Background/Aims: The standard of care for older patients with oropharyngeal dysphagia (OD) is poor. Stimulation of transient receptor potential vanilloid 1 might become a pharmacological strategy for these patients. This study aimed to compare the therapeutic effect of film food containing 0.75 µg of capsaicin in these patients. Methods: In a crossover, randomized trial, 49 patients with OD were provided capsaicin or identical placebo at least 7 days apart. Patients' reported symptoms during repeated swallowing, the volume, pH and substance P (SP) concentrations in saliva, and cervical esophageal wall motion evaluated by ultrasonographic tissue Doppler imaging were obtained before and after capsaicin or placebo administration. Results: Significantly more patients with OD who took capsaicin experienced improvement in symptoms than those who took placebo. Salivary SP levels were significantly increased after capsaicin administration compared with placebo in the effective group. The duration of cervical esophageal wall opening was significantly shorter in capsaicin administration in the effective group. Furthermore, a significant negative correlation was found between the duration of cervical esophageal wall opening and salivary SP levels. Conclusion: Elevated salivary SP concentrations stimulated by capsaicin greatly improve the safety and efficacy of swallowing, and shorten the swallow response in older patients with OD.

1.
Serra-Prat M, Hinojosa G, López D, Juan M, Fabré E, Voss DS, Calvo M, Marta V, Ribó L, Palomera E, Arreola V, Clavé P: Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 2011;59:186-187.
[PubMed]
2.
Almirall J, Rofes L, Serra-Prat M, Icart R, Palomera E, Arreola V, Clavé P: Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J 2013;41:923-928.
[PubMed]
3.
van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C: Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res 2011;90:1398-1404.
[PubMed]
4.
Baine WB, Yu W, Summe JP: Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998. Am J Public Health 2001;91:1121-1123.
[PubMed]
5.
Kohno S, Imamura Y, Shindo Y, Seki M, Ishida T, Teramoto S, Kadota J, Tomono K, Watanabe A: Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation]. Respir Investig 2013;51:103-126.
[PubMed]
6.
Sarkar IN: Biodiversity informatics: the emergence of a field. BMC Bioinformatics 2009;10(suppl 14):S1.
[PubMed]
7.
Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P: Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 2002;17:139-146.
[PubMed]
8.
Furuta M, Yamashita Y: Oral health and swallowing problems. Curr Phys Med Rehabil Rep 2013;1:216-222.
[PubMed]
9.
Faverio P, Aliberti S, Bellelli G, Suigo G, Lonni S, Pesci A, Restrepo MI: The management of community-acquired pneumonia in the elderly. Eur J Intern Med 2014;25:312-319.
[PubMed]
10.
Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwijnenberg IR: Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia 2014;29:183-198.
[PubMed]
11.
Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P: Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010;39:39-45.
[PubMed]
12.
Clavé P, Shaker R: Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 2015;12:259-270.
[PubMed]
13.
Butler SG, Stuart A, Leng X, Rees C, Williamson J, Kritchevsky SB: Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope 2010;120:2147-2152.
[PubMed]
14.
Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rösler A, Shaker R, Warnecke T, Sieber CC, Volkert D: Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 2016;11:189-208.
[PubMed]
15.
Aviv JE, Martin JH, Jones ME, Wee TA, Diamond B, Keen MS, Blitzer A: Age-related changes in pharyngeal and supraglottic sensation. Ann Otol Rhinol Laryngol 1994;103:749-752.
[PubMed]
16.
Aviv JE: Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med 1997;103:74S-76S.
[PubMed]
17.
Mortelliti AJ, Malmgren LT, Gacek RR: Ultrastructural changes with age in the human superior laryngeal nerve. Arch Otolaryngol Head Neck Surg 1990;116:1062-1069.
[PubMed]
18.
Robbins J, Hamilton JW, Lof GL, Kempster GB: Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 1992;103:823-829.
[PubMed]
19.
Shaw DW, Cook IJ, Gabb M, Holloway RH, Simula ME, Panagopoulos V, Dent J: Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing. Am J Physiol 1995;268(3 pt 1):G389-G396.
[PubMed]
20.
Bessac BF, Jordt SE: Breathtaking TRP channels: TRPA1 and TRPV1 in airway chemosensation and reflex control. Physiology (Bethesda) 2008;23:360-370.
[PubMed]
21.
Alvarez-Berdugo D, Rofes L, Farré R, Casamitjana JF, Enrique A, Chamizo J, Padrón A, Navarro X, Clavé P: Localization and expression of TRPV1 and TRPA1 in the human oropharynx and larynx. Neurogastroenterol Motil 2016;28:91-100.
[PubMed]
22.
Ebihara T, Sekizawa K, Nakazawa H, Sasaki H: Capsaicin and swallowing reflex. Lancet 1993;341:432.
[PubMed]
23.
Ebihara T, Takahashi H, Ebihara S, Okazaki T, Sasaki T, Watando A, Nemoto M, Sasaki H: Capsaicin troche for swallowing dysfunction in older people. J Am Geriatr Soc 2005;53:824-828.
[PubMed]
24.
Rofes L, Arreola V, Martin A, Clavé P: Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia. Gut 2013;62:1280-1287.
[PubMed]
25.
