Examination of Differences Between Dysphagia and Pill Dysphagia: VF Examination Using Barium Capsules

Abstract

　Even among patients without issues swallowing food, some have trouble swallowing pills (such as tablets, capsules, or powders). We therefore used barium capsules in videofluoroscopic (VF) examinations to compare the swallowing patterns of food versus capsules and investigate the differences.

　This study targeted patients undergoing VF examinations admitted to the recovery rehabilitation ward who were taking capsules and showed no laryngeal penetration when swallowing water or thickened liquids. The barium capsule was prepared by filling a size four capsule with 250 mg of barium sulfate powder and was taken with 20 mL of water or thickened water. Dysphagia was defined as a Functional Impairment Level of Swallowing (FILS) of 9 or below. Pill dysphagia was assessed based on swallowing status and transit time to the esophageal entrance. Sub-analyses examined associations with age, gender, cognitive function, jaw position (cervical-lower edge of the mandibular angle), number of medications, and anticholinergic drugs.

　Thirty-eight patients were included, with a mean age of 85.5 years [75.8, 87.3]; 18 patients experienced choking, eight had an upward positioned jaw, and 23 had cognitive impairment. Twenty-eight patients had dysphagia. Fourteen patients had pill dysphagia, requiring over 11 seconds for a capsule to pass, and among these, two patients were unable to swallow capsules. Among the 28 patients with dysphagia, 16 had no pill dysphagia, conversely, among the 10 patients without dysphagia, 2 had pill dysphagia (p＝0.269). Pill dysphagia was associated with cognitive impairment (p＝0.020) and jaw position during capsule intake (p＝0.034). Conversely, dysphagia was strongly associated with choking (p＜0.001) and age (p＝ 0.048).

　This suggests that the presence and factors of dysphagia and pill dysphagia may differ. All healthcare and care professionals should recognize the existence of pill dysphagia as distinct from dysphagia. Furthermore, we consider that pharmacists have a significant responsibility for the assessment and management of patients with pill dysphagia.