal IBP. Patients’ clinical features were evaluated. ResultsFunctional EGJ obstruction patients presented with dysphagia (96%) and/or chest pain (42%). IBP was significantly elevated in idiopathic and post-fundoplication dysphagia patients versus controls. Among the idiopathic EGJ obstruction group treated with pneumatic dilation, BoToxTM, or Heller myotomy, only the three treated with Heller myotomy responded well. Among the post-fundoplication dysphagia patients, three of four responded well to redo operations. ConclusionFunctional EGJ obstruction is characterized by pressure topography metrics demonstrating EGJ outflow obstruction of magnitude comparable to that seen with post-fundoplication dysphagia. Affected patients experience dysphagia and/or chest pain. In some cases, functional EGJ obstruction may represent an incomplete achalasia syndrome.

Reversible oropharyngeal dysphagia secondary to cricopharyngeal sphincter achalasia in a patient with myasthenia gravis: a case report.

Bulbar weakness and fatigue resulting in dysphagia and dysarthria is common in myasthenia gravis. In chronic MG it is often assumed that these symptoms herald an exacerbation of the patient's disease and doses of cholinergic agents and immunomodulatory therapies may be increased, along with initiation of plasma exchange. A case is presented in which dysphagia was refractory to standard MG therapy, leading to the subsequent discovery of cricopharyngeal sphincter achalasia as the primary cause of the patient's symptoms rather than an assumed myasthenia gravis exacerbation. The patient's dysphagia resolved after esophageal dilatation. Cricopharyngeal sphincter achalasia is a common disorder producing dysphagia in the elderly and needs to be considered in the evaluation of a myasthenic patient with worsening dysphagia when standard myasthenia gravis therapy fails. Discussion of myasthenia gravis, cholinergic therapy and cricopharyngeal sphincter achalasia is undertaken. Clinicians are encouraged to consider non-neurologic causes of worsening dysphagia in the myasthenic patient.

The many faces of Ewing sarcoma: Difficult to diagnose pediatric cases

Ewing sarcoma (ES) is the second most frequent primary malignant bone cancer, following osteosarcoma. ES is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. We describe four children aged 3, 3.5, 9, and 9.5 years, who presented with two femur masses simultaneously (patient 1), a huge mediastinal mass (patient 2), an abdomino-mediastinal mass with dysphagia (patient 3), and a huge abdomino-pelvic mass (patient 4). Our patients were of younger age and had abnormal presentations that made initial diagnosis difficult, but also are representative of the different problems encountered in pediatric practice. Biopsy initially revealed round cell tumor and by immunohistochemistry, CD99 was positive, which confirmed the diagnosis of ES. Our patients were difficult to diagnosis.The patients were misdiagnosed initially, so there was a delay in diagnosis. Definitive diagnosis required use of various radiological imaging methods and immunohistochemistry.

Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy

Patients with locally advanced esophageal cancer who require neoadjuvant therapy have significant dysphagia. To prospectively evaluate Polyflex stents to treat malignant dysphagia and to ameliorate weight loss in patients with locally advanced esophageal cancer who will undergo neoadjuvant therapy. A prospective nonrandomized study. Tertiary-referral cancer center. Thirteen patients with esophageal cancer (11 adenocarcinoma, 2 squamous-cell carcinoma). All patients were men, with a mean age of 63 years. EUS followed by stent placement. Dysphagia scores and patient weights. There were no perforations and no episodes of bleeding. Immediate complications included chest discomfort in 12 of 13 patients. The mean dysphagia score at the time of stent placement was 3. Mean dysphagia scores obtained at 1, 2, 3, and 4 weeks after stent placement were 1.1 (P = .005), 0.8 (P = .01), 0.9 (P = .02), and 1.0 (P = .008), respectively. Stent migration occurred at some point in 6 of 13 patients (46%). A single center and small size of study. Simultaneous EUS staging and Polyflex stent placement is safe and allows oral feeding during neoadjuvant therapy. Dysphagia scores improved in a statistically significant manner. Stent migration was a common event, although not all patients with a migrated stent will require stent replacement, because migration may be a sign of tumor response to neoadjuvant therapy.

Effect of nursing intervention and early rehabilitation training in dysphagia patients after stroke

Objective To explore the effects of nursing intervention and early rehabilitation training in dysphngia patients after stroke. Methods 112 dysphagia patients after stroke were divided randomly into routine nursing group (54 cases) and rehabilitation nursing group (58 cases) in which the patients were carried out nurs-ing intervention and early swallowing function training. Swallowing function of patients in the two groups was as-sessed with water drinking test. Results Swallowing function of patients in rehabilitation group were apparently su-perior to those in routine group (P<0.05) . Conclusions Nursing intervention plus early rehabilitation training is effective in improving the swallowing function and nutrition of patients with stroke and reducing the incidence rate of aspirated pneumonia. Key words: Nursing intervention; Early rehabilitation training; Dysphagia; Stroke