嚥下障害に対する薬物治療の現状と将来展望

抄録

Recently, swallowing disorders have increasingly become a critical clinical issue. The aims of treatment for dysphagic patients are focused on the recovery of oral alimentation and prevention of aspiration pneumonia. Rehabilitation and surgical interventions have been the basic treatment strategies. In addition, pharmacologic treatment options have been developed over the last two decades. Substance P plays an important role as a neurotransmitter for inducing the swallowing or cough reflex. Angiotensin converting enzyme inhibitors, dopamine agonists, and capsaicin facilitate local accumulation of substance P, therefore, they upregulate the impaired swallowing reflex. Many recent reports have described that these pharmacotherapeutic approaches could reduce the risk of pneumonia. Our clinical study showed that capsaicin administration for a month improved decreased pharyngeal contraction and upper esophageal sphincter function. Also, anti-platelet therapy with cilostazol, traditional Chinese medicine (Hange-Koboku To), and olfactory stimulation with black pepper oil and menthol were reported to prevent pneumonia, especially in the elderly. However, many of these reports lack sufficient evidence, and additional studies are warranted. Botulinum toxin injection into the cricopharyngeal muscle has a direct effect on various types of dysphagia by blocking sustained contraction of the upper esophageal sphincter. It can be an alternative treatment instead of cricopharyngeal myotomy. Influenza or pneumococcal vaccination were reported to be beneficial and recommended for elderly disabled patients at high-risk for pneumonia, but its efficacy is still the subject of discussion. In conclusion, although pharmacologic treatment for dysphagia is a novel research topic, it has a great possibility as an efficient therapeutic option for numerous patients with swallowing disorders. Further studies are necessary.