Dysphagia In Patients Research Articles

Assessing Knowledge, Usage, and Perceptions of the Frazier Free Water Protocol: A Pilot Study

IntroductionDysphagia is very common among hospitalized patients and is associated with increased length of hospital stay, morbidity, and mortality. Diet restrictions for dysphagia cause dehydration and discontent. The Frazier Free Water Protocol (FFWP) was developed to improve hydration and quality of life in dysphagia patients by establishing the safety of allowing sips of water between meals. Despite these potential benefits, we hypothesized that the FFWP is not widely utilized. We sought to determine barriers to utilization by assessing the familiarity, usage, and perceptions of the FFWP among health-care providers at our institution. MethodsWe distributed an anonymous questionnaire to a convenience sample of nurses in the hospital during daily huddles. The questionnaire was adapted from a validated framework to assess provider acceptability of health-care interventions. ResultsOf the 66 surveys distributed, we had 58 completed (88%). Only 10 nurses (17%) had heard of the “FFWP” by name. For those that were familiar with the indications, benefits, and risks of giving free water to patients with dysphagia (n = 18), less than half (39%) reported doing so. No nurses that had less than 10 y of patient care experience gave water to dysphagia patients, even if they knew the indications, benefits, and risks. Similarly, less than a fifth (19%) of all nurses surveyed were comfortable giving water to dysphagia patients, but comfort increased for some if the protocol was recommended by a speech-language pathologist (33%) or physician (13%). Nursing experience of >10 y or in intensive care settings did not yield significant differences in knowledge, usage, or comfort level than those with less years or nonintensive care experience, respectively. ConclusionsNurses are essential to the implementation of the FFWP, yet many are unfamiliar and uncomfortable with utilizing it. Education about the protocol is necessary to improve patient outcomes and quality of life. We plan to provide targeted education about the FFWP as well as assess other members of the health-care team, in an attempt to increase utilization of the protocol and improve dysphagia management.

Development and Validation of Serum Markers as Noninvasive Diagnostic Methods for Achalasia.

Currently, the diagnosis of achalasia mainly relies on invasive or radioactive examinations. This study aimed to develop a noninvasive diagnostic method for achalasia based on specific serum markers. Serum levels of profilin-1, galectin-10, immunoglobulin heavy variable 3-9, vasodilator-stimulated phosphoprotein, and transgelin-2 were measured in patients with achalasia and controls by enzyme-linked immunosorbent assay. The diagnostic values and thresholds were determined by the receiver operating characteristic curve analysis. Then, patients with dysphagia were prospectively enrolled to validate the ability of these molecules for achalasia diagnosing. A total of 142 patients with achalasia and 50 nonachalasia controls (healthy volunteers and patients with reflux esophagitis) were retrospectively included. The serum levels of profilin-1, galectin-10, and transgelin-2 in patients with achalasia were significantly higher than those in healthy volunteers and patients with reflux esophagitis ( P all < 0.001). Profilin-1, galectin-10, and transgelin-2 were of good performance in diagnosing achalasia, with optimal thresholds of 2,171.2, 33.9, and 1,630.6 pg/mL, respectively. Second, 40 patients with dysphagia were prospectively enrolled to the validation of achalasia. For profilin-1, the positive predictive value, negative predictive value, sensitivity, and specificity were 100.0%, 64.5%, 45.0%, and 100.0%, respectively. The figures for transgelin-2 were 65.5%, 90.9%, 95.0%, and 50.0%. When both increased, the positive predictive value reached to 100.0%. When both indexes were normal, the negative predictive value was 100.0%. Profilin-1 and transgelin-2 were promising biomarkers for achalasia diagnosis and performed better in combination. Further multicenter studies are necessary to verify their application as preliminary screening tools for achalasia.

Exploring the Factors Affecting Speech and Language Pathologists’ Decision to Transition from Oral to Non-Oral Feeding in Patients with Dysphagia: A Qualitative Study

Aim: Speech and language pathologists (SLP) make decisions regarding the use of alternative feeding methods when oral feeding presents a vital risk for the dysphagia patients or when the patient’s food intake is deficient. This decision affects the lives of patients from physiological, psychological, and social aspects. The decision mechanisms of SLPs involve the medical status of the patient and evaluation results. This study aims to explore factors influencing the decision of SLPs to transition from oral to non-oral feeding.&#x0D; Material and Methods: Our study was conducted with a phenomenological design. Nine SLPs who had experience working with dysphagia patients participated in semi-structured interviews. Data were coded on the MAXQDA program using a thematic analysis approach. &#x0D; Results: Six main themes were constructed. In addition to the medical status of the patients, participants described giving importance to the reactions of patients and relatives, the moment of explaining their decision to the patient, interactions with other professionals, work environments, experiences and educational backgrounds, and the assessments and therapies patients underwent.&#x0D; Conclusion: The decision mechanisms of SLPs regarding feeding are not only affected by the physiological condition of the patient, but also by factors regarding patient relatives, the SLP’s personal approaches, communication with other professionals, the assessment process, and therapy implementation. Non-oral feeding decisions are also linked to their clinical experience and educational backgrounds. It is recommended that SLPs think multi-dimensionally about feeding transitions and give critical importance to their decision processes.

Effect of Shaker Exercise and Masako Maneuver on Swallowing Function and Quality of Life in Patients with Dysphagia following Stroke: An Interventional Comparative Study

Background: Dysphagia is a condition that affects the normal deglutition leading to difficulty in swallowing food and liquid. It is a common problem in stroke survivors. Dysphagia after stroke can cause various complications, especially aspiration pneumonia, which can be life-threatening. Some rehabilitation methods reduce the severity of swallowing, improve quality of life, reduce the L-tube intubation period, and reduce the hospital stay duration in patients with dysphagia after stroke. The study compares the effect of the Shaker exercise with conventional therapy and the Masako maneuver with conventional therapy on post-stroke dysphagia. Some studies show the individual effectiveness of the shaker exercise and the Masako maneuver in post-stroke patients. Hence the need arises to evaluate the effectiveness of the Masako maneuver and Shaker exercises in post-stroke dysphagia patients. Aim: To study the effects of the Shaker exercise with conventional therapy and Masako maneuver with conventional therapy in patients with dysphagia following stroke. Methodology: convenient sampling was done for the selection of participants. Thirty patients who met the inclusion criteria were recruited from various hospitals in Vadodara. There were 11 men and 19 women among the 30 participants. The patients were divided into two groups. Group 1 received Shaker exercise along with conventional therapy, and Group 2 was received Masako maneuver along with conventional therapy. Baseline data were collected by EAT-10 scale. After 4 weeks, the participants were evaluated again. Result: The data were analyzed using the paired t-test. During the between-group comparison, group 1 (Shaker Group) showed greater improvement on EAT-10 scale than Group 2 (Masako Group). The SPSS version 23 used for data analysis and the p-value is 0.05. Conclusion &amp; Clinical Implication: the present study concluded that Shaker exercise along with conventional therapy showed greater improvement in swallowing function and quality of life in patients with post stroke dysphagia. Shaker exercise obtained better results with regards to quality of life and swallowing function than Masako maneuver with conventional therapy. KEY WORDS: stroke, dysphagia, Shaker Exercise, Masako Maneuver, EAT-10 scale, swallowing, and quality of life.

