Therapeutic Effect on Swallowing Function and on Hydration Status of a New Liquid Gum-Based Thickener in Independently-Living Older Patients with Oropharyngeal Dysphagia

ThickenUp (R) Gel Express (TUGE) is a new, xanthan- and acacia-gum-based, liquid, thickening product. In independently living older adults with oropharyngeal dysphagia (OD), we assessed: (1) the rheological properties of TUGE; (2) its therapeutic effect at four viscosity levels (achieved by 5 g, 10 g, 20 g and 30 g of TUGE in water + Omnipaque X-ray contrast) versus thin liquid; and (3) the effect on hydration status and gastrointestinal tolerance after fourteen days. Shear viscosity of TUGE was measured in SI units (mPa center dot s at 50 s-1). The Penetration Aspiration Scale (PAS) score and the swallow response at each viscosity level was assessed with videofluoroscopy (VFS), and in the 14-day study we assessed fluid intake, hydration, and tolerance. Thickened fluids with TUGE were unaffected (-0.3%) by alpha-salivary amylase (alpha-SA). The shear viscosity values with VFS were 49.41 +/- 2.38, 154.83 +/- 10.22, 439.33 +/- 11.72 and 672.5 +/- 35.62 mPa center dot s. We studied 60 independently living adults (70 +/- 11.4 years) with mild OD (PAS 4.1 +/- 2.2, 25% aspirations). TUGE caused a shear-viscosity-dependent improvement in PAS at 150-670 mPa center dot s and in safety of swallow, slightly increased oral residue, did not affect pharyngeal residue and reduced time to laryngeal vestibule closure (-27%) at 670 mPa center dot s. Fluid intake with TUGE (1488 mL/day) was well tolerated, and hydration status improved. In conclusion, TUGE was unaffected by alpha-SA and strongly improved safety of swallow in a viscosity-dependent manner without affecting pharyngeal residue. Fourteen-day treatment of thickened fluids with TUGE is safe and well tolerated and improves hydration status in older adults with dysphagia.

Automated summary

ThickenUp (R) Gel Express (TUGE) is a new liquid thickening product based on xanthan and acacia gum, which can improve swallowing difficulties in older adults without negative effects on oral and pharyngeal residues. During a 14-day treatment with TUGE-thickened fluids, older adults experienced increased fluid intake, improved hydration status, and good tolerance.