Stroke patients fed via nasogastric tube and are on Proton Pump Inhibitor (PPi) subjected to more X-ray radiation than patients who are not on (PPi)?
Dr A. Afzal, Dr R. Yonas, Dr A K Singh
Introduction
Almost 50% of stroke patients have difficulty with swallowing especially in the first few weeks and require early nasogastric tube (NG) feeding [1, 2]. Ischemic stroke patients treated with antiplatelets need Proton Pump Inhibitor (PPI) for gastric protection. NG fed patients have persistently high pH on aspirate, resulting in more frequent Chest X-rays (CXR) to confirm NG tube position. We wished to ascertain the number of CXRs conducted in each category in a DGH, and to discern whether there is a direct link between the use of PPI and number of CXRs. 
Methods
We selected 50 dysphagic stroke patients with NG tube admitted to Acute Stroke Unit between December 2016 and January 2018. Data was collected using medical notes and online database. We looked at the number of CXRs performed on patients who were on PPI and those who were not and also at the number of patients who required NG tube replacement following the CXR. 
Results
72% (36/50) of patients were on PPI and had a total of 182 CXRs (5.06 CXRs per patient). In comparison, the patients who were not on any PPI (14/50) only required 3.79 CXRs per patient. The average number of NG replaced was 2.79 for patients who were not on PPI and 3.19 for patients on PPI. 
Conclusion
Patients on PPIs had higher false positive aspirates resulting in more CXRs to confirm correct NG tube placement. Number of patients requiring NG tube replacement based on CXRs was not significantly different in the two groups.
References: 
1)	Stroke Association- https://www.stroke.org.uk/resources/dealing-swallowing-problems
2)	Royal College Of Physcian National Clinical Guideline For Stroke, Fifth Edition, 2016

Stroke patients fed via nasogastric tube and are on Proton Pump Inhibitor (PPi) subjected to more X-ray radiation than patients who are not on PPi?