title: The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia.
abstract: BACKGROUND
  Increasing bolus viscosity of thin liquids is a basic therapeutic strategy to protect patients with oropharyngeal dysphagia (OD) from aspiration. However, conventional starch thickeners increase post-deglutitive residue.
  
  
  OBJECTIVE
  To assess the therapeutic effect of a new xanthan gum-based thickener, Resource ThickenUp Clear (Nestlé Health Science, Vevey, Switzerland) on patients with oropharyngeal dysphagia.
  
  
  METHODS
  We studied the effect of Resource ThickenUp Clear using a clinical method and videofluoroscopy on 120 patients with oropharyngeal dysphagia (66 with stroke, 41 older and 13 with neurodegenerative diseases) and 14 healthy volunteers while swallowing thin-liquid, nectar-like and spoon-thick boluses. We assessed the prevalence of signs of impaired safety and efficacy of swallow and the physiology of the swallow response.
  
  
  RESULTS
  Increasing bolus viscosity with Resource ThickenUp Clear: (i) improved safety of swallow demonstrated by a reduction in the prevalence of cough and voice changes in the clinical study and penetrations and aspirations during video fluoroscopy. Prevalence of aspirations was 12.7% with thin liquid, 7.7% with nectar-like (P < 0.01) and 3.4% with spoon-thick (P < 0.01) viscosities. Penetration-Aspiration Scale was reduced from 3.24 ± 0.18 at thin liquid to 2.20 ± 0.18 at nectar-like (P < 0.001) and to 1.53 ± 0.13 at spoon-thick (P < 0.001) viscosities; (ii) did not enhance pharyngeal residue; (iii) nectar-like viscosity did not affect bolus velocity nor timing of swallow response and (iv) spoon-thick viscosity reduced bolus velocity.
  
  
  CONCLUSIONS
  Resource ThickenUp Clear improves the safety of swallow without increasing residue providing a viscosity-dependent therapeutic effect for patients with oropharyngeal dysphagia. At nectar viscosity, the effect is due to intrinsic texture properties, spoon-thick viscosity adding changes in swallow physiology. NCT01158313.
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Rofes
authors.forename: V
authors.initials: V
authors.lastname: Arreola
authors.forename: R
authors.initials: R
authors.lastname: Mukherjee
authors.forename: J
authors.initials: J
authors.lastname: Swanson
authors.forename: P
authors.initials: P
authors.lastname: Clavé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003371:Cough / Q000453:epidemiology; D003679:Deglutition / Q000187:drug effects*; D003680:Deglutition Disorders / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000378:metabolism; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage* / Q000737:chemistry; D015995:Prevalence; D013213:Starch / Q000737:chemistry; D014783:Viscosity; D055815:Young Adult
chemical_list: D011135:Polysaccharides, Bacterial; D013213:Starch; C002563:xanthan gum