An Overview of Natural Disintegrating Agent Used in Dispersible Tablets

The oral therapy is the most commonly used method for administering many medications since it is thought to be the safest, most practical, and least expensive method. Fast dissolving pills are highly popular right now because they dissolve or easily dissolve in the mouth after administration without the need for water. Fast dissolving tablets have been developed to address the drawbacks of conventional dose forms, particularly dysphagia (refers to problem in which it becomes difficult to swallow), in pediatric and geriatric patients. Natural materials offer an advantage in comparison to the synthetic ones since they are more easily accessible, cost effective, not harmful, and chemically inert. By acting as a binder, diluent, and superdisintegrant, natural polymers such as locust bean gum, banana powder, mango peel pectin, Mangifera indica gum, and Hibiscus rosa-sinensis mucilage improve tablet properties, increase the solubility of drugs which are insoluble or poorly soluble, helps in reducing the disintegration time, and aid as nutritional supplements. Natural polymer is derived from natural source, are economical, not harmful, decomposable, and environmentally helpful, free of negative effects, restorable, and serve as nutritional supplements. Studies have shown that natural polymers are more effective and safer than manufactured polymers. The aim of the current article is to study and examine natural polymers which have been approved by Food and Drug Administration for use in quick dissolving tablets.

The Swallowing Intelligent Assessment System Based on Tongue Strength and Surface EMG

Dysphagia is a very important issue in modern society, and it is common in stroke patients and the elderly. Many studies have shown that tongue strength can be used as an evaluation criterion for swallowing function. This work has implemented a methodology to assess and improvise the swallowing function of dysphagia patients. To execute the same, a tongue pressure instrument was used as a tool to assess tongue strength, and a surface electromyography instrument was used to collect electrical data on larynx muscles. In addition to this, an assessment task has been carried out that is combined with interesting games to increase users’ willingness. After completing the task, the system collects tongue pressure and muscle electrical data. We use the Scoring Function calculation to quantify the user’s swallowing performance quality. In addition to calculating the quality score of the motion, we also extract features from the collected data, build a variety of machine learning models to compare each model’s classification effectiveness and select the best model to correctly predict the level of the user’s swallowing function. Through this evaluation system, we hope to provide fast and accurate evaluation results, so that medical personnel can have more convenient and effective tools for dysphagia diagnosis and rehabilitation training.

Mealcoach: Contact Microphone-Based Meal Supervision For Post-Stroke Dysphagia Patients.

Meal supervision for post-stroke dysphagia patients significantly improves prognosis during rehabilitation. Aspiration often occurs during meals, which may further incur aspiration pneumonia. Therefore, it's necessary to know the patient's swallowing ability as well as the occurrence of cough. Recently, some researchers have detected swallowing or coughing with audio signals and have made remarkable achievements. However, the users need to stay in quiet environments or wear uncomfortable cervical auscultation devices because the signals generated by swallowing are weak. In this work, we present MealCoach, a system that utilizes a contact microphone to collect high-quality signals to identify the events during meals. We take advantage of the insensitivity of contact microphones to ambient noise for free-living environment supervision. After balancing the wearing experience and identification accuracy, we elaborately select the optimal site to leverage the unique characteristics of cricoid cartilage movement during meals to accurately identify swallowing, coughing, speaking, and other events during meals. We collected data from thirty PSD patients in the hospital and evaluated our system, and the results demonstrate that MealCoach achieves a mean classification accuracy of 95.4%.

Physico-chemical, antioxidant, sensory and electromyographic analyses of shrikhand (flavored strained yoghurt) formulated for dysphagia patients under IDDSI levels 4 and 5

Physico-chemical, antioxidant, sensory and electromyographic analyses of shrikhand (flavored strained yoghurt) formulated for dysphagia patients under IDDSI levels 4 and 5

Non-invasive way to diagnose dysphagia by training deep learning model with voice spectrograms

