Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain,
J Gastroenterol. 2014 Dec;49(12):1517-23. doi: 10.1007/s00535-013-0920-0. Epub 2013 Dec 11.
Oropharyngeal dysphagia (OD) is a major gastrointestinal motility disorder that causes severe nutritional and respiratory complications in elderly and neurological patients. In an earlier study, we found that stimulation of pharyngeal sensory neurons by capsaicinoids acting on transient receptor potential vanilloid 1 (TRPV1) improved the swallow response of dysphagic patients. The aim of this study was to explore the effect of piperine, a dual TRPV1/TRPA1 agonist, on the swallow response of dysphagic patients.
A videofluoroscopic study was performed to assess the signs of impaired safety and efficacy of swallow and the swallow response of 40 dysphagic patients while swallowing one series of nectar control boluses and two series of nectar boluses supplemented with piperine. Patients were randomized into two groups: one group received 150 μM piperine and the other group received 1 mM.
Piperine improved the safety of swallow by: (a) reducing the prevalence of unsafe swallows by -34.48% (P = 0.004) at 150 μM and -57.19% (P < 0.001) at 1 mM, and the severity score of the penetration-aspiration scale from 3.25 ± 0.51 to 1.85 ± 0.27 (P = 0.003, 1 mM); and (b) shortening the time to laryngeal vestibule closure from 0.366 ± 0.024 to 0.270 ± 0.022 s with 150 μM piperine (P < 0.001) and from 0.380 ± 0.032 to 0.306 ± 0.028 s with 1 mM piperine (P < 0.05).
Supplementing the alimentary bolus with piperine speeds swallow response and strongly improves safety of swallow in patients with OD, with a maximal therapeutic effect at 1 mM. Our results suggest that activation of TRPV1/A1 in oropharyngeal sensory neurons is a very promising neurostimulation strategy for dysphagic patients.
口咽吞咽困难（OD）是一种主要的胃肠动力障碍，会导致老年和神经科患者出现严重的营养和呼吸并发症。在之前的一项研究中，我们发现辣椒素作用于瞬时受体电位香草素 1（TRPV1）刺激咽感觉神经元可改善吞咽困难患者的吞咽反应。本研究旨在探讨胡椒碱（双重 TRPV1/TRPA1 激动剂）对吞咽困难患者吞咽反应的影响。
进行视频荧光透视研究，以评估 40 例吞咽困难患者吞咽一系列花蜜对照液和两种花蜜液补充胡椒碱时吞咽安全性和有效性受损的迹象和吞咽反应。患者随机分为两组：一组接受 150μM 胡椒碱，另一组接受 1mM。
胡椒碱通过以下方式改善吞咽安全性：（a）在 150μM 时，不安全吞咽的发生率降低了 34.48%（P=0.004），在 1mM 时降低了 57.19%（P<0.001），穿透-吸入量表的严重程度评分从 3.25±0.51 降至 1.85±0.27（P=0.003，1mM）；（b）用 150μM 胡椒碱时，喉前庭闭合时间从 0.366±0.024 缩短至 0.270±0.022s（P<0.001），用 1mM 胡椒碱时，从 0.380±0.032 缩短至 0.306±0.028s（P<0.05）。
在食团中补充胡椒碱可加速吞咽反应，并强烈改善 OD 患者的吞咽安全性，在 1mM 时达到最大治疗效果。我们的结果表明，激活口咽感觉神经元中的 TRPV1/A1 是一种很有前途的吞咽困难患者的神经刺激策略。
