Weslania Viviane do Nascimento

The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review

Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration–aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.

Effect of age on proximal esophageal response to swallowing

CONTEXT It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION We conclude that the age may affects the response of the proximal esophagus to wet swallows.

Effect of Bolus Volume and Consistency on Swallowing Events Duration in Healthy Subjects

Background/Aims Swallowing is a complex function with the control of the swallowing center being located in the brain stem. Our aim in this investigation was to evaluate, in healthy volunteers, the oral and pharyngeal transit of 2 bolus volumes and 2 consistencies, and the influence of these boluses on the proportion of pharyngeal clearance duration/hyoid movement duration. Methods Videofluoroscopic evaluation of swallows was performed in 30 healthy volunteers, aged 29–77 years (mean 58 years). The subjects swallowed in duplicate of 5 mL and 10 mL of thick liquid barium and honey thick barium. We measured the duration of oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement, oropharyngeal transit, and the relation pharyngeal clearance duration/hyoid movement duration. Results A 10 mL bolus volume caused a longer UES opening duration than a 5 mL bolus volume, for both consistencies. The pharyngeal transit was longer for honey thick bolus consistency than for thick liquid, with both the volumes of 5 mL and 10 mL. For pharyngeal clearance, the difference was significant only with the 10 mL bolus volume. There was no difference associated with bolus volume or consistency in the relation between pharyngeal clearance duration and hyoid movement duration. Conclusions Increase in the swallowed bolus volume causes a longer UES opening duration and an increase in bolus consistency from thick liquid to honey thick causes a longer pharyngeal transit duration. The proportion between pharyngeal clearance and hyoid movement does not change with bolus volume or bolus consistency.

Efeito do gênero, da altura corporal e da etnia nas medidas antropométricas orofaciais

PURPOSE: The aim of this study was to assess the influence of gender, height and ethnicity on anthropometric orofacial measures in the adult population, and the possible correlation between these measures. METHODS: Anthropometric orofacial measurements were performed in asymptomatic volunteers, being 56 women and 44 men, aged 19 to 53 years. The measure were: upper lip height (sn-sto); lower lip height (sto-gn); filter height (sn-ls); upper third of the face (tr-g); middle third of the face (g-sn); lower third of the face (sn-gn); and distance between the outer canthus (ex) and cheilion (ch). RESULTS: All measurements were larger for men than for women. There was a positive correlation between most of the measures. There was no correlation between height and anthropometric orofacial measures, except for the middle third of the face (g-sn) of men, which had a weak positive correlation. Afro-Brazilian subjects presented larger measures for the lower third of the face (sn-gn) and for the distance between the outer canthus (ex) and the left cheilion (ch) than white subjects. CONCLUSION: Men have greater orofacial anthropometric measures than women. Height does not seem to have an influence on such measures.

Disfagia em pacientes com doença de Chagas e divertículo de Zenker

It is described the cases of two patients, one female and one male, both 64 years old, who had Zenker’s diverticulum associated to chagasic esophagopathy. One of them had esophageal dysphagia for five years, later associated with oropharyngeal dysphagia (for nine months). The other patient had oropharyngeal dysphagia for eight months. Both had lived in endemic areas for Chagas’ disease, and had positive serologic tests for the disease. In the clinical evaluation, both patients had slow ingestion of liquids and paste bolus, and residues in oral cavity, without coughing after deglutition. Diagnosis was made by serologic test and radiologic examination of pharynx and esophagus, as well as a careful endoscopic examination. Radiologic results showed, in one of the subjects, pharyngoesophageal diverticulum (Zenker), and slow barium bolus transit (more than ten seconds to cross the esophageal body), and, in the other patient, Zenker’s diverticulum and normal esophageal transit duration (less than ten seconds), with presence of tertiary contractions. Treatment consisted of diverticulectomy, cricopharyngeal myotomy, and cardiomyotomy of the lower esophageal sphincter for one patient, and cricopharyngeal myotomy for the other one. It is concluded that it is possible to have association of two causes of dysphagia in the same patient: the oropharyngeal, due to Zenker’s diverticulum, and the esophageal, due to Chagas’ disease. The knowledge of cause-effect relationship between these conditions needs further investigations.

