Effect of a gum-based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia
Bolivar-Prados, Mireia (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Rofes, L. (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas)
Arreola, Viridiana (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Guida, S. (Danone Nutricia Research. Nutricia Advanced Medical Nutrition)
Nascimento, Weslania Viviane. (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Martin, Alberto (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Vilardell, N. (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Ortega, Omar (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Ripken, D. (Danone Nutricia Research. Nutricia Advanced Medical Nutrition)
Lansink, M. (Danone Nutricia Research. Nutricia Advanced Medical Nutrition)
Clavé i Civit, Pere (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2019
Resum:	Background: Increasing viscosity with thickening agents is a valid therapeutic strategy for oropharyngeal dysphagia (OD). To assess the therapeutic effect of a xanthan gum-based thickener (Nutilis Clear) at six viscosities compared with thin liquid in poststroke OD (PSOD) patients. Methods: A total of 120 patients with PSOD were studied in this controlled, multiple-dose, fixed-order, and single-blind study using videofluoroscopy (VFSS). A series of boluses of 10 mL thin liquid and 2000, 1400, 800, 450, 250, and 150 mPa s viscosities were given in duplicate, interrupted in case of aspiration. We assessed the safety and efficacy of swallow and the kinematics of the swallow response. Key Results: A total of 41. 2% patients had safe swallow at thin liquid which significantly increased for all viscosities from 71. 9% at 150 mPa s to 95. 6% at 1400 mPa s (P <. 001). PAS score (3. 7 ± 2. 3) at thin liquid was also reduced by increasing bolus viscosity (P <. 001). The prevalence of patients with aspiration at thin liquid was 17. 5% and decreased at all viscosities (P <. 01), except at 150 mPa s. Increasing viscosity shortened time to laryngeal vestibule closure (LVC) at all viscosities (P <. 01) and reduced bolus velocity at ≥450 mPa s (P <. 05). The prevalence of patients with pharyngeal residue at each viscosity 37. 7%-44. 7% was similar to that at thin liquid (41. 2%). Conclusions and Inferences: The prevalence of unsafe swallow with thin liquids is very high in PSOD. Increasing shear bolus viscosity with this xanthan gum-based thickener significantly increased the safety of swallow in patients with PSOD in a viscosity-dependent manner without increasing the prevalence of pharyngeal residue.
Ajuts:	Instituto de Salud Carlos III PI14/00453 Instituto de Salud Carlos III PI18/00241 Instituto de Salud Carlos III INT15/00026 Instituto de Salud Carlos III INT16/00111
Nota:	Altres ajuts: This work has been supported by Danone Nutricia Research, Fundació Salut del Consorci Sanitari del Maresme, Furega (Fundació per a la Recerca en Gastroenterologia) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Spiration ; Deglutition disorders ; Shear viscosity ; Stroke ; Swallow response ; Thickener ; Xanthan gum
Publicat a:	Neurogastroenterology and Motility, Vol. 31 Núm. 11 (november 2019) , p. e13695, ISSN 1365-2982

DOI: 10.1111/nmo.13695
PMID: 31402571

11 p, 1.5 MB

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