Development and validation of a predictive model for patients with post-extubation dysphagia

BACKGROUND:Swallowing disorder is a common clinical symptom that can lead to a series of complications,including aspiration,aspiration pneumonia,and malnutrition.This study aimed to investigate risk factors of post-extubation dysphagia(PED)in intensive care unit(ICU)patients with endotracheal intubation,and to develop a risk-predictive model for PED,which could serve as an assessment tool for the prevention and control of PED.METHODS:Patients retrospectively selected from June to December 2021 in a tertiary hospital served as the derivation cohort.Patients recruited from the same hospital from March to June 2022served as the external validation cohort for the predictive model.We used a combination of variable screening and least absolute shrinkage and selection operator(LASSO)regression to select the most useful candidate predictors and checked the multicollinearity of independent variables using the variance inflation factor method.Multivariate logistic regression analysis was performed to calculate the odds ratio(OR;95%confidence interval[95%CI])and P-value for each variable to predict diagnosis.The screened risk factors were introduced into R software to build a nomogram model.The performance of the model,including discrimination ability,calibration,and clinical benefit,was evaluated by plotting the receiver operating characteristic(ROC),calibration,and decision curves.RESULTS:A total of 305 patients were included in this study.Among them,235 patients(53PED vs.182 non-PED)were enrolled in the derivation cohort,while 70 patients(17 PED vs.53 nonPED)were enrolled in the validation cohort.The independent predictors included age,pause of sedatives,level of consciousness,activities of daily living(ADL)score,nasogastric tube,sore throat,and voice disorder.These predictors were used to establish the predictive nomogram model.The model demonstrated good discriminative ability,and the area under the ROC curve(AUC)was 0.945(95%CI 0.904-0.970).Applying the predictive model to the validation cohort demonstrated good discrimination with an AUC of 0.907(95%CI 0.831-0.983)and good calibration.The decision-curve analysis of this nomogram showed a net benefit of the model.CONCLUSION:A predictive model that incorporates age,pause of sedatives,level of consciousness,ADL score,nasogastric tube,sore throat,and voice disorder may have the potential to predict PED in ICU patients.

Presbyphagia:Dysphagia in the elderly

Dysphagia has been classified as a“geriatric syndrome”and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide.A characteristic age-related change in swa-llowing is defined as“presbyphagia.”Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing.However,there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging.Our review provides an overview of presbyphagia,which has been a neglected health problem for a long time.Attention and awareness of dysphagia in the elderly population should be strengthened,and targeted intervention measures should be actively imple-mented.

Research Progress of Swallowing Therapy in Relieving Dysphagia after Stroke

This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon catheter dilatation,etc.,all of which have many clinical applications,hoping to play a guiding role in future research.

Dysphagia and daily oral fluids among cerebrovascular stroke patients:an theory-based nursing intervention protocol

Objective:To evaluate the improvement of dysphagia and the daily amounts of oral fluids served among people who had recently experienced a cerebrovascular stroke(CVS)after applying a nursing intervention protocol.Methods:A quasi-experimental design was used to examine 60 stroke patients who were randomly and alternatively divided equally into a study group and a control group.Gugging Swallowing Screen(GUSS)and fluid balance chart were used.Within the first 24 h of a patient’s admission,expert nurses were trained in nursing intervention protocol to manage dysphagia and daily oral fluids.Results:Post-nursing intervention,the severity of dysphagia decreased among the study group more than in the control group.Additionally,the study group began taking greater amounts of fluids by the oral route than before the nursing intervention.Conclusions:A standardized nursing intervention protocol is needed to decrease the severity of dysphagia after CVS and increase the amount of daily oral fluids.The presence of a structured theory-based nursing intervention protocol for dysphagia management will greatly contribute to decreasing the consequences of dysphagia after CVS,and can also be expected to attenuate the effects of aspiration pneumonia,dehydration,and malnutrition;further,it also increases adherence to the protocol by both nurses and patients.