Kondo E, Jinnouchi O, Ohnishi H, Kawata I, Nakano S, Goda M, Kitamura Y, Abe K, Hoshikawa H, Okamoto H, Takeda N: Effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia. Clin Interv Aging 2014;9:1661-1667.
[PubMed]
26.
Tsutsui H, Manabe N, Uno M, Imamura H, Kamada T, Kusunoki H, Shiotani A, Hata J, Harada T, Haruma K: Esophageal motor dysfunction plays a key role in GERD with globus sensation - analysis of factors promoting resistance to PPI therapy. Scand J Gastroenterol 2012;47:893-899.
[PubMed]
27.
Manabe N, Haruma K, Hata J, Imamura H, Kamada T, Kusunoki H, Sanuki E, Tsumaru S, Futagami Y, Sadamoto Y, Tokutomi T, Kurose H: Clinical characteristics of Japanese dyspeptic patients: is the Rome III classification applicable? Scand J Gastroenterol 2010;45:567-572.
[PubMed]
28.
Yasuda T, Nakamori Y, Shiraishi O, Yasuda A, Peng Y, Shinakai M, Imano M, Imamoto H, Shiozaki H: Decreased preoperative plasma substance P concentration is likely associated with postoperative silent aspiration after esophagectomy. Esophagus 2014;11:99-107.
29.
Manabe N, Hata J, Haruma K: Newly developed ultrasonographic screening method for oropharyngeal dysphagia: tissue Doppler imaging. Gastroenterology 2015;148(suppl 1):S168.
30.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ: Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008;117:919-924.
[PubMed]
31.
Wakabayashi H, Kayashita J: Translation, reliability, and validity of the Japanese version of the 10-item Eating Assessment Tool(EAT-10) for the screening of dysphagia. Japanese Society for Parenteral and Enteral Nutrition 2014;29:871-876.
32.
Fukuhara S, Suzukamo Y: Manual of the SF-8 Japanese Version. Kyoto, Institute for Health Outcomes and Process Evaluation Research, 2004.
33.
Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, Kuribayashi S, Higuchi T, Zai H, Ino K, Horikoshi T, Sugiyama T, Toki M, Ohwada T, Mori M: Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004;39:888-891.
[PubMed]
34.
Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L: The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996;111:85-92.
[PubMed]
35.
Hill LD, Kozarek RA, Kraemer SJ, Aye RW, Mercer CD, Low DE, Pope CE 2nd: The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996;44:541-547.
[PubMed]
36.
Babbar S, Marier JF, Mouksassi MS, Beliveau M, Vanhove GF, Chanda S, Bley K: Pharmacokinetic analysis of capsaicin after topical administration of a high-concentration capsaicin patch to patients with peripheral neuropathic pain. Ther Drug Monit 2009;31:502-510.
[PubMed]
37.
Yoshikawa H, Furuta K, Ueno M, Egawa M, Yoshino A, Kondo S, Nariai Y, Ishibashi H, Kinoshita Y, Sekine J: Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function. J Gastroenterol 2012;47:412-420.
[PubMed]
38.
Peng CL, Jost-Brinkmann PG, Miethke RR, Lin CT: Ultrasonographic measurement of tongue movement during swallowing. J Ultrasound Med 2000;19:15-20.
[PubMed]
39.
Cordaro MA, Sonies BC: An image processing scheme to quantitatively extract and validate hyoid bone motion based on real-time ultrasound recordings of swallowing. IEEE Trans Biomed Eng 1993;40:841-844.
[PubMed]
40.
Chi-Fishman G: Quantitative lingual, pharyngeal and laryngeal ultrasonography in swallowing research: a technical review. Clin Linguist Phon 2005;19:589-604.
[PubMed]
41.
Onishi T, Uematsu M, Nanto S, Iida O, Morozumi T, Kotani J, Awata M, Nagata S: Positive isovolumic relaxation velocity detected by a spectral tissue Doppler mapping technique as an indicator of coronary artery disease: a prospective study. J Am Soc Echocardiogr 2007;20:158-164.
[PubMed]
42.
Yu CM, Fung JW, Zhang Q, Chan CK, Chan YS, Lin H, Kum LC, Kong SL, Zhang Y, Sanderson JE: Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation 2004;110:66-73.
[PubMed]
43.
Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P: Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil 2010;22:851-858.e230.
[PubMed]
44.
Martin-Harris B, Jones B: The videofluorographic swallowing study. Phys Med Rehabil Clin N Am 2008;19:769-785, viii.
[PubMed]
45.
Akbar A, Yiangou Y, Facer P, Walters JR, Anand P, Ghosh S: Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut 2008;57:923-929.
[PubMed]
46.
Wouters MM, Balemans D, Van Wanrooy S, Dooley J, Cibert-Goton V, Alpizar YA, Valdez-Morales EE, Nasser Y, Van Veldhoven PP, Vanbrabant W, Van der Merwe S, Mols R, Ghesquière B, Cirillo C, Kortekaas I, Carmeliet P, Peetermans WE, Vermeire S, Rutgeerts P, Augustijns P, Hellings PW, Belmans A, Vanner S, Bulmer DC, Talavera K, Vanden Berghe P, Liston A, Boeckxstaens GE: Histamine receptor H1-mediated sensitization of TRPV1 mediates visceral hypersensitivity and symptoms in patients with irritable bowel syndrome. Gastroenterology 2016;150:875-887.e9.
[PubMed]
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