Omari T, Ross A, Schar M, Campbell J, Thompson A, Besanko L, Lewis D A, Robinson I, Farahani M, Cock C, Mossel B
Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia.
Trisco Foods, Carole Park, Queensland, Australia.
Neurogastroenterol Motil. 2025 Apr;37(4):e15003. doi: 10.1111/nmo.15003. Epub 2025 Jan 21.
Fluid thickeners used in the management of oropharyngeal dysphagia exhibit non-Newtonian shear-thinning rheology, impacting their viscosity during deglutition. This study investigated how the rheological properties of thickened fluids affect pharyngeal swallowing parameters in patients with oropharyngeal motor disorders diagnosed by pharyngeal high-resolution manometry impedance (P-HRM-I).
Seventy-two patients (18-89 years) referred for P-HRM-I were diagnostically assessed with a 10 mL thin bolus. In 57 of the patients, 10 mL swallows of two moderately thick formulations-xanthan gum (XG) and sodium carboxymethylcellulose gum (CMC)-were also tested. The XG and CMC fluids had equivalent empirical thickness but different viscosity at pharyngeal phase shear rates: XG 87 mPa.s (83-91) versus CMC mean 157 mPa.s (148-164) at 300 s. Standard metrics of pharyngeal and upper esophageal sphincter (UES) function were derived from P-HRM-I recordings and analyzed to characterize patients into one of four disorder subtypes: (i) No Disorder, (ii) UES Disorder, (iii) Pharyngeal Disorder, and (iv) Combination UES/Pharyngeal Disorder. Impedance recordings also assessed pharyngeal bolus transit.
Patients with a Combination UES/Pharyngeal Disorder were most likely to have abnormal bolus transit (82%, p < 0.001). Increasing bolus viscosity significantly influenced UES residual pressure, UES opening area, and post-swallow residue. Patients with UES Disorder exhibited pronounced increases in UES residual pressure with CMC compared to XG. Pharyngeal contractility was unaffected by viscosity changes. Post-swallow residue increased with CMC, particularly in patients with a Combination Disorder. Case-by-case analysis revealed individual variability in response to the different viscosities.
The rheological properties of thickened fluids significantly affect swallowing function, with these effects dependent upon the disorder subtype.
用于口咽吞咽困难管理的增稠剂表现出非牛顿剪切变稀流变学特性，这会影响吞咽过程中的粘度。本研究调查了增稠液体的流变特性如何影响经咽部高分辨率测压阻抗（P-HRM-I）诊断为口咽运动障碍患者的咽部吞咽参数。
72名（18 - 89岁）因P-HRM-I前来就诊的患者接受了10毫升稀食团的诊断评估。在其中57名患者中，还测试了10毫升两种中度稠度配方——黄原胶（XG）和羧甲基纤维素钠胶（CMC）的吞咽情况。XG和CMC液体具有相同的经验稠度，但在咽部剪切速率下粘度不同：在300秒时，XG为87毫帕·秒（83 - 91），而CMC平均为157毫帕·秒（148 - 164）。咽部和食管上括约肌（UES）功能的标准指标来自P-HRM-I记录，并进行分析以将患者分为四种障碍亚型之一：（i）无障碍，（ii）UES障碍，（iii）咽部障碍，以及（iv）UES/咽部联合障碍。阻抗记录还评估了咽部食团通过情况。
UES/咽部联合障碍患者最有可能出现食团通过异常（82%，p < 0.001）。食团粘度增加显著影响UES残余压力、UES开口面积和吞咽后残留物。与XG相比，UES障碍患者在吞咽CMC时UES残余压力显著增加。咽部收缩力不受粘度变化影响。吞咽后残留物随CMC增加，尤其是在联合障碍患者中。逐例分析显示对不同粘度的反应存在个体差异。
增稠液体的流变特性显著影响吞咽功能，且这些影响取决于障碍亚型。