Sideropenic Dysphagia综合征膜性蹼26例分析

目的 :研究SideropenicDysphagla (S -D)综合征膜性蹼产生的机制。方法 :回顾分析S -D综合征2 6例的临床资料。结果 :影像学检查显示膜性蹼在颈段食道前壁呈 2mm深的模样陷凹。血液学检查为缺铁性低血红蛋白性贫血改变。结论 :缺铁性贫血是S -D综合征的原因 。

Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke

Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group（n = 22）, a midbrain and pons infarction group（n = 16）, and a multiple cerebral infarction group（n = 26） according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan（PC6）, Renzhong（DU26）, Sanyinjiao（SP6）, Fengchi（GB20）, Wangu（GB12）, and Yifeng（SJ17）. Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction（95.9%）. These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient＇s swallowing ability and quality of life.

Dysphagia in patients with isolated pontine infarction

Little is known about dysphagia after pontine infarction. In this study, we evaluated the incidence of dysphagia after isolated pontine infarction and identified the predictive factors for the occurrence of dysphagia. A total of 146 patients were included in this study. All patients underwent clinical testing for dysphagia within 1 day after admission and at the time of discharge. We compared the incidence of dysphagia between patients with unilateral pontine infarction and those with bilateral pontine infarction. To evaluate the functional status of patients, we investigated their initial modified Rankin Scale（mRS） score and initial National Institutes of Health Stroke Scale（NIHSS） score within 1 day of admission. Of 146 patients, 50（34.2%） had dysphagia initially within 1 day after admission. At the second evaluation at the time of discharge, dysphagia was diagnosed in 24 patients（16.4%）. Patients with bilateral pontine infarction were more likely to present with dysphagia. In addition, clinical severity（in terms of mRS and NIHSS scores） was identified as a predictor of dysphagia in patients with cerebral infarction（multiple binary logistic regression analysis, mRS： P = 0.011, NIHSS： P = 0.004）. Dysphagia frequently occurs in patients with isolated pontine infarction. Clinicians should pay particular attention to the occurrence of dysphagia, especially in patients with bilateral pontine infarction or high functional disability.

Treatment of Post-stroke Dysphagia by VitalStim Therapy Coupled with Conventional Swallowing Training

To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia,a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups：conventional swallowing therapy group,VitalStim therapy group,and VitalStim therapy plus conventional swallowing therapy group.Prior to and after the treatment,signals of surface electromyography（sEMG） of swallowing muscles were detected,swallowing function was evaluated by using the Standardized Swallowing Assessment（SSA） and Videofluoroscopic Swallowing Study（VFSS） tests,and swallowing-related quality of life（SWAL-QOL） was evaluated using the SWAL-QOL questionnaire.There were significant differences in sEMG value,SSA,VFSS,and SWAL-QOL scores in each group between prior to and after treatment.After 4-week treatment,sEMG value,SSA,VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group,but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group.It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

Compensatory recombination phenomena of neurological functions in central dysphagia patients

We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-depen- dent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex （BA4）, insula （BA13）, premotor cortex （BA6/8）, supramarginal gyrus （BA40）, and anterior cingulate cortex （BA24/32） were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In re- current cerebral infarction patients with central dysphagia, BA4, BA13, BA40 aild BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex （BA23/31）, visual association cortex （BA18/19）, primary auditory cortex （BA41） and parahippocampal cortex （BA36）. Somatosen- sory association cortex （BA7） and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimu- late swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

A case of hemangiopericytoma of the soft palate with articulate disorder and dysphagia

We report a case of hemangiopericytoma of the soft palate of 60-year-old patient, who noticed a mass of the soft palate and experienced difficulty in speaking. We found a pediculate, hard, elastic mass measuring 38 mm （cross-sectional diameter）. Computed tomography （CT） scans and dynamic magnetic resonance imaging （MRI） confirmed irregularly shaped mass and revealed a heterogeneous internal composition, consistent with vascular tumors. We excised the tumor under general anesthesia. Histopathological diagnosis was based on positive immunoreactivity of CD99 and vimentin and weak, positive staining of CD34. Three and half years following tumor excision, there is no recurrence or metastasis.

Rheological aspects of dysphagia-oriented food products:A mini review

Dysphagia is a symptom,commonly found in healthcare residents and the elderly,may lead to undernutrition and negative effects on quality of life.Providing special food products that cannot only be swallowed by patients but also meet nutritional requirements is a challenge for food rheologists and healthcare staff.The purpose of this paper was to review the literature on rheological aspects of dysphagia-oriented products.Also,some suggestions were proposed for better exploitation of rheological data in the field of dysphagia-rheology.©2013 Beijing Academy of Food Sciences.Production and hosting by Elsevier B.V.All rights reserved.

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation:a case-control study

Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.

Surface electromyography for diagnosing dysphagia in patients with cerebral palsy

AIM: To determine the accuracy of 2-channel surface electromyography(sE MG) for diagnosing oropharyngeal dysphagia(OPD) in patients with cerebral palsy.METHODS: Participants with cerebral palsy and OPD between 5 and 30 years of age and age- and sexmatched healthy individuals received s EMG testing during swallowing. Electrodes were placed over the submental and infrahyoid muscles, and s EMG recordings were made during stepwise(starting at 3 mL) determination of maximum swallowing volume. Outcome measures included submental muscle group maximum amplitude, infrahyoid muscle group maximum amplitude(IMGMA), time lag between the peak amplitudes of 2 muscle groups, and amplitude difference between the 2 muscle groups.RESULTS: A total of 20 participants with cerebral palsy and OPD(OPD group) and 60 age- and sex-matched healthy volunteers(control group) were recruited. Among 20 patients with OPD, 19 had Dysphagia Outcome and Severity Scale records. Of them, 8 were classified as severe dysphagia(level 1), 1 was moderate dysphagia(level 3), 4 were mild to moderate dysphagia(level 4), 3 were mild dysphagia(level 5), and 3 were within functional limits(level 6). Although the groups were matched for age and sex, participants in the OPD group were significantly shorter, weighed less and had lower body mass index than their counterparts in the control group(both, P < 0.001). All s EMG parameter values were significantly higher in the OPD group compared with the control group(P < 0.05). Differences were most pronounced at the 3 mL swallowing volume. IMGMA at the 3 mL volume was the best predictor of OPD with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 85.0%, 90.0%, 73.9%, 94.7% and 88.8%, respectively.

Rare case of dysphagia, skin blistering, missing nails in a young boy

Epidermolysis bullosa is a group of genetic disorders with an autosomal dominant or an autosomal recessive mode of inheritance and more than 300 mutations. The disorder is characterized by blistering mucocutaneous lesions and has several varying phenotypes due toanchoring defect between the epidermis and dermis. The variation in phenotypic expression depends on the involved structural protein that mediates cell adherence between different layers of the skin. Epidermolysis bullosa can also involve extra-cutaneous sites including eye, nose, ear, upper airway, genitourinary tract and gastrointestinal tract. The most prominent feature of the gastrointestinal tract involvement is development of esophageal stricture. The stricture results from recurrent esophageal mucosal blistering with consequent scarring and most commonly involves the upper esophagus. Here we present a case of a young boy with dominant subtype of dystrophic epidermolysis bullosa who presented with dysphagia, extensive skin blistering and missing nails. Management of an esophageal stricture eventually requires dilatation of the stricture or placement of a gastrostomy tube to keep up with the nutritional requirements. Gastrostomy tube also provides access for esophageal stricture dilatation in cases where antegrade approach through the mouth has failed.

