粟飯原 けい子

Abstract Background Pill‐swallowing difficulty is common yet under‐recognised, and patients rarely seek or receive support from healthcare professionals. Lubricating jelly pastes are widely available in Japan, yet evidence for their effectiveness in pill administration remains limited. The PILL‐5 enables validated, self‐reported screening of clinically relevant pill‐swallowing difficulty. Aim This study aimed to explore whether a lubricating jelly paste reduced self‐reported pill‐swallowing difficulties using the Japanese version of the PILL‐5 questionnaire. Method In a pilot randomised, parallel‐group trial, 24 participants with PILL‐5 scores ≥2 were stratified and randomised 1:1 to one‐week pill intake using a lubricating jelly paste (IDDSI Level 4) (intervention group) or pill intake as usual (control group). The PILL‐5 was administered at baseline, Day 1, and Day 7. The primary outcome was change in total PILL‐5; between‐group differences were tested with the exact Mann–Whitney U test. Ethical approval was granted by the Ethics Review Committee of Fujita Health University (Reference no: HM20‐076; HM20‐619) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants via the distribution of project information and completion of written consent forms. The study was registered in the UMIN Clinical Trials Registry (UMIN‐CTR) (Registration ID: UMIN000057324). Results The median PILL‐5 scores at baseline were 4.5 and 5.5 for the intervention and control groups, respectively (p = 0.525). At Day 1, median scores were 3.0 and 4.5 in the intervention group and control group, respectively and on Day 7, median scores were 3.0 and 4.0 in the intervention and control groups, respectively. From baseline to Day 1, the between‐group median difference in change (intervention minus control) was 2 (95% confidence interval [CI] 0–2, p = 0.037), indicating a greater reduction in the intervention group. On Day 7, the between‐group difference was 1 (95% CI 0–2, p = 0.119) and not significant. Conclusion Lubricating jelly paste use was associated with an early, self‐reported reduction in PILL‐5 scores at Day 1, with a significant between‐group difference. By Day 7, the between‐group difference was not significant, likely due to floor effects from low baseline severity. Future studies with stricter inclusion criteria and larger sample sizes are warranted to further clarify the potential benefits.

The super-supraglottic swallow (SSGS) improves laryngeal closure, and head flexion compensates for inadequate closure of the airway. These two procedures are typically utilized by speech-language pathologists for specific patient populations. This study compared the effect of the SSGS with head flexion (i.e., modified SSGS [mSSGS]) on laryngeal closure with that of usual swallowing and the SSGS in healthy individuals. Twenty-one healthy volunteers were instructed to swallow 4 ml of thin liquid barium in a sitting position during usual swallowing, SSGS, and mSSGS under X-ray fluoroscopy. The primary outcome was the distance between the epiglottis and arytenoid (DEA) at onset of the swallowing reflex. The secondary outcomes were DEA before onset of the swallowing reflex, the head flexion angle before and at onset of the swallowing reflex, and the Penetration-Aspiration Scale (PAS) score. The relative ease of performing the mSSGS compared with the SSGS was evaluated using a 7-point Likert scale. DEA at onset of the swallowing reflex was significantly shorter with mSSGS than with usual swallowing (P < 0.001) or the SSGS (P = 0.006). DEA before swallowing was also significantly shorter with the mSSGS than with usual swallowing (P < 0.001) and the SSGS (P = 0.006). PAS score was 1 in all trials. The median Likert score was 3, indicating that the SSGS was easier than the mSSGS. The findings suggest that the mSSGS maneuver enhances laryngeal closure more than the SSGS maneuver and usual swallowing.

This study aimed to establish reference values for quantitative measurements of pharyngeal volume and residue during swallowing in healthy individuals and to examine how these measurements are influenced by age, sex, height, and bolus properties. We performed a retrospective analysis of 288 swallows from 135 healthy Japanese adults (median age, 43 years; height, 163 cm) who underwent Swallowing CT. Test boluses included thin or extremely thick liquids in either 3 mL, 10 mL, or 20 mL amounts. Pharyngeal cavity volume at bolus hold (PVHOLD), unobliterated air and bolus volume at maximum pharyngeal constriction (PVMAX), and pharyngeal volume constriction ratio (PVCR), and post-swallow pharyngeal residue were measured on dynamic 3D-CT images using a semi-automated software. We determined the 2.5th, 50th, 97.5th percentile values to obtain normative reference values for each parameter and made generalized linear regression models to determine how these volume measurements are associated with demographic factors and bolus properties. Normative values (median [97.5th percentile]) across all swallows were PVHOLD 20.9 cm3 [38.6 cm3], PVMAX 0.3 cm3 [2.1 cm3], PVCR 98.8% [2.5th percentile 89.1%], and residue 0 cm3 [0.4 cm3]. Males exhibited larger values than females. PVHOLD significantly increased with height (β = 0.465, p < 0.001) and age (β = 0.068, p = 0.001), while PVMAX and PVCR increased with larger bolus volumes (β = 0.293, p = 0.005) and in thicker consistencies (β = 0.376, p = 0.017). Pharyngeal residue was present in 98/288 (34.0%) of swallows and was significantly associated with increasing bolus volume (adjusted odds ratio [aOR] = 1.865 [95% confidence interval: 1.275-2.727]), age (aOR = 1.025 [1.010-1.040]), thicker bolus (aOR = 1.806 [1.275-2.727]). Each 1 cm2 increase in PVMAX was associated with nearly double the odds of residue (aOR = 1.86 [1.202-2.862]). Similarly, each 1% decrease in PVCR corresponded to a 10.6% increase in the odds of residue (aOR = 1.106 [1.015-1.295]). These normative data provide a bases for comparing individuals with or without pharyngeal impairments.