Timing of Pharyngeal Swallow Events in Chagas’ Disease

Background Esophageal involvement by Chagas’ disease causes a significative decrease in the number of neurons of the esophageal myenteric plexus, causing an impairment of esophageal motility with the same alterations described in primary esophageal achalasia. There is also a longer duration of pharyngeal transit, which might be consequent of the involvement of the central control of swallowing by the disease, or an adaptation of the pharynx to the difficult bolus transit through the esophagus, which could contribute to the complaint of dysphagia. Methods We studied, by videofluoroscopy, the sequence and timings of pharyngeal bolus transit in 16 patients with esophageal involvement by Chagas’ disease and 12 healthy volunteers. Each subject swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses. Results There was no difference between Chagas’ disease patients and normal volunteers in the sequence and timing of events associated with pharyngeal bolus flow, for liquid and paste boluses, and for 5 mL and 10 mL. Conclusion The timing and sequence of swallow pharyngeal events of patients with Chagas’ disease do not differ from that of control subjects, which suggested that the central control of swallowing is not impaired by the disease.

Intervenção fonoaudiológica e anuência familiar em caso de criança com encefalopatia crônica não progressiva

Our objective was to describe the case of a 5-year-old child with chronic non-progressive encephalopathy and dysphagia since birth. In videofluoroscopy, aspiration was observed with liquid barium, but not with paste barium. Gastrostomy for feeding and fluid intake was indicated. The family did not follow the guidelines determined by the therapist, as the child drank fluids orally and, therefore, had several episodes of pneumonia. Although the mother was advised to provide liquid only by gastrostomy and not by oral feeding, such guidance was ignored for no apparent reason. We emphasize the importance of family adherence to treatment guidelines to prevent pulmonary complications resulting from the aspiration of food.

Variability of Oral and Pharyngeal Transit Between Two Consecutive Swallows in Chagas' Disease.

Background Chagas’ disease causes dysphagia, regurgitation and retention of food in the esophageal body. Patients have longer pharyngeal clearance, which might be consequent of the involvement of the central nervous system or an adaptation to the esophageal transit impairment. If there is central nervous system involvement by the disease, we expect a larger difference in the oral and pharyngeal phases of swallowing between two consecutive swallows than that seen in controls. Our objective was to evaluate the difference of oral and pharyngeal transit duration between two consecutive swallows in patients with Chagas’ disease compared with controls. Methods By videofluoroscopy, the duration of oral and pharyngeal transit, pharyngeal clearance, upper esophageal sphincter transit, hyoid movement and oropharyngeal transit was measured in 17 patients with Chagas’ disease and 15 asymptomatic volunteers. Each subject swallowed in duplicate and in sequence 5 mL and 10 mL of barium liquid and 5 mL and 10 mL of barium paste boluses. The differences were calculated between the two swallows of each volume and consistency in patients and controls. Results There were no differences between controls and patients in the values of the differences between the two consecutive swallows, except for the hyoid movement duration of the 5 mL liquid bolus, causing a higher difference in controls than in patients. Conclusion Oral and pharyngeal transit variation between two consecutive swallows is similar between patients with Chagas’ disease and controls, which suggests that the longer pharyngeal clearance duration previously described is not a consequence of impairment of the central nervous system control of swallowing.

Videofluoroscopic analysis of different volumes of liquid bolus swallowing in healthy individuals: comparison between height and sex

OBJECTIVE: The volume of swallowed bolus affects the pharyngeal transit duration. The sex and corporal height of individuals may likely influence this effect. The aim of this investigation was to determine the influence of sex and corporal height on the pharyngeal transit modification produced by the swallowed bolus volume. METHODS: Forty healthy volunteers, 20 men and 20 women, including tall (10 men and 10 women, corporal height: 1.71--2.07m) and short (10 men and 10 women, corporal height: 1.52--1.70m) persons, ranging in age between 20 and 50 years, were included in the study. Videofluoroscopic evaluation of swallowing was performed with the subjects in the sitting position. Each individual swallowed three 5 mL and three 10 mL boluses of liquid barium in a random sequence. The durations of oral transit, pharyngeal transit, pharyngeal clearance, hyoid movement, upper esophageal sphincter opening and oral-pharyngeal transit were evaluated. RESULTS: In men and women, and in taller and shorter individuals, the increase of the swallowed liquid bolus volume from 5 mL to 10 mL causes a faster transit of the bolus tail from the oral-pharyngeal transition to the upper esophageal sphincter and an increase in the duration of the upper esophageal sphincter opening, with similar alteration in men and women and in taller and shorter individuals. CONCLUSION: An increase in the swallowed liquid bolus volume from 5 mL to 10 mL causes a faster pharyngeal bolus transit and a longer bolus transit through the upper esophageal sphincter, with similar alterations in men and women and in shorter and taller individuals.

INFLUENCE OF AGE ON SWALLOWS OF A HIGHLY VISCOUS LIQUID BOLUS

BACKGROUND Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. OBJECTIVES Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. METHODS We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women) aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women) aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm3, and viscosity of 895 cp. Results The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. CONCLUSIONS On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old) than in younger subjects (19-55 years old), which suggested an adaptation to the aging process to maintain a safe swallow.