title: Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety.
abstract: Dysphagia is the medical term for difficulty swallowing. Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. A range of starches and gums has historically been used to thicken liquids. Although thickened liquids improve swallow safety, they appear to have a great potential for unintended physiological consequences. Initial concerns were raised about the impact of thickeners on water binding due to the high prevalence of dehydration amongst individuals with dysphagia. Thankfully, regardless of thickening agent, thickeners do not affect water bioavailability. This effect holds true even for extremely thick fluids. However, bioavailability of medication is impaired with viscous substances. Liquids thickened to as little as 150 mPa.s retards drug release. In addition, feelings of satiety and thirst increase with increasingly viscous fluids. Flavour deteriorates with increasing thickness regardless of thickening agent. Therapeutically clinicians often prescribe small volumes of thickened liquids, consumed often. Yet small volumes of thick substances consumed with a long oral processing time, which is common for individuals with dysphagia, reduces the amount consumed. A combination of poor flavour, and increasing feelings of fullness result in little motivation and poor physiologic drive to consume thickened liquids.
authors: Julie A Y
authors: JA
authors: Cichero
mesh_terms: D001628:Beverages / Q000032:analysis*; D001682:Biological Availability; D003680:Deglutition Disorders / Q000628:therapy*; D003681:Dehydration / Q000453:epidemiology* / Q000628:therapy; D019468:Disease Management; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D015995:Prevalence; D012527:Satiation; D014867:Water / Q000378:metabolism*
chemical_list: D014867:Water
references: Am J Physiol. 1990 May;258(5 Pt 1):G675-81
references: 2333995
references: Chem Pharm Bull (Tokyo). 1992 Feb;40(2):459-62
references: 1606645
references: Am J Clin Nutr. 2000 Aug;72(2):361-8
references: 10919928
references: J Clin Nurs. 2009 Jun;18(11):1649-59
references: 19490301
references: Am J Physiol Gastrointest Liver Physiol. 2001 Jun;280(6):G1227-33
references: 11352816
references: Int J Pharm. 2008 May 1;355(1-2):93-9
references: 18226480
references: Age Ageing. 2010 Jan;39(1):39-45
references: 19561160
references: Rehabil Nurs. 2012 Sep-Oct;37(5):252-7
references: 22949278
references: Int J Obes Relat Metab Disord. 1998 Sep;22(9):906-9
references: 9756250
references: Eur J Clin Pharmacol. 1984;26(2):279-81
references: 6327318
references: Am J Clin Nutr. 2009 Aug;90(2):269-75
references: 19515731
references: Pharm Res. 2005 Jan;22(1):11-23
references: 15771225
references: J Neurophysiol. 2003 Dec;90(6):3711-24
references: 12917386
references: Dysphagia. 2005 Fall;20(4):325-35
references: 16633878
references: J Texture Stud. 1971 Dec;2(4):451-459
references: 28370128
references: Chem Senses. 2002 Sep;27(7):583-91
references: 12200337
references: J Am Diet Assoc. 2004 Aug;104(8):1222-6
references: 15281038
references: Physiol Behav. 2000 Feb;68(4):579-83
references: 10713300
references: Dis Esophagus. 2011 Sep;24(7):476-80
references: 21385285
references: Geriatr Nurs. 1999 Mar-Apr;20(2):77-82; quiz 84
references: 10382421
references: J Hum Nutr Diet. 2009 Apr;22(2):148-55
references: 19302120
references: J Am Diet Assoc. 2006 Jul;106(7):1049-54
references: 16815121
references: Int J Obes (Lond). 2008 Apr;32(4):676-83
references: 18071342
references: Dysphagia. 2010 Mar;25(1):1-5
references: 19557477
references: Arch Phys Med Rehabil. 2001 Dec;82(12):1744-6
references: 11733894
references: Int J Speech Lang Pathol. 2012 Jun;14(3):214-25
references: 22443610
references: AAPS PharmSciTech. 2009;10(1):270-5
references: 19280345
references: Obes Res. 2005 Mar;13(3):537-44
references: 15833939
references: J Pharm Sci. 1982 Dec;71(12):1375-80
references: 7153886
references: Arch Otolaryngol Head Neck Surg. 2010 Aug;136(8):784-9
references: 20713754
references: Gerontology. 2007;53(4):179-83
references: 17264513
references: Dysphagia. 1994 Spring;9(2):101-6
references: 8005004
references: J Perinatol. 2012 Feb;32(2):150-2
references: 22289705
references: Iran J Pharm Res. 2012 Spring;11(2):513-21
references: 24250474
references: Clin Nutr. 2001 Oct;20(5):423-8
references: 11534937
references: Contemp Nurse. 2008 Dec;31(1):44-56
references: 19117500
references: CMAJ. 2003 Nov 11;169(10):1041-4
references: 14609974
references: J Pharm Bioallied Sci. 2012 Jul;4(3):175-85
references: 22923958
references: Dysphagia. 2007 Jul;22(3):193-203
references: 17287924
references: Eur J Nutr. 2009 Jun;48(4):251-8
references: 19306033
references: J Nutr. 2004 Sep;134(9):2293-300
references: 15333719