Difficult Intubation in a Patient with Dysphagia after Posterior Occipitocervical Fusion: A Case Report

The authors encountered a case involving difficult intubation during anesthesia for revision of cervical fixation angle in a 62-year-old woman, with a history of chronic rheumatoid arthritis, who experienced dysphagia after initial posterior occipitocervical fusion to correct atlantoaxial subluxation. Two days after initial surgery, she developed trismus with neck flexion and dysphagia, and underwent revision surgery. General anesthesia was planned;however, tracheal intubation using the McGrath laryngoscope and bronchofiberscope was difficult, which prolonged anesthesia induction. Narrowing of the oral and pharyngeal cavities associated with overcorrection of the cervical spine was believed to be the reason for difficulty in manipulating the tracheal intubation devices. In posterior occipitocervical fusion, intraoperative evaluation of the occipito-second cervical vertebra (O-C2) angle is reported to be useful in preventing postoperative dyspnea and/or dysphagia, and avoids the need for revision of fixation angle. However, when revision surgery is needed, selection of airway management methods and tracheal intubation devices are important considerations because patients are likely to have restricted mobility in the cervical spine and narrowing of the oral and pharyngeal cavities.

Relationship between Dysphagia and Serum Substance P Level in Chronic Central Nervous Disease

Purpose: We compared serum substance P (SP) levels in underlying diseases and dysphagia, or its absence, in patients with cerebrovascular disease, neurodegenerative disease or Alzheimer’s disease, to investigate the relationship between dysphagia and serum SP in chronic central nervous disease. Methods: Subjects comprised 94 patients admitted to a hospital or nursing home during the 5 years between April 2007 and April 2012 with central nervous symptoms. Serum SP levels were measured by enzyme immunoassay, and video endoscopy using a nasal endoscope in all subjects to objectively evaluate swallowing function. Results: Serum SP level was very similar in central nervous disease without dysphagia and controls without central nervous disease. Conversely, serum SP level was significantly lower in central nervous disease with dysphagia. When comparing underlying diseases, serum SP was significantly lower in Parkinson’s disease than in other disease groups (cerebrovascular disease, Alzheimer’s disease). Looking at changes in serum SP levels over time after disease onset, SP level was significantly low in subjects without dysphagia at the time of onset who went on to develop dysphagia during the disease course, whereas serum SP level tended to be higher in subjects with dysphagia at the time of onset and improvement during the disease course. With Parkinson’s disease and cerebrovascular disease, serum SP was low, particularly in subjects thought to have severe damage to the basal ganglia. Conclusion: Serum SP is generally thought to decrease in patients with cerebrovascular disease accompanied by dysphagia, but these results suggest that serum SP levels can be expected to improve to some extent, even if dysphagia is present at disease onset, assuming, for example, that some basal ganglia function remains. Positive therapeutic interventions such as swallowing rehabilitation should be promoted in such patients, with the goal of improving swallowing function.

Esophageal dysphagia and reflux symptoms before and after oral IQoro^(R) training

AIM: To examine whether muscle training with an oral IQoroR screen(IQS) improves esophageal dysphagia and reflux symptoms.METHODS: A total of 43 adult patients(21 women a n d 2 2 m e n) w e re c o n s e c u t i ve l y re fe r re d t o a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study(group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients(group B; median age 57 years,range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire(esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale(ability to swallow food: score 0-100), lip force test(≥ 15 N), velopharyngeal closure test(≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients(median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score(range): 2.5(1-3) vs 0.9(0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7(0-3) vs 0.5(0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71(30-100) vs 22(0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N(12-80 N) vs 54 N(27-116), P < 0.001] and velopharyngeal closure test values [28 s(5-74 s) vs 34 s(13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mm Hg at rest(range: 0-0 mm HG) to 65 mm Hg(range: 20-100 mm Hg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

Effect of Feeding Management on Aspiration Pneumonia in Elderly Patients with Dysphagia

