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Current Gastroenterology Reports

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Open Access 01-03-2017 | Esophagus (J Clarke and N Ahuja, Section Editors)

Diagnosis of Swallowing Disorders: How We Interpret Pharyngeal Manometry

Authors: Charles Cock, Taher Omari

Published in: Current Gastroenterology Reports | Issue 3/2017

Abstract

Purpose of review

We provide an overview of the clinical application of novel pharyngeal high-resolution impedance manometry (HRIM) with pressure flow analysis (PFA) in our hands with example cases.

Recent findings

In our Centre, we base our interpretation of HRIM recordings upon a qualitative assessment of pressure-impedance waveforms during individual swallows, as well as a quantitative assessment of averaged PFA swallow function variables. We provide a description of two global swallowing efficacy measures, the swallow risk index (SRI), reflecting global swallowing dysfunction (higher SRI = greater aspiration risk) and the post-swallow impedance ratio (PSIR) detecting significant post-swallow bolus residue. We describe a further eight swallow function variables specific to the hypopharynx and upper esophageal sphincter (UES), assessing hypo-pharyngeal distension pressure, contractility, bolus presence and flow timing, and UES basal tone, relaxation, opening and contractility.

Summary

Pharyngeal HRIM has now come of age, being applicable for routine clinical practice to assess the biomechanics of oropharyngeal swallowing dysfunction. In the future, it may guide treatment strategies and allow more objective longitudinal follow-up on clinical outcomes.

• Omari TI, Jones CA, Hammer MJ, Cock C, Dinning P, Wiklendt L, et al. Predicting the activation states of the muscle governing upper esophageal sphincter relaxation and opening. Am J Physiol Gastrointest Liver Physiol. 2016;310:G359–66. Direct measurement of cricopharyngeal and submental-EMG with correlation of findings to pressure-flow based assessment of UES relaxation and opening.CrossRefPubMedPubMedCentral

• Cock C, Jones CA, Hammer MJ, Omari TI, McCulloch TM. Modulation of upper esophageal sphincter (UES) relaxation and opening during volume swallowing. Dysphagia. 2016. doi 10.1007/s00455-016-9744-4. Sensory modulation of swallowing assessed by pressure-flow analysis. Mechanism of UES opening shifts from neuromyogenic to bolus based distention with volume increase. Optimal biomechanical opening at 10-15ml in young healthy volunteers.

Cook IJ, Dodds WJ, Dantas RO, Kern MK, Massey BT, Shaker R, et al. Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing. Dysphagia. 1989;4:8–15.CrossRefPubMed

Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, et al. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257:G748–59. Classic paper describing UES opening mechanism.PubMed

Omari TI, Dejaeger E, Tack J, Van Beckevoort D, Rommel N. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia. 2013;28:146–52.CrossRefPubMed

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. Classic description of aspiration on videofluoroscopy.CrossRefPubMed

• Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28:494–500. Assessment of aspiration on subsequent swallowing related to presence of objectively assessed pharyngeal residue.CrossRefPubMed

Pal A, Williams RB, Cook IJ, Brasseur JG. Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow. Am J Physiol Gastrointest Liver Physiol. 2003;285:G1037–48.CrossRefPubMed

Williams RB, Wallace KL, Ali GN, Cook IJ. Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Am J Physiol Gastrointest Liver Physiol. 2002;283:G16–26.CrossRefPubMed

10.

Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and computerized pharyngeal manometry – videomanometry. Acta Radiol. 1994;35:30–4.CrossRefPubMed

11.

Nativ-Zelzer N, Kahrilas PJ, Logemann JA. Manofluorography in the evaluation of oropharyngeal dysphagia. Dysphagia. 2012;27:151–61.CrossRef

12.

Omari TI, Rommel N, Szczesniak MM, Fuentealba S, Dinning PG, Davidson GP, et al. Assessment of intraluminal impedance for the detection of pharyngeal bolus flow during swallowing in healthy adults. Am J Physiol Gastrointest Liver Physiol. 2006;290:G183–8.CrossRefPubMed

13.

Szczesniak MM, Rommel N, Dinning PG, Fuentealba S, Cook IJ, Omari TI. Optimal criteria for detecting bolus passage across the pharyngo-esophageal segment during the normal swallow using intraluminal impedance recording. Neurogastroenterol Motil. 2008;20:440–7.CrossRefPubMed

14.

Omari TI, Papathanasopoulos A, Dejaeger E, Wauters L, Scarpellini E, Vos R, et al. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Clin Gastroenterol Hepatol. 2011;9:862–7.CrossRefPubMed

15.

• Omari TI, Savilampi J, Kokkinn K, Schar M, Lamvik K, Doeltgen S, et al. The reliability of pharyngeal high resolution manometry with impedance for derivation of measures of swallowing function in healthy volunteers. Int J Otolaryngol. 2016;2016:2718482. doi:10.1155/2016/2718482. Recent paper assessing inter-, intra- and test-retest reliability of pharyngeal manometry using pressure flow analyses. This study demonstrated a high degree of reliability for intra-bolus pressure and timing measurements, including of test -retest