Abstract
BackgroundIncreasing 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.MethodsA 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 ResultsA 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 InferencesThe 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.
Highlights
Oropharyngeal dysphagia (OD) is a motility disorder characterized by difficulty forming or moving the alimentary bolus from the mouth to the esophagus and can include aspiration.[1]
The pathophysiology of poststroke OD (PSOD) is characterized by several motor impairments in the kinematics of the swallow response including de‐ layed laryngeal vestibule closure (LVC) and decreased bolus propulsion forces 12; patients affected by unilateral stroke showed a disrupted pattern of sensory cortical activation after pharyngeal stimulation as a distinctive marker of abnormal sensory integration of swallowing path‐ ways in PSOD.[13]
The aim of this study was to assess the effect of a gum‐based thickener (Nutilis Clear®) on the safety and efficacy of swallow‐ ing in patients with poststroke OD by evaluating seven different shear viscosities (150‐2000 mPa s) during swallowing with vid‐ eofluoroscopy swallowing study (VFSS)
Summary
Oropharyngeal dysphagia (OD) is a motility disorder characterized by difficulty forming or moving the alimentary bolus from the mouth to the esophagus and can include aspiration.[1]. The aim of this study was to assess the effect of a gum‐based thickener (Nutilis Clear®) on the safety and efficacy of swallow‐ ing in patients with poststroke OD by evaluating seven different shear viscosities (150‐2000 mPa s) during swallowing with vid‐ eofluoroscopy swallowing study (VFSS). We assessed 7 shear viscosity levels with a xanthan gum‐based thickener in stroke patients with dysphagia and found a viscosity‐dependent improvement in swal‐ lowing safety from 150 mPa s to 800 mPa s through reduced time to laryngeal vestibule closure and bolus velocity. Secondary outcome parameters were as follows: (a) safety of swallowing expressed by the mean PAS score,[21] and the percentage of patients with penetration (PAS score of 3,4,5), or aspiration (PAS score of 6,7,8); and (b) the efficacy of swallowing expressed by the presence and severity of oral and pharyngeal residue. Due to the relevance of the information for patient safety, comparisons on the prevalence of patients with safe swallow and mean PAS scores were performed between all the different viscosities assayed in this study
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