Assessment of Functional Food Dioscorea Japonica Paste As A Thickened Liquid For Elderly With Dysphagia

Background: In the elderly, reduced mastication and swallowing functions result in malnutrition and deterioration in the quality of life. As individuals age in the society, the novel concept of dysphagia diet is essential in order to prevent lifestyle and chronic diseases and maintain nutrition intake. Recently, we reported that Dioscorea japonica, a wild yam, has preventive effects on chronic inflammation via the inhibition of proinflammatory lipid mediator synthesis. The paste of Dioscorea japonica showed conformable physical properties as a thickened liquid for patients with dysphagia in rheological analysis. In the present study, we focused on the unique physical properties of Dioscorea japonica paste and evaluated its stability and usefulness as a thickened liquid compared with commercially available thickened liquids. Methods: The paste prepared using a uniformly freeze-dried Dioscorea japonica powder could suitably modify the viscosity by altering the blending amount. Viscosities of the Dioscorea japonica paste, xanthan gum, and commercially available thickened liquids were measured using a cone and plate viscometer after 1 min by employing the following setting: temperature of 20°C and shear rate of 50 s−1. The effect of changes in temperature and pH, and addition of NaCl and α-amylase, on viscosity was compared among the thickened liquids. Results: Compared with the other commercially available agents, the Dioscorea japonica paste was stable in terms of viscosity on the addition of NaCl, and no change was observed on the addition of α-amylase as similar as the others. Although the Dioscorea japonica paste was relatively stable in terms of viscosity with change in pH, it was slightly unstable with change in temperature. Conclusion: The findings of this study indicate that the Dioscorea japonica paste is useful as a novel type of thickened liquid for patients with dysphagia.

Evaluation of thickened liquid viscoelasticity for a swallowing process using an inclined flow channel instrument

An inclined flow channel instrument that can be developed to be a structurally simple and easy-to-use rheometer was applied to control the thickness, specifically the viscosity and elasticity, of liquids thickened to support swallowing in nursing-care practice. Aqueous solutions containing salt or acid, which might be used as ingredients in drinks, were thickened with a commercial thickener. The thickener efficacy decreased because of the salt or acid in liquid phase. Analysis of the flows in the instrument by experimentation yielded a dimensionless relation representing changes of the Deborah number in the flow process, as indicated by the relative flow length, considering the shear rate in oral processing. One unique methodology to evaluate the viscoelasticities of thickened liquids during the swallowing process was presented utilizing the measurements such as elapsed time and velocity in the instrument.

Dysphagia in Pediatric Patients with Tracheostomy

Objective: Post-tracheotomy swallowing function has not been well described in the pediatric population. This study aims to (1) determine differences in swallowing functioning pre- and post-tracheotomy and (2) examine the association between postoperative dysphagia and indication for tracheotomy, age at the time of tracheotomy, and time between tracheotomy and modified barium swallow (MBS). Methods: A retrospective chart review was performed on 752 patients who underwent a tracheotomy from 2003 to 2018 and had adequate documentation for review. Patients were included if they received a post-operative MBS. Descriptive statistics, logistic regression, and Fisher’s exact test were used to analyze the data. Results: The cohort included 233 patients. The mean age at the time of tracheotomy was 25 months (±50.5). The indications for the tracheotomy were upper airway obstruction (110/233, 47.2%), chronic respiratory failure (104/233, 44.6%), and neurologic disease (19/233, 8.2%). The mean time from tracheotomy to post-operative MBS was 224 days (±297.7). Of the patients who had documented pre- and post-tracheotomy diets, nearly half of patients had improvement in their swallowing function after tracheotomy placement (82/195; 42.1%). Post-tracheotomy MBS recommended thickened liquids in 30.9% of the patients (72/233) and 42.5% (99/233) were recommended thin liquids. The remainder (62/233, 26.6%) remained nothing by mouth (NPO). Patients with neurological disease as the indication for the tracheotomy were more likely to remain NPO ( P = .039). Conclusion: A tracheotomy can functionally and anatomically affect swallowing in pediatric patients. The majority of our studied cohort was able to resume some form of an oral diet postoperatively based on MBS. This study highlights the need for objective measurements of swallowing in the postoperative tracheotomy patient to allow for safe and timely commencement of an oral diet. Level of Evidence Level 3.

A Case Study Vignette for a Pediatric Patient With Eosinophilic Esophagitis

Objectives Eosinophilic Esophagitis (EoE) is a chronic inflammatory, immune/antigen-mediated condition of the esophagus. It is common in pediatric patients and can lead to several complications such as esophageal remodeling/fibrosis, growth stunting, and low bone mineral density. Nutrition interventions, such as elimination or elemental diets, are the first therapeutic tool for EoE management along with pharmacological interventions. Methods KS is a 20 month-old female whose weight-for-length has fallen above the 55th percentile since birth. She has a history of gastroesophageal reflux, dysphagia, and aspiration requiring thickened liquids for almost 2 years. During infancy she tolerated milk based thickened formula and transitioned to 1% milk at 1 year. She was diagnosed with EoE during a triple endoscope for laryngeal cleft repair. The pathology revealed rings and furrows in the mid/distal esophagus, and > 20 eosinophils per high powered field (HPF) in distal, mid, and proximal esophagus with evidence of subepithelial fibrosis. At that time she had no dietary restrictions or use of antacids. Since cleft repair, dysphagia improved and she started on a dairy free diet for EoE. However, she experienced an adverse reaction to dairy free nut-based cheese with subsequent positive radioallergosorbent testing to tree nuts. Follow-up endoscopy improved on an 8-week dairy and tree nut free diet, but eosinophils persisted in proximal esophagus with evidence of basal cell hyperplasia. Results The patient was able to make important strides towards remission by eliminating suspected trigger foods, with diagnosis and intervention initiation before signs of inadequate growth or nutrition. Conclusions Nutrition interventions are often imperative to achieve remission of EoE. There are potential nutrition related concerns including increased risk of nutrient deficiencies, inadequate growth, and poor quality of life as the patient follows an elimination/elemental diet. EoE should become a consideration when feeding or swallowing difficulties arise, especially in pediatric patients. Proper diagnosis, tailored interventions, and appropriate monitoring and evaluation with the help of a multidisciplinary team can lead to successful management. Funding Sources N/A.

Determining the Impact of Thickened Liquids on Swallowing in Patients Undergoing Irradiation for Oropharynx Cancer

The current standard for the treatment of oropharynx cancers is radiation therapy. However, patients are frequently left with dysphagia characterized by penetration-aspiration (impaired safety) and residue (impaired efficiency). Although thickened liquids are commonly used to manage dysphagia, we lack evidence to guide the modification of liquids for clinical benefit in the head and neck cancer population. The objective of this study was to assess the impact of slightly and mildly thick liquids on penetration-aspiration and residue in 12 patients with oropharyngeal cancer who displayed penetration-aspiration on thin liquid within 3 to 6 months after completion of radiotherapy. Significantly fewer instances of penetration-aspiration were seen with slightly and mildly thick liquids as compared with thin ( P < .05). No differences were found across stimuli in the frequency of residue. Patients with oropharyngeal cancers who present with post–radiation therapy dysphagia involving penetration-aspiration on thin liquids may benefit from slightly and mildly thick liquids without risk of worse residue.