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18 pages, 2659 KiB

Open AccessArticle

Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia

by Omar Ortega, Mireia Bolívar-Prados, Viridiana Arreola, Weslania Viviane Nascimento, Noemí Tomsen, Crispulo Gallegos, Edmundo Brito-de La Fuente and Pere Clavé

Nutrients 2020, 12(6), 1873; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12061873 - 23 Jun 2020

Cited by 48 | Viewed by 4700

Abstract

Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener [...] Read more.

Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener^® (FCT)] on four phenotypes of OD patients: G1) 36 older; G2) 31 head/neck cancer (HNC); G3) 30 Parkinson’s disease; and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5/20 mL boluses, at four levels of shear-viscosity (<50, 250, 1000 and 2000 mPa·s). The effect of α-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 ± 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 250–1000 mPa·s (74.19–96.67%, safe swallows in G1, G3, G4, and 58.06% in G2), without increasing pharyngeal residue. Viscosity was unaffected by α-amylase. Increasing shear-viscosity with FCT causes a strong viscosity-dependent therapeutic effect on the safety of swallow. This effect depends on the phenotype and is similar among older, Parkinson’s and post-stroke patients. Full article

(This article belongs to the Special Issue Dysphagia and Nutritional Stategies: Clinical Application of Rheology of Fluids and Texture Modified Foods for Patients with Oropharyngeal Dysphagia)

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10 pages, 3110 KiB

Open AccessArticle

Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission

by Wei-Kuo Chang, Hsin-Hung Huang, Hsuan-Hwai Lin and Chen-Liang Tsai

Nutrients 2019, 11(12), 2969; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11122969 - 05 Dec 2019

Cited by 17 | Viewed by 8792

Abstract

Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions [...] Read more.

Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule. Full article

(This article belongs to the Special Issue Dysphagia and Nutritional Stategies: Clinical Application of Rheology of Fluids and Texture Modified Foods for Patients with Oropharyngeal Dysphagia)

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Review

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16 pages, 4836 KiB

Open AccessReview

Textural Changes by Mastication and Proper Food Texture for Patients with Oropharyngeal Dysphagia

by Koichiro Matsuo and Ichiro Fujishima

Nutrients 2020, 12(6), 1613; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12061613 - 30 May 2020

Cited by 40 | Viewed by 9275

Abstract

Bolus texture is a key factor for safe swallowing in patients with dysphagia since an improper texture may result in aspiration and/or pharyngeal residue. This article discusses swallowing bolus texture from two key aspects: the textural change of solid food by mastication and [...] Read more.

Bolus texture is a key factor for safe swallowing in patients with dysphagia since an improper texture may result in aspiration and/or pharyngeal residue. This article discusses swallowing bolus texture from two key aspects: the textural change of solid food by mastication and the current standardized definition of food texture in Japan. When swallowing a liquid bolus, the texture is mostly maintained from ingestion to swallow onset. For solid food, however, the food is crushed by chewing and mixed with saliva before swallowing; the texture of the ingested food is modified to an easily swallowable form at swallow onset by mastication. Understanding the mechanism of mastication and its assessment are therefore important in deciding the proper diet for dysphagic patients. As standardized criteria for classifying the texture of food and liquid are essential as well, this report also describes the Japanese Dysphagia Diet 2013 that is commonly used as the standardized index for dysphagic diets in Japan. Full article

(This article belongs to the Special Issue Dysphagia and Nutritional Stategies: Clinical Application of Rheology of Fluids and Texture Modified Foods for Patients with Oropharyngeal Dysphagia)

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