Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

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.

Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic

“…In addition, caregivers perceived more confidence in themselves to feed their family members. This observation is consistent with the data published by other authors [ 36 , 37 , 38 ].…”

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

“…Older and stroke patients recruited in this study were demographically similar to those studied previously by our group [ 25 , 26 , 27 , 40 ]. Regarding the swallowing status of our phenotypes, older and stroke presented severe OD in terms of prevalence of signs of impaired safety (63.89% in older and 77.42% in stroke), impaired efficacy of swallow (100% in older and 96.67% in stroke), and PAS (mean PAS score of 4.08 ± 0.39 in older and 4.55 ± 0.41 in stroke).…”

“…Biomechanics of OSR were described as in previous studies [ 11 , 35 ], included the time to LVC, to upper esophageal sphincter opening (UESO), final kinetic energy (KE) of the bolus, bolus propulsion force, and mean bolus velocity. OSR was measured with specific software (Swallowing Observer; Image & Physiology SL, Barcelona, Spain) [ 25 , 27 ].…”

“…Moreover, in less than 30 s in the oral phase of swallow, the viscosity of starch-based thickeners can be dramatically reduced by oral salivary α-amylase as this breaks down starch molecules [ 21 ], reducing its therapeutic effect [ 22 , 23 ]. A new generation of thickening agents, such as xanthan gum or mixtures of gums and α-amylase-resistant modified starches, has shown better therapeutic properties for these patients [ 24 , 25 , 26 , 27 ] than the starch-based thickeners. The first generation of thickening agents marketed in EU was made of starch or starch derivatives (maltodextrins).…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…Different classifications of viscosity levels have emerged in recent years such as the National Dysphagia Diet (NDD) [267], the International Dysphagia Diet Standardisation Initiative (IDDSI) [268], and the Japanese Dysphagia Diet 2013 (JDD2013) [269] all using different and arbitrary viscosity levels and terminology. The ESSD proposes to go further than just the use of a descriptive classification of viscosity levels and therefore recommends that manufacturers of thickening agents also include the viscosity values in Système Internationale d'Unités (SI) units (mPa•s) into the labels of thickening agents [100,270,271] (Fig. 2).…”