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Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia

  • Original Article—Alimentary Tract
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Abstract

Background

Oropharyngeal dysphagia (OD) is a major gastrointestinal motility disorder that causes severe nutritional and respiratory complications in elderly and neurological patients. In an earlier study, we found that stimulation of pharyngeal sensory neurons by capsaicinoids acting on transient receptor potential vanilloid 1 (TRPV1) improved the swallow response of dysphagic patients. The aim of this study was to explore the effect of piperine, a dual TRPV1/TRPA1 agonist, on the swallow response of dysphagic patients.

Methods

A videofluoroscopic study was performed to assess the signs of impaired safety and efficacy of swallow and the swallow response of 40 dysphagic patients while swallowing one series of nectar control boluses and two series of nectar boluses supplemented with piperine. Patients were randomized into two groups: one group received 150 μM piperine and the other group received 1 mM.

Results

Piperine improved the safety of swallow by: (a) reducing the prevalence of unsafe swallows by −34.48 % (P = 0.004) at 150 μM and −57.19 % (P < 0.001) at 1 mM, and the severity score of the penetration-aspiration scale from 3.25 ± 0.51 to 1.85 ± 0.27 (P = 0.003, 1 mM); and (b) shortening the time to laryngeal vestibule closure from 0.366 ± 0.024 to 0.270 ± 0.022 s with 150 μM piperine (P < 0.001) and from 0.380 ± 0.032 to 0.306 ± 0.028 s with 1 mM piperine (P < 0.05).

Conclusions

Supplementing the alimentary bolus with piperine speeds swallow response and strongly improves safety of swallow in patients with OD, with a maximal therapeutic effect at 1 mM. Our results suggest that activation of TRPV1/A1 in oropharyngeal sensory neurons is a very promising neurostimulation strategy for dysphagic patients.

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Acknowledgments

We would like to thank our patients for their cooperation, as well as all the members of the dysphagia team of Hospital de Mataró who participated in this study. Thanks also to Jane Lewis for reviewing the English.

This work was supported by grants from the Spanish Ministerio de Ciencia e Innovación (PS09/01012, INT 10/228), the Agencia de Gestió d’Ajuts Universitaris i de Recerca (2009 SGR 708) and Fundació Agrupació Mútua.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain

    Laia Rofes & Pere Clavé

  2. Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain

    Viridiana Arreola, Alberto Martin & Pere Clavé

Authors
  1. Laia Rofes
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  2. Viridiana Arreola
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  3. Alberto Martin
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  4. Pere Clavé
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Correspondence to Pere Clavé.

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Rofes, L., Arreola, V., Martin, A. et al. Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia. J Gastroenterol 49, 1517–1523 (2014). https://doi.org/10.1007/s00535-013-0920-0

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  • DOI: https://doi.org/10.1007/s00535-013-0920-0

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