Oral Medication Swallowing in Dysphagia: Prevalence of Penetration, Aspiration, Residue, and Epiglottic Morphology Impact-A Retrospective Study.

Abstract

Objectives: Pill dysphagia, defined as difficulty swallowing oral medications, is associated with liquid penetration, aspiration, and residue. However, data on these outcomes based on videofluoroscopic swallowing studies (VFSS) are limited. This study aimed to determine the prevalence of liquid penetration-aspiration and tablet residue using VFSS and identify the associated risk factors.

Methods: This retrospective study analyzed 93 patients with dysphagia who exhibited a Penetration-Aspiration Scale (PAS) score of 1 while drinking moderately thickened liquids. The patients were evaluated with small, medium, or both tablet sizes based on clinical judgment. Primary endpoints were liquid penetration-aspiration (PAS ≥2) and tablet residue. We analyzed liquid penetration-aspiration risk factors using multivariable logistic regression. Because of sample imbalance for residue, we examined the association with epiglottic morphology using univariate analysis.

Results: Liquid penetration-aspiration and tablet residue occurred in 33.3% and 34.4% of the patients, respectively. Multivariable logistic analysis identified that unthickened liquid [odds ratio (OR) = 4.40] and small tablet size (OR = 3.19) were significantly associated with liquid penetration-aspiration. In the univariate analysis, intermediate epiglottic morphology was significantly associated with vallecular residue.

Conclusions: Even when swallowing liquids is safe, patients may experience penetration, aspiration, or residue during oral medication swallowing. Unthickened liquids were independently associated with liquid penetration-aspiration. The association between small tablets and aspiration likely reflects confounding by indication in patients requiring a more cautious swallowing approach. Although not an independent risk factor for overall residue, intermediate epiglottic morphology may specifically contribute to vallecular tablet residue.