Pureed diets containing a gelling agent to reduce the risk of aspiration in elderly patients with moderate to severe dysphagia: A randomized, crossover trial.

GOALS: The aim of this study was to evaluate the effectiveness of adding a gelling agent to pureed diets to prevent aspiration pneumonia in elderly patients with moderate to severe dysphagia. BACKGROUND: Pureed diets are often used to reduce aspiration in patients with dysphagia. However, the ideal texture of a pureed diet to prevent aspiration pneumonia remains unclear. MATERIALS AND METHODS: We prospectively conducted a randomized, crossover trial of pureed rice with or without a gelling agent in patients with moderate to severe dysphagia (ClincialTrials.gov number, NCT03163355). The primary outcome measure was pharyngeal residuals using an endoscopic scoring system. The secondary outcome was the sense of material remaining in the throat following swallowing. RESULTS: Sixty two patients (58% men), mean age 83 ±â€Š9 years with moderate to severe dysphagia were included. Residuals in the throat were significantly less likely with pureed rice with than without the gelling agent (median cyclic ingestion score (range); 1 (0-4) vs 2 (0-4); P = .001). Irrespective of the presence or absence of the gelling agent, the sense of material remaining in the throat was significantly less frequent in older patients (87 ±â€Š7.6 vs 75 ±â€Š9.1 years, P < .01; 86 ±â€Š7.3 vs 75 ±â€Š8.6 years, P < .01). CONCLUSIONS: Pureed diets containing a gelling agent may reduce the risk of aspiration pneumonia possibly by decreasing pharyngeal residues in elderly patients with moderate to severe dysphagia.

Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.

AIM: To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method. METHODS: Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by "white-out" following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets. RESULTS: One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91). CONCLUSION: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

Transnasal endoscopic evaluation of swallowing: a bedside technique to evaluate ability to swallow pureed diets in elderly patients with dysphagia.

BACKGROUND: Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia. OBJECTIVE: To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia. METHODS: EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration/aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods. RESULTS: During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration/aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods. CONCLUSIONS: Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia.