Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Accuracy of an Esophageal Screening Protocol Interpreted by the Speech-Language Pathologist

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Oropharyngeal and esophageal dysphagia may occur simultaneously. However, symptoms are often evaluated separately. Few standardized, multi-texture esophageal screening protocols exist as an addition to the modified barium swallow study (MBSS). Given the gap in MBSS evaluation standards, providers may be lacking information needed to fully assess the swallowing process and create appropriate dysphagia management plans. The aim was to assess the diagnostic accuracy of a standardized esophageal screening protocol performed by an SLP compared to formal reference esophageal examinations. A cross-sectional analytic study was performed. Consecutively referred patients who underwent same-day consultation with the SLP and a gastroenterologist were included. MBSS with a standardized esophageal screen was performed. Same-day formal esophageal testing was completed and included timed barium emptying study or high-resolution manometry. Summary diagnostic accuracy measures were calculated. Seventy-three patients matched the inclusion criteria. Median age was 62.5 years (25–87), 55% were female. Sensitivity of the esophageal screen for the detection of esophageal abnormality was 83.7% (95% CI 70–91.9%); specificity was 73.7% (95% CI 55.6–85.8%). The positive likelihood ratio was 3.14 (95% CI 1.71–5.77), whereas the negative likelihood ratio was 0.22 (95% CI 0.11–0.45). Positive and negative predictive values were 82% and 76%, respectively. Use of a systematic, multi-texture esophageal screen protocol interpreted by SLPs accurately identifies multiphase dysphagia and should be considered in addition to standard MBSS testing. Inclusion of a cursory esophageal view may more adequately assess dysphagia symptoms and help to promote multidisciplinary care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cangelosi MJ, Rodday AM, Saunders T, Cohen JT. Evaluation of the economic burden of diseases associated with poor nutrition status. J Parent Enteral Nutr. 2013;38(2 Suppl):35S-41S. https://doi.org/10.1177/0148607113514612.

    Article  Google Scholar 

  2. Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc. 2009;57(11):2101–6. https://doi.org/10.1111/j.1532-5415.2009.02526.x.

    Article  PubMed  Google Scholar 

  3. Allen J, Greene M, Sabido I, Stretton M, Miles A. Economic costs of dysphagia among hospitalized patients. Laryngoscope. 2020;130(4):974–9.

    Article  Google Scholar 

  4. Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29(5):545–52. https://doi.org/10.1007/s00455-014-9543-8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9. https://doi.org/10.1177/0194599814549156.

    Article  PubMed  Google Scholar 

  6. Triadafilopoulos G, Hallstone A, Nelson-Abbott H, Bedinger K. Oropharyngeal and esophageal interrelationships in patients with nonobstructive dysphagia. Dig Dis Sci. 1992;37(4):551–7.

    Article  CAS  Google Scholar 

  7. O’Rourke A, Morgan LB, Coss-Adame E, Morrison M, Weinberger P, Postma G. The effect of voluntary pharyngeal swallowing maneuvers on esophageal swallowing physiology. Dysphagia. 2014;29(2):262–8.

    Article  Google Scholar 

  8. Borgstrom PS, Olsson R, Sundkvist G, Ekberg O. Pharyngeal and oesophageal function in patients with diabetes mellitus and swallowing complaints. Br J Radiol. 1988;61(729):817–21.

    Article  CAS  Google Scholar 

  9. Farwell DG, Rees CJ, Mouadeb DA, Allen J, Chen AM, Enepekides DJ, Belafsky PC. Esophageal pathology in patients after treatment for head and neck cancer. Otolaryngol Head Neck Surg. 2010;143(3):375–8.

    Article  Google Scholar 

  10. Huffman JA. Esophageal considerations after spinal cord injury. Perspectives on swallowing and swallowing disorders. Dysphagia. 2011;20(1):9–13.

    Google Scholar 

  11. Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12(1):11–8.

    Article  CAS  Google Scholar 

  12. Montesi A, Pesaresi A, Cavalli ML, Ripa G, Candela M, Gabrielli A. Oropharyngeal and esophageal function in scleroderma. Dysphagia. 1991;6(4):219–23.

    Article  CAS  Google Scholar 

  13. Elkberg O. To sweep or not to sweep. Dysphagia. 2019;34(1):1–1. https://doi.org/10.1007/s00455-018-09967-4.

    Article  Google Scholar 

  14. American Speech-Language-Hearing Association: Practice portal for adult dysphagia (2017) http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550&section=Assessment. Accessed 5/5/2020

  15. Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing. Otolaryngol Head Neck Surg. 2016;152(3):488–93.

    Article  Google Scholar 

  16. Allen JE, White C, Leonard R, Belafsky PC. Comparison of esophageal screen findings on videofluoroscopy with full esophagram results. Head Neck. 2012;34(2):264–9. https://doi.org/10.1002/hed.21727.

    Article  PubMed  Google Scholar 

  17. Watts S, Gaziano J, Jacobs J, Richter J. Improving the diagnostic capability of the modified barium swallow study through standardization of an esophageal sweep protocol. Dysphagia. 2019;34(1):34–42.

    Article  Google Scholar 

  18. Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.

    Article  Google Scholar 

  19. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AM, International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motilitydisorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl. 1):57–65.

    Article  Google Scholar 

  20. Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, Obuchowski N, Koehler RE, Richter JE, Baker ME. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia AJR. Am J Roentgenol. 1997;169(2):473–9.

    Article  Google Scholar 

  21. Blonski W, Kumar A, Feldman J, Richter JE. Timed barium swallow: diagnostic role and predictive value in untreated achalasia, esophagogastric junction outflow obstruction, and non-achalasia dysphagia. Am J Gastroenterol. 2018;113(2):196–203.

    Article  Google Scholar 

  22. Edwards DAW. Discriminitive information in the diagnosis of dysphagia. J R Coll Phys Lond. 1975;9(3):257–63.

    CAS  Google Scholar 

  23. Roeder BE, Murry JA, Dierkhising RA. Patient localization of esophageal dysphagia. Dig Dis Sci. 2004;49(4):697–701.

    Article  Google Scholar 

  24. Marvin S, Thibeault S. Pharyngeal versus esophageal stasis: accuracy of symptom localization. Am J Speech Lang Pathol. 2020;29(2):664–72. https://doi.org/10.1044/2019_AJSLP-19-00161.

    Article  PubMed  Google Scholar 

  25. Castell JA, Johnston BT, Colcher A, Li Q, Gideon RM, Castell DO. Manometric abnormalities of the oesophagus in patients with Parkinson’s disease. Neurogastroenterol Motil. 2001;13(4):361–4.

    Article  CAS  Google Scholar 

  26. Mendell D, Logemann JA. A retrospective analysis of the pharyngeal swallow in patients with a clinical diagnosis of GERD compared with normal controls: a pilot study. Dysphagia. 2002;17(3):220–6.

    Article  Google Scholar 

  27. Sivit CJ, Curtis DJ, Crain M, Cruess DF, Winters C. Pharyngeal swallow in gastroesophageal reflux disease. Dysphagia. 1988;2(3):151–5.

    Article  CAS  Google Scholar 

  28. Lever TE, Cox KT, Holbert D, Shahrier M, Hough M, Kelley-Salamon K. The effect of an effortful swallow on the normal adult esophagus. Dysphagia. 2007;22(4):312–25.

    Article  Google Scholar 

  29. Vanek AW, Diamant NE. Responses of the human esophagus to paired swallows. Gastroenterology. 1987;92(3):643–50.

    Article  CAS  Google Scholar 

  30. Gullung JL, et al. Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry. Ann Otology Rhinol Laryn. 2012;121(11):738–745

    Article  Google Scholar 

  31. Jou J, Radowsky J, Gangnon R, Sadowski E, Kays S, Hind J, Gaumnitz E, Taylor AJR. Esophageal clearance patterns in normal older adults as documented with videofluoroscopic esophagram. Gastroenterol Res Pract. 2009;1:1–6.

    Article  Google Scholar 

  32. Levine M, Rubesin S, Laufer I. Barium studies in modern radiology: do they have a role? Radiology. 2009;250(1):18–22.

    Article  Google Scholar 

  33. Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018;18(1):594. https://doi.org/10.1186/s12913-018-3376-3.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Swallowing Disorders, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA

    Stephanie Watts, Joy Gaziano, Ambuj Kumar & Joel Richter

Authors
  1. Stephanie Watts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joy Gaziano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ambuj Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SW: study concept and design, acquisition of data, drafting of the manuscript, statistical analysis. JG: data analysis, manuscript preparation. AK: statistical analysis. JR: study concept and design, study supervision, critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Stephanie Watts.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watts, S., Gaziano, J., Kumar, A. et al. Diagnostic Accuracy of an Esophageal Screening Protocol Interpreted by the Speech-Language Pathologist. Dysphagia 36, 1063–1071 (2021). https://doi.org/10.1007/s00455-020-10239-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-020-10239-3

Keywords

Search

Navigation