Background and objectivePatients with dysphagia show changes in articulation and voice quality, and recent studies using machine learning models have been employed to help in the classification. This study aimed to apply a novel deep learning method using only the patient‘s voice to classify normal controls from dysphagia patients and determine whether this new deep learning method may help provide a rapid and accurate means to supplement the existing clinical methods in dysphagia screening and assessment. MethodsVoice samples from 299 healthy controls and 290 patients with post-stroke dysphagia; who performed four simple phonation tasks; were obtained in a prospective manner at a university-affiliated hospital using a smart digital device. Deep learning methods were employed as follows: firstly, a spectrogram is obtained through the short time Fourier transform (STFT) and Mel-frequency cepstral coefficients (MFCC) on a sound signal, respectively. Secondly, the STFT and MFCC spectrograms obtained for each protocol are fed to each multibranch model. Finally, during the test, each model is ensembled in a soft voting method to distinguish normal and dysphagia classes. ResultsFive evaluation metrics are used to evaluate the performance of the model: AUC, Sensitivity, Specificity, Positive predictive value (PPV), and Negative predictive value (NPV). Among the performance metrics, sensitivity and specificity levels are compared with the existing diagnostic tools. The ensemble model incorporating all four tasks showed an AUC of 0.950 ± 0.004, with sensitivity and specificity levels as high as 94.7% and 77.9%, respectively. ConclusionsThe novel deep learning model proposed in this paper shows promising performance levels in dysphagia classification. Our results show that the ensemble method used in this study may be utilized as a convenient and rapid digital biomarker of dysphagia in a non-invasive and automated manner.

Rheology, Texture and Swallowing Characteristics of a Texture-Modified Dysphagia Food Prepared Using Common Supplementary Materials.

A dysphagia diet is a special eating plan. The development and design of dysphagia foods should consider both swallowing safety and food nutritional qualities. In this study, the effects of four food supplements, namely vitamins, minerals, salt and sugar, on swallowing characteristics, rheological and textural properties were investigated, and a sensory evaluation of dysphagia foods made with rice starch, perilla seed oil and whey isolate protein was carried out. The results showed that all the samples belonged to foods at level 4 (pureed) in The International Dysphagia Diet Standardization Initiative (IDDSI) framework, and exhibited shear thinning behavior, which is favorable for dysphagia patients. Rheological tests showed that the viscosity of a food bolus was increased with salt and sugar (SS), while it decreased with vitamins and minerals (VM) at shear rates of 50 s-1. Both SS and VM strengthened the elastic gel system, and SS enhanced the storage modulus and loss modulus. VM increased the hardness, gumminess, chewiness and color richness, but left small residues on the spoon. SS provided better water-holding, chewiness and resilience by influencing the way molecules were connected, promoting swallowing safety. SS brought a better taste to the food bolus. Dysphagia foods with both VM and 0.5% SS had the best sensory evaluation score. This study may provide a theoretical foundation for the creation and design of new dysphagia nutritional food products.

Translation and Validation of the Tamil Version of the Dysphagia Handicap Index in Tamil-Speaking Patients.

Introduction Dysphagia is one of the general symptoms encountered in clinical practice. The impact of dysphagia can be devastating to a patient's physical condition and quality of life (QOL). To evaluate the QOL of patients with dysphagia there are numerous self-reported questionnaires. The most commonly used one such questionnaire is the Swallowing Quality-of-Life Questionnaire (SWAL-QOL). However, it is not concise and is incomplete as it does not address all the aspects of dysphagia. To overcome this, the Dysphagia Handicap Index (DHI) was developed. It focuses on the functional and emotional aspects in addition to the physical aspects of dysphagia. Objective To develop a Tamil version of the DHI (DHI-T) and assess its reliability, cultural adaptability and validity. Materials and method This cross-sectional study was conducted from May 2021 to December 2022 on 140 participants consisting of 70 dysphagia patients and 70 healthy individuals. Results The reliability and validity of the DHI-T were good with a high correlation between DHI-T and self-perceived severity scales of dysphagia. The mean total score in the Dysphagia group was 59.77 with the mean physical, functional and emotional scores being 23.86, 17.46 and 18.46 respectively. These scores were less compared to the Healthy group (p-value <0.01). Conclusion This study shows that DHI-T can be used as a reliable and valid tool to grade and study the different domains of dysphagia in our study population. Among the various causes of dysphagia studied in our population, it wasnoted thatcoronavirus disease 2019 (COVID-19)-related dysphagia patients had higher mean score in the emotional domain. To the best of our knowledge, the DHI scores for COVID-19-related dysphagia have not been done before. As the application of DHI in routine clinical practice and research is increasing, we believe this DHI-T can be of aid to Tamil-speaking patients.

Successful Treatment of Achalasia With Endoscopic Ultrasound–Guided Botulinum Injection in Setting of Esophageal Varices

ABSTRACT Achalasia in a patient with liver cirrhosis decompensated by esophageal varices is an extremely rare presentation with complex management implications. We describe a case of achalasia and malnutrition in a male patient with esophageal varices treated by endoscopic ultrasound–guided botulinum toxin injection. After treatment, the patient's dysphagia dramatically improved, and his weight loss stabilized, which allowed an important window to remove the barrier of nutritional status for transplant candidacy. Endoscopic ultrasound–guided botulinum toxin injection to avoid varices is potentially a safer method for delivering botulinum toxin injection to the lower esophageal sphincter in a patient with esophageal varices.

Temperature controlled cryoprinting of food for dysphagia patients

Temperature Controlled Cryoprinting (TCC), employs temperature-controlled freezing to generate a desired ice crystal microstructures in each printed voxel, to yield a 3D printed bioproduct with intended microstructure. We introduce the use of TCC, originally developed for tissue engineering, for food manufacturing. TCC was used to make a beef product with anisotropic texture, for people with dysphagia (food swallowing difficulties). The effects of printing, cross-linking order, and directional freezing rates on the microstructure, viscoelastic and textural properties of TCC beef, were examined. Scanning electron microscopy shows that when directional freezing occurred before cross-linking, the microstructure consists of anisotropic alternating ridges of beef material with elongated pores parallel to the freezing direction. Shear stress tests confirmed that the meat had solid-like behavior and textural anisotropy, a desirable property lacking in conventional isotropic dysphagia foods. International Dysphagia Diet Standardization Initiative tests categorize the TCC beef as level 6 (soft and bite-sized) food. Industrial relevanceThe TCC technology can be used to provide texture and anisotropic microstructure to a variety of isotropic food products, such as ground meat, alternative meat or synthetic meat. The TCC technology could be also used for one-step process that combines manufacturing and freezing of foods.

Knowledge, attitudes, and behaviors of dysphagia clinicians regarding oral health-An international study.

The aim of this study was to investigate the knowledge, attitudes, and behaviors of dysphagia clinicians regarding oral health care. An 11-question and 37-statement survey inquiring the clinicians' descriptive information, knowledge, attitudes, and behaviors related to oral health was administered via Google forms. A total of 234 dysphagia clinicians responded on behalf of themselves. The findings showed that 41.5% (n=97) of the clinicians had a high level of knowledge about oral health. There was a significant relationship between the level of oral health knowledge and the clinicians' oral health education (p<.05). A percentage of 6.4 (n=15) of the clinicians had a high level of attitude toward oral health. Oral health education status of clinicians and their profession was significantly related to the attitude toward oral health (p<.05). Most of the clinicians (44.0%, n=103) had low behavior level. The level of behavior was significantly associated with status of receiving oral health education, their professions, duration of experience, and institution (p<.05). The study showed that clinicians exhibit moderate mean knowledge, attitudes, and behaviors scores, and these states are significantly associated with oral health education. This can serve as a stimulus for clinicians caring for dysphagia patients to receive oral health education during their university education.

Treatment of Post-Stroke Dysphagia with Repetitive Transcranial Magnetic Stimulation Based on the Bimodal Balance Recovery Model: A Pilot Study.

