Review of the effect of amylase-resistant dysphagia products on swallowing safety

Abstract

Purpose of reviewThickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety. Recent findingsNo studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starchbased dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients.

Effects of Calcium and pH on Rheological Thermal Resistance of Composite Xanthan Gum and High-Methoxyl Apple Pectin Matrices Featuring Dysphagia-Friendly Consistency

“…Cichero [ 56 ] and Burning [ 57 ] highlighted a shift from starch-based dysphagia products to gum-based ones, citing improved palatability, stable thickness, and patient preference for serving temperature. Leonard et al conducted a clinical trial with 118 enrolled dysphagia patients, comparing gum-thickened matrices to thin water and starch-thickened ones, all designated as having the consistency of nectar [ 58 ].…”

“…A study on 120 post-stroke patients with dysphagia showed that gum-based thickeners with a viscosity range of 150 to 800 mPa.s significantly improved swallowing safety [ 59 ]. Burnip [ 57 ] and Cichero [ 56 ] noted that applying these recommendations clinically may be limited due to the viscosity labeling system’s requirement of laboratory-grade rheometers and engineering expertise.…”

Getting the consistency right in thickened liquids using Viscgo Sticks: A validation study

“…Thickeners are made from either starch or gum. The present study focuses on gum‐based thickeners only, which are preferable for dysphagia management, offering better palatability and improved stability of thickness over time and different temperatures 21–25 . In addition, experimental investigations with different types of thickener have confirmed the perception of gum‐based liquids being ‘slippery’ compared to other types of thick liquid, making them a suitable option for successful swallowing 19 …”