Modified Mondays: DID that medicine go down?
In case you missed last Friday’s fun fact (and cat meme), a national survey indicated that around 40% of the general population has difficulty swallowing pills, and of residents of long term care facilities that have difficulty swallowing pills, 27% report that they don’t even bother to try to swallow pills that give them trouble. Here are two clips of two different patients, with the same story, but with two different presentations of pill dysphagia.
Both patients complained of “feeling like things are sticking”. A previous MBS had been completed for both at a hospital, which patients reported was normal and that they “passed” (don’t get me started on “passing” an MBS). Once we started our protocol, the physiology looked pretty functional throughout. We decided to try a barium tablet for each. Here is where these two clips show something a little different.
On the first patient, you can see that despite multiple swallows and repeated continual swallows of thin, the pill remains in the valleculae for quite some time.
On the second patient, the pill remains in the esophagus for what seemed like forEVERRRRR. (Keep in mind that with both patients, the fluoro was turned off for several minutes in between images, so in both patients the pill was stuck for much longer than you are seeing.)
After questioning, both patients reported skipping medications. Pill dysphagia is concerning, not only because it can lead to patients not taking needed medication, but it can also result in damage to the esophagus (a real concern for patient #2!) See the links below for some work done in pill dysphagia. NFOSD recently also had a FANTASTIC webinar on this topic… check their website for the handouts!
https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/649710