University of Canterbury, New Zealand.
Curr Opin Otolaryngol Head Neck Surg. 2022 Jun 1;30(3):169-176. doi: 10.1097/MOO.0000000000000799.
Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety.
No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients.
Despite references to the 'importance' of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management.
目的综述：浓稠的液体是一种广泛应用的补偿性管理策略，用于治疗吞咽功能障碍的人群。近年来，人们的治疗实践已经从基于淀粉的产品转变为基于胶基的产品。其主要的营销信息是，具有抗淀粉酶特性的胶基增稠剂在促进“更安全的吞咽”方面更具优势。本综述旨在评估具有抗淀粉酶特性的产品对吞咽安全的影响。
最近发现：没有研究直接比较具有抗淀粉酶特性的产品与常规护理或无抗淀粉酶特性的产品的效果。有五篇研究提到了抗淀粉酶特性，并将胶基与淀粉基吞咽障碍产品或稀薄液体进行了比较。吞咽安全性通常通过评分量表进行主观判断。未纳入吞咽生物力学，也未报告有临床意义的结局，如吸入性肺炎的发生率。对灰色文献的范围综述发现，几乎没有证据表明吞咽障碍产品的抗淀粉酶特性引起了临床医生或患者的关注。
总结：尽管提到了吞咽障碍产品的抗淀粉酶特性的“重要性”，但没有证据表明这种特性能提高吞咽安全性。需要使用客观和具有临床意义的结局指标进一步研究，以便临床医生和患者能够为吞咽障碍管理做出明智的决策。
