Olfactory Stimulation Using Black Pepper Oil Facilitates Oral Feeding in Pediatric Patients Receiving Long-Term Enteral Nutrition

Abstract

Patients with severe neurological disorders often require enteral nutrition (EN). Since long-term EN can cause multiple complications, reinstating the oral intake of food is beneficial. Olfactory stimulation using black pepper oil (BPO), a strong appetite stimulant, was reported to facilitate swallowing in older people. Therefore, the effects of olfactory stimulation with BPO were investigated in pediatric patients receiving long-term EN due to neurological disorders. The effects of scenting with BPO for 1 min immediately before every meal were evaluated in ten patients: 4 boys and 6 girls, aged 19-97 months (51 ± 26 months). The neurological disorders included periventricular leukomalacia (3 patients), hypoxic ischemic encephalopathy (3), Costello syndrome (1), Russell-Silver syndrome (1), Miller-Dieker syndrome (1), and cerebral palsy of unknown etiology (1). In eight of these patients, BPO intervention was continued for 3 months. Five of these eight patients showed increases in the amount of oral intake with desirable effects including facilitated swallowing movement, although complete elimination of the need for EN was not achieved. In the other three patients, BPO intervention was not effective; severe cerebral tissue loss, profound malformation or intractable seizures seemed to reduce the efficacy of BPO. In two cases, BPO intervention was discontinued due to cough or because the odor of BPO was unbearable to the family. In conclusion, olfactory stimulation with BPO facilitated oral intake in a subset of patients on long-term EN. BPO stimulation may be useful for facilitating oral intake when used in combination with conventional methods. dysphagia; food aversion; enteral nutrition; black pepper oil; cerebral palsy. Tohoku

Sensory Stimulation to Improve Swallowing Reflex and Prevent Aspiration Pneumonia in Elderly Dysphagic People

“…When we investigated the effect of black pepper essential oil inhalation on nursing residents, we found that black pepper oil improved the swallowing reflex and serum substance P concentration, suggesting that olfactory stimulation using black pepper is an effective method to treat feeding and swallowing disorders and to prevent aspiration pneumonia (29). This beneficial effect of black pepper aromatherapy is confirmed not only in the elderly but also in children (30). The single photon emission tomography study showed that olfactory stimulation with black pep- per oil increased cerebral blood flow in the right anterior cingulate cortex and the left insular cortex (29), which is impaired in patients with aspiration pneumonia (26).…”

The Nutrient Formula Containing Eicosapentaenoic Acid and Docosahexaenoic Acid Benefits the Fatty Acid Status of Patients Receiving Long-Term Enteral Nutrition

“…Patients with neurological disorders often require chronic support with enteral nutrition (EN) because of problems with eating and swallowing (Munakata 2008). For these patients, the intake of essential fatty acids depends primarily on the EN.…”

The Change of Salivary Flow Rate according to Olfactory Stimulation

“…After the 6th stimulation, the rate of salivation in the BPO group consistently increased in comparison with the LVO and DW groups. In contrast, the LVO group showed the same rate as the BPO group following the initial stimulation, but the rate was maintained at a lower level until the 6th stimulation, while it subsequently increased in comparison with the DW group Munakata et al 22) argued that BPO is associated with appetite, has an effect of increasing food intake, and improves the chewing function. Moreover, Park 36) has reported similar findings, and suggested that a conventional rehabilitation therapy for the chewing function could be used in parallel with the conventional therapy; thus, the effect of the latter could not be excluded.…”

“…To date, the method that has been frequently used to administer olfactory stimulation has been nasal inhalation. Similarly to previous studies, 21,22,36) nasal inhalation in the present study was administered by rubbing the olfactory stimulant on a cotton swab that was subsequently placed at a 3 to 5 cm distance from the participant's nose, without touching the nose. Park 36) has suggested that further research is required to improve the methods of administering olfactory stimulation.…”

“…20) Ebihara et al 21) have used BPO in older patients with dysdipsia, and have reported reduced symptoms due to activated left insular cortex. Munakata et al 22) have reported an increased food intake in children as a consequence of BPO, while Park et al 23) have reported enhanced swallowing functions in patients following treatment with BPO.…”