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<p>Difficulty swallowing solid oral dosage forms such as pills and capsules is common among adults and is particularly prevalent in patients with oropharyngeal dysphagia. The study aim was to investigate the prevalence, characteristics, and predictors of pill dysphagia using fiberoptic endoscopic evaluation of swallowing (FEES). A retrospective review of 107 adults attending a dysphagia clinic who underwent FEES including a standardized capsule challenge (swallowing two empty gelatin capsules under endoscopic observation). Pill dysphagia was defined as capsule stasis in the pharynx, airway invasion of the capsule or ingesting medium, and/or need for swallowing maneuvers to swallow the capsule. Subjects with and without pill dysphagia were compared for demographic and clinical characteristics as well as endoscopic findings during FEES. Forty of 107 patients (37.4%) exhibited pill dysphagia during FEES. Pharyngeal residue in the vallecula and piriform sinuses was significantly higher in patients with pill dysphagia (Median Yale pharyngeal Severity Rating Score for thin liquids was 3 (IQR 1.8-4.0) vs. 1.0 (1.0–2.0) for the vallecula and 2.5 (1.0-3.2) vs. 1.0 (1.0–1.0) for the piriform sinuses, <i>p</i> &lt; 0.001 for both). The pill dysphagia group also showed higher prevalence of aspiration (33.3% vs. 3.0%, for solids, <i>p</i> &lt; 0.001). Capsule stasis in the vallecula was the most common phenotype of pill dysphagia (52.5%) followed by penetration-aspiration of the ingestion medium (22.5%). Despite these difficulties, 92.5% of patients eventually swallowed the capsules successfully. In a multivariable analysis, piriform sinus residue on FEES was the only independent predictor of pill dysphagia (adjusted OR ~ 18, <i>p</i> = 0.001). Pill dysphagia is frequent in adults with swallowing disorders and typically manifests as stasis in the pharynx with concurrent aspiration of the ingesting medium. Incorporating a brief capsule-swallow challenge into FEES is feasible and may help identify pill swallowing difficulties and guide management.</p>

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Prevalence and Characteristics of Pill Dysphagia in Adults with Swallowing Disorders: A FEES Based Retrospective Study

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Yael Shapira-Galitz,
  • Alaa Awisat,
  • Nadine Hendi,
  • Raviv Allon

摘要

Difficulty swallowing solid oral dosage forms such as pills and capsules is common among adults and is particularly prevalent in patients with oropharyngeal dysphagia. The study aim was to investigate the prevalence, characteristics, and predictors of pill dysphagia using fiberoptic endoscopic evaluation of swallowing (FEES). A retrospective review of 107 adults attending a dysphagia clinic who underwent FEES including a standardized capsule challenge (swallowing two empty gelatin capsules under endoscopic observation). Pill dysphagia was defined as capsule stasis in the pharynx, airway invasion of the capsule or ingesting medium, and/or need for swallowing maneuvers to swallow the capsule. Subjects with and without pill dysphagia were compared for demographic and clinical characteristics as well as endoscopic findings during FEES. Forty of 107 patients (37.4%) exhibited pill dysphagia during FEES. Pharyngeal residue in the vallecula and piriform sinuses was significantly higher in patients with pill dysphagia (Median Yale pharyngeal Severity Rating Score for thin liquids was 3 (IQR 1.8-4.0) vs. 1.0 (1.0–2.0) for the vallecula and 2.5 (1.0-3.2) vs. 1.0 (1.0–1.0) for the piriform sinuses, p < 0.001 for both). The pill dysphagia group also showed higher prevalence of aspiration (33.3% vs. 3.0%, for solids, p < 0.001). Capsule stasis in the vallecula was the most common phenotype of pill dysphagia (52.5%) followed by penetration-aspiration of the ingestion medium (22.5%). Despite these difficulties, 92.5% of patients eventually swallowed the capsules successfully. In a multivariable analysis, piriform sinus residue on FEES was the only independent predictor of pill dysphagia (adjusted OR ~ 18, p = 0.001). Pill dysphagia is frequent in adults with swallowing disorders and typically manifests as stasis in the pharynx with concurrent aspiration of the ingesting medium. Incorporating a brief capsule-swallow challenge into FEES is feasible and may help identify pill swallowing difficulties and guide management.