Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study.

This was a retrospective records study at one centre, so it can show associations but cannot prove that bulbar onset or fast progression caused earlier dysphagia or PEG indication. Only 108 patients had complete data from the centre database, and exclusions included incomplete records, sudden death before dysphagia, centre change or becoming housebound, which may bias who was analysed. FEES timing varied depending on patient needs, so the recorded time of dysphagia onset may reflect when the scope happened rather than the true first onset. Dysphagia and PEG indication were defined by PAS cut-offs in the records, and some patients were not included in follow-up because of death, so time-to-PEG findings may be affected by missing outcome information. The supplied text does not describe whether PAS scoring was blinded or independently adjudicated, and it does not report how many PEG decisions were made by clinical judgement rather than the PAS threshold.

The supplied text states the funder was Università degli Studi di Roma La Sapienza. It does not provide an author conflict-of-interest declaration.

Do not read the study as showing that PEG timing can be set by PAS scores alone. The paper used PAS thresholds as retrospective cut-offs, and PEG recommendation in practice also depends on symptoms, nutrition and respiratory function.