Objective： To investigate the effects of feeding safety instructions and dietary intervention on aspiration pneumonia in elderly patients with dysphagia. Methods： The study included 40 long-term hospitalized elderly patients with dysphagia who needed oral intake, According to the voluntary and matching principle, participants were divided into the intervention group （n =20） and control group （n = 20）. We formed a multi-disciplinary team including clinical nurses, rehabilitation therapists and nutritionists. Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management. The patients in the control group were fed with semi-solid food, thick liquid, a partial mushy diet and so on according to their swallowing situations and tastes or preferences. The patients in the intervention group were fed with an all mushy diet. Patients in both groups were able to eat foods on their own or with assistance. Results： After a three-month intervention, the incidence of aspiration pneumonia in both groups was decreased, and the difference was statistically significant （P〈0.05）. In the control group, seven patients had aspiration pneumonia, including two cases who died after nasogastric feeding due to aggravated dysphagia. In the control group, seven patients had aspiration pneumonia, including two cases was given nasogastric feeding due to aggravated dysphagia and then one case died. In the intervention group, four patients had aspiration pneumonia. There was no dropouts in either group. Conclusions： Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management. Nurses should conduct safety guidance for care catering and encouraging patients to actively eat a mushy diet. The diet can reduce the incidence of aspiration pneumonia, maintain oral intake and improve the quality of life.

Analysis of Adaptation Process of Evidence-Based Interventions by Taking Post-Stroke Dysphagia Screening As an Example--Based on a Series of Empirical Studies

Background:Evidence-based interventions(EBIs)are frequently adapted or modified during the implementation process to meet the needs of the target context,public health professionals,or health practitioners.However,little is known about how the EBIs of the same clinical problem at a different time(sustainability)and a different setting(scalability)should be adapted to facilitate implementation.To address this gap,this research aims to analyze the adaptations process of EBIs by taking post-stroke dysphagia screening as an example based on a series of empirical studies.Methods:We reviewed three best practice implementation projects of post-stroke dysphagia identification and management in China's Mainland,and conducted a comparative analysis of three projects of dysphagia screening practical decision-making according to core elements of evidence-based nursing(EBN).Results:We identified the core elements of EBN that influence decision-making in each best practice implementation project.The decision-making of screening time and tool for dysphagia in the three projects varied.Project 1:Post-stroke dysphagia was screened using Water Swallow Test(WST)before the first intake of liquid or food.Project 2:A sustainability study based on project 1,post-stroke dysphagia was screened using Standardized Swallowing Assessment(SSA)before the first intake of liquid or food,within 24 hours of admission.Project 3:A community scalability study based on project 2,post-stroke dysphagia was screened using Water Swallow Test(WST)before the first intake of liquid or food,within 24 hours after referral.Conclusions:Adaption of EBIs needs to fully consider the best available external evidence from systematic research,clinical expertise,patient preferences,as well as context.

Effects of High Pressure on the Textural and Sensory Properties of Minced Fish Meat Gels for the Dysphagia Diet

A new product of minced fish meat with high pressurization was produced for individuals with difficulties in mastication and swallowing and for elderly people on a dysphagia diet. Minced fish meat was added to distilled water at ratios of 1:0.5, 1:1 and 1:1.5 by mixing with 1.5% NaCl. Half of the samples were modified by heating (H-gels) and half by high pressure at 400 MPa for 20 min (P-gels). The hardness of the H- and P-gels was 0.97 to 2.83 [×104 N/m2] and 2.25 to 10.03 [×104 N/m2], respectively. For SDS-PAGE analysis, low-molecular-weight proteins in the P-gel were released more easily than those in the H-gel by the difference in gel formation, which is related to the detection of α-actinin in the supernatant of pressurized actomyosin. The ultrastructural observations showed a regular filamentous network structure in the P-gel. For the sensory evaluation, the P-gels were determined to be more lustrous, juicier, more moderately elastic and smoother. These gels conformed to the criteria of Dietary Uses for Dyspahgic Patients and Japanese Dysphagia Diet 2013. High pressure treatment denatured the protein composition of the minced fish meat gel, which led to a clearer three-dimensional network structure. High pressure made it possible to form minced fish meat gels with a low salt concentration. Obtained minced fish meat gels were improved in textural properties by addition of water and under high pressure, which were different from the ones by traditional heating. Improvement in textural properties will raise the sensory evaluation for elderly and dysphagic people. It is expected that the pressurized gels will be practical for a dysphagia diet.