Brain plasticity and functional reorganization are the main mechanisms of stroke rehabilitation and the theoretical basis for transcranial magnetic therapy. Bimodal balance recovery model suggests that the structural integrity of neural pathways affects the functional reorganization mode of brain recovery after stroke. The principal neural pathway that innervates swallowing is the corticobulbar tract (CBT). The goal is to investigate the impact of corticobulbar tract integrity on swallowing function recovery in post-stroke dysphagia (PSD) patients treated with repetitive transcranial magnetic stimulation (rTMS). Thirty-five patients with high CBT integrity (relative fractional anisotropy (rFA) >0.5) and 32 patients with low CBT integrity (rFA ≤0.5) were respectively assigned to three subgroups through a random number table: 5 Hz frequency rTMS group, 1 Hz frequency rTMS group, and Sham rTMS group. The Standardized Swallowing Assessment (SSA), Penetration Aspiration Scale (PAS), and Dysphagia Outcome Severity Scale (DOSS) were analyzed before and after therapy. Significant improvements in SSA (p < 0.05), PAS (p < 0.05), and DOSS scores (p < 0.05) were seen in the high frequency (HF) and low frequency (LF) groups compared with the Sham group for patients with high CBT integrity. Increased SSA (p < 0.05), PAS (p < 0.05), and DOSS scores (p < 0.05) demonstrated that the HF group achieved greater remediation than the LF and Sham groups for patients with low CBT integrity. Both 5 Hz and 1 Hz rTMS over the contralateral hemisphere are effective for the treatment of swallowing disorders for patients with high CBT integrity after stroke; 5 Hz rTMS over the contralateral hemisphere is more effective than 1 Hz and sham stimulation for patients with low CBT integrity.

Protein gel with designed network and texture regulated via building blocks to study dysphagia diet classifications

We described the successful fabrication of protein gels with varying textures through a mild enzymatic reaction where Ca2+ regulated the structure of gel network building blocks (i.e., casein micelles). Using identical starting components, different building blocks were constructed into a fine- or thick-chain network through Ca2+ concentration to tune the texture of the gels. The fabricated proteins were characterized and their classifications for dysphagia diets according to the guidelines of Universal Design Food (UDF)/International Dysphagia Diet Standardization Initiative (IDDSI) were also reported. The classifications by both guidelines were found to be confusing as a single protein gel could be categorized into different tolerated levels of chewing/swallowing ability, and recommended to patients with different severity of dysphagia. For instance, a gel (with 0.0267 g Ca2+/g CM) considered safe for dysphagia patients who could only use tongue to swallow under IDDSI recommendation, but it was suggested by UDF standards to be crushed with the help of gums before swallowing. Mismatch between international standards should be taken into account during classification to prevent irreparable clinical impact. In conclusion, this research focused on the design and creation of food models which could be useful in the future clinical studies to investigate dysphagia diets and their categorization.

Main approaches to evaluating the quality of chewable tablets and medicated chewing gums

Chewable tablets and medicated chewing gums are currently gaining importance in the pharmaceutical market due to their numerous advantages such as the ease of use, rapid onset of pharmacological effect, and high patients’ compliance, in particular, of dysphagia patients. The usage of chewable tablets and medicated chewing gums involves special methods for evaluating their textural, structural and mechanical characteristics, as well as individual methods for studying the drug release. The review provides an analysis of the main methods for studying structural, mechanical, and technological characteristics of chewable tablets and medicated chewing gums. In addition, the principles of operation and design of test devices, as well as pharmacopoeial methods for evaluating the drug release, are shown.

Pea protein isolates affected by ultrasound and NaCl used for dysphagia's texture-modified food: Rheological, gel, and structural properties

Providing texture-modified food for dysphagia patients has been one of the most effective treatment methods. The current study aimed to evaluate a specially designed commercial pea protein isolate (PPIc) -based texture-modified food by ultrasonic treatment (US, 390 W; 20 min) at different NaCl concentrations by adjusting its texture and structure. The results showed that US can improve the texture properties of PPIc within a certain range of NaCl concentration (0.03–0.6 M). The prepared PPIc samples exhibited good mastication and swallowing characteristics with proper viscosity (33.31–704.2 mPa·s), softness (gel strength <30 g), wetness (good solubility and water holding capacity), etc. While with ultrasonic condition at the low NaCl concentration (0.1 M), the PPIc could achieve an overall superior textural attribute than those with other salt concentrations. Further research showed that US-NaCl combination could facilitate PPIc gel to maintain a more proper dysphagia texture, not only by reducing the number of pores and unfolding structures during processing, but also by enhancing the surface area of protein particles and cross-linking interaction of proteins through more exposure of sulfhydryl groups. It was also found that the β-turns of untreated-PPIc transformed to β-sheets at high salt concentration, whereas inverted transformation was observed at low NaCl concentration (0.03 M). We further unveiled US significantly enhanced the solubility, water holding capacity, and gelling ability of the PPIc. Overall, US-NaCl would be a promising method for the preparation of modified textural PPIc, which provides a new approach to formulate low-salt, high-nutrition, and customizable food for special populations such as the elderly and dysphagia.

Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

BackgroundMagnetic sphincter augmentation (MSA) erosion, disruption or displacement clearly requires device removal. However, up to 5.5% of patients without anatomical failure require removal for dysphagia or recurrent GERD symptoms. Studies characterizing these patients or their management are limited. We aimed to characterize these patients, compare their outcomes, and determine the necessity for further reflux surgery.MethodsThis is a retrospective review of 777 patients who underwent MSA at our institution between 2013 and 2021. Patients who underwent device removal for persistent dysphagia or recurrent GERD symptoms were included. Demographic, clinical, objective testing, and quality of life data obtained preoperatively, after implantation and following removal were compared between removal for dysphagia and GERD groups. Sub-analyses were performed comparing outcomes with and without an anti-reflux surgery (ARS) at the time of removal.ResultsA total of 40 (5.1%) patients underwent device removal, 31 (77.5%) for dysphagia and 9 (22.5%) for GERD. After implantation, dysphagia patients had less heartburn (12.9-vs-77.7%, p = 0.0005) less regurgitation (16.1-vs-55.5%, p = 0.0286), and more pH-normalization (91.7-vs-33.3%, p = 0.0158). Removal without ARS was performed in 5 (55.6%) GERD and 22 (71.0%) dysphagia patients. Removal for dysphagia patients had more complete symptom resolution (63.6-vs-0.0%, p = 0.0159), freedom from PPIs (81.8-vs-0.0%, p = 0.0016) and pH-normalization (77.8-vs-0.0%, p = 0.0455).Patients who underwent removal for dysphagia had comparable symptom resolution (p = 0.6770, freedom from PPI (p = 0.3841) and pH-normalization (p = 0.2534) with or without ARS. Those who refused ARS with removal for GERD had more heartburn (100.0%-vs-25.0%, p = 0.0476), regurgitation (80.0%-vs-0.0%, p = 0.0476) and PPI use (75.0%-vs-0.0%, p = 0.0476).ConclusionsMSA removal outcomes are dependent on the indication for removal. Removal for dysphagia yields excellent outcomes regardless of anti-reflux surgery. Patients with persistent GERD had worse outcomes on all measures without ARS. We propose a tailored approach to MSA removal-based indication for removal.Graphical abstract

Towards attractive texture modified foods with increased fiber content for dysphagia via 3D printing and 3D scanning

As life expectancy increases so do age related problems such as swallowing disorders, dysphagia, which affects 10%–30% of people over 65 years old. For dysphagia patients the texture and rheological properties of the food, and the bolus, is critical to avoid choking and pneumonia. Texture modified foods, timbals, are often served to these patients due to their ease of swallowing. The main concern with these foods is that they do not look visually alike the food they replace, which can decrease the patient’s appetite and lead to reduced food intake and frailty. This study aims to improve both the visual appearance of texturized food as well as the energy density and fiber content of the timbal formulation. 3D scanning and additive manufacturing (3D Printing) were used to produce meals more reminiscent of original food items, increasing their visual appeal. Rheology was used to ensure the original flow profile was maintained as the timbal was reformulated by reducing starch contents and partially replacing with dietary fibers. The amount of starch was reduced from 8.7 wt% in the original formulation to 3.5 wt% and partially replaced with 3 wt% citrus fiber, while maintaining properties suitable for both swallowing and 3D printing. The resulting formulation has improved nutritional properties, while remaining suitable for constructing visually appealing meals, as demonstrated by 3Dprinting a chicken drumstick from a model generated with 3D scanning.