Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Is the Gag Reflex Useful in the Management of Swallowing Problems in Acute Stroke?


The goal of this study was to compare the diagnostic value of an absent gag reflex in acute stroke patients with the bedside swallowing assessment (BSA) and assess its relationship to outcomes. Two hundred forty-two acute stroke patients had their gag reflex tested and a BSA performed. Numbers needing nasogastric or gastrostomy tube insertion were noted, also their discharge destination, discharge Barthel Index, and mortality. The mean age of the subjects was 76.5 ± 10.2 years; 37.6% were male; 41.7% of the patients were dysphagic on BSA; 18.2% had an absent gag. Dysphagia was present in 88.6% of the patients with an absent gag and in 31.3% of those with an intact gag. The gag reflex was absent in 38.6% of dysphagic and 3.5% of nondysphagic patients. Comparing an absent gag against the criterion of the BSA, its specificity was 0.96, sensitivity 0.39, positive predictive value 0.89, and negative predictive value 0.69. Regression analyses found that an intact gag gave an Odds Ratio [CI] of 0.23 [0.06–0.91] for gastrostomy feeding but did not predict other outcomes. We conclude that the gag reflex is as specific as but less sensitive than the BSA in detecting dysphagia in acute stroke patients. An intact gag may be protective against longer-term swallowing problems and the need for enteral feeding.

This is a preview of subscription content, log in to check access.


  1. 1

    SK Daniels K Brailey DH Priestly LS Herrington LA Weisberg AL Foundas (1998) ArticleTitleAspiration in patients with acute stroke Arch Phys Med Rehabil 79 14–19 Occurrence Handle10.1016/S0003-9993(98)90200-3 Occurrence Handle9440410

  2. 2

    DG Smithard PA O’Neill C Park R England DS Renwick R Wyatt J Morris DF Martin (1998) ArticleTitleCan bedside assessment reliably exclude aspiration following acute stroke? Age Ageing 27 99–106

  3. 3

    DG Smithard PA O’Neill RE England CL Park R Wyatt DF Martin J Morris (1997) ArticleTitleThe natural history of dysphagia following a stroke. Dysphagia 12 IssueID4 188–193 Occurrence Handle9294937

  4. 4

    AE Davies D Kidd SP Stone J MacMahon (1995) ArticleTitlePharyngeal sensation and gag reflex in healthy subjects. Lancet 345 487–488 Occurrence Handle10.1016/S0140-6736(95)90584-7 Occurrence Handle7861875

  5. 5

    J Horner SR Brazer EW Massey (1993) ArticleTitleAspiration in bilateral stroke patients: a validation study. Neurology 43 IssueID2 430–433 Occurrence Handle8437716

  6. 6

    J Horner EW Massey (1988) ArticleTitleSilent aspiration following stroke. Neurology 38 IssueID2 317–319 Occurrence Handle3340301

  7. 7

    G Mann GJ Hankey (2001) ArticleTitleInitial clinical and demographic predictors of swallowing impairment following acute stroke. Dysphagia 16 IssueID3 208–215 Occurrence Handle10.1007/s00455-001-0069-5 Occurrence Handle11453569

  8. 8

    JA Logemann (1995) ArticleTitleDysphagia: evaluation and treatment Folia Phoniatr Logop 47 140–164 Occurrence Handle7640720

  9. 9

    RW Bastian LC Riggs (1999) ArticleTitleRole of sensation in swallowing function. Laryngoscope 109 1974–4977 Occurrence Handle10591357

  10. 10

    NR Bleach (1993) ArticleTitleThe gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy. Clin Otolaryngol 18 303–307 Occurrence Handle8877191

Download references

Author information

Correspondence to Deborah Ramsey MA, MRCP.

Additional information

Deborah Ramsey’s post has been funded by Action Research.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ramsey, D., Smithard, D., Donaldson, N. et al. Is the Gag Reflex Useful in the Management of Swallowing Problems in Acute Stroke?. Dysphagia 20, 105–107 (2005). https://doi.org/10.1007/s00455-004-0024-3

Download citation


  • Gag reflex
  • Stroke, acute
  • Dysphagia
  • Deglutition disorders
  • Deglutition