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.

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

doi:10.3390/nu12061873

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® (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.

Highlights

Oropharyngeal dysphagia (OD) is a deglutition disorder, which has been classified in the last editions of the International Classification of Diseases ICD-9 and ICD-10 (787.2, R13) of the WorldHealth Organization [1]
Prevalence is increasing with the aging of the population and it is a common condition among four main phenotypes of patients: older patients, patients treated for head and neck cancer and patients with neurological and neurodegenerative diseases [2]
Delayed laryngeal vestibule (LV) closure has been recognized as the main mechanism of impaired airway protection in patients with OD leading to unsafe swallow [11]

Summary

Introduction

Oropharyngeal dysphagia (OD) is a deglutition disorder, which has been classified in the last editions of the International Classification of Diseases ICD-9 and ICD-10 (787.2, R13) of the WorldHealth Organization [1]. Prevalence is increasing with the aging of the population and it is a common condition among four main phenotypes of patients: older patients, patients treated for head and neck cancer and patients with neurological and neurodegenerative diseases [2]. Videofluoroscopy (VFS) is the gold standard method to diagnose the biomechanical alterations of the oropharyngeal swallow response (OSR) [13]. It consists of a dynamic radiological exploration that evaluates the safety and efficacy of deglutition, characterizes the major signs of oropharyngeal dysfunction, quantifies the OSR and assesses the short-term effect of therapeutic strategies on patients with OD [13,14,15]. Delayed laryngeal vestibule (LV) closure has been recognized as the main mechanism of impaired airway protection in patients with OD leading to unsafe swallow [11]

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