Taste receptor stimulation in the oral cavity contributes to triggering deglutition and enhancing its performance in amyotrophic lateral sclerosis patients with oropharyngeal dysphagia

Background. Oropharyngeal dysphagia is an early and incapacitating symptom in Amyotrophic Lateral Sclerosis (ALS ). Taste receptors are located all along gastrointestinal tract and their role are not yet completely understood . Those situated in the oral cavity may contribute to trigger and improve deglutition performance but real impact is still unclear. Aim. To investigate whether by modifying taste of the liquid thickener in the daily diet can improve the swallowing function in dysphagic ALS patients and whether tasted thickeners can contribute to increase patients weight. Patients and Methods. Twenty ALS patients requiring liquid thickener for their swallowing impairment were weighted, filled in the validated Swallowing Dysfunction Questionnaire and added to liquid foods a standard neutral thickener during a six week period. Subsequently they indicated the most agreeable taste among 5 differently flavored thickeners and used it in the diet of the following 6 weeks. Finally, patients were weighted and filled in the questionnaire again. Results. Nine patients chose acid, eight sweet and three bitter taste. Subjective and objective (SDQ score) improvement in swallowing was reported by 10 and 13 patients respectively . Selective liquid dysphagia score was rated 2.4+1.0 on usual diet and 1.9+1.0 (p<0.04) after 6 weeks on preferred taste thickener. There was not significant body weight variation during the study period. Conclusions. Flavoring liquid thickener with individualized selected taste can improve subjective and objective swallowing act in ALS patients.