Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders

Background Oro‐pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high‐resolution manometry impedance (P‐HRM‐I). We aimed to establish methodology to diagnose disorders utilizing P‐HRM‐I, hypothesizing that the objective mea...

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Bibliographic Details
Published in:Neurogastroenterology and motility 2023-01, Vol.35 (1), p.e14461-n/a
Main Authors: Omari, Taher, Cock, Charles, Wu, Peter, Szczesniak, Michal Marcin, Schar, Mistyka, Tack, Jan, Rommel, Nathalie
Format: Article
Language:English
Subjects:
Contractility
Deglutition - physiology
Deglutition Disorders
diagnosis
dysphagia
Electric Impedance
Esophageal sphincter
Esophageal Sphincter, Upper - physiology
Esophagus
Fluoroscopy
high‐resolution manometry
Humans
impedance
Information processing
Manometry - methods
Motor Disorders
Movement disorders
Pharynx
Pressure
Sphincter
swallowing
upper esophageal sphincter
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Summary:Background Oro‐pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high‐resolution manometry impedance (P‐HRM‐I). We aimed to establish methodology to diagnose disorders utilizing P‐HRM‐I, hypothesizing that the objective measures could be used to diagnose disordered deglutition evidenced by greater aspiration scores. Methods Patients (n = 509, 18–91 years) were compared to controls (n = 120, 20–94 years). Variables measuring UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contractile strength were derived for 10 ml liquid swallows. Three associated pharyngeal pressurization patterns, which may be indicative of obstructed flow, were characterized: pan‐pressurization (Type 1), distal compartmentalized pressurization (Type 2), and transient pressurization (Type 3). Deglutitive aspiration was determined from video fluoroscopy. Results UES relaxation pressure was best able to differentiate patients from controls (T 6.528, p 8 mmHg) more frequently exhibited pharyngeal pressurization patterns and had adjunct evidence of reduced luminal distensibility (high intrabolus pressure and/or reduced UES opening). Utilizing this information, a diagnostic scheme was devised identifying 138 patients with UES disorder. A further 96 patients without evidence of UES disorder had abnormally weak pharyngeal pressures, confirming propulsive disorder. Amongst a sub‐sample of 320 patients undergoing video fluoroscopy, those with pharyngeal pressurizations and adjunct evidence of reduced UES relaxation and/or distensibility had higher aspiration scores (Chi‐square 60.169, p 
ISSN:1350-1925
1365-2982
DOI:10.1111/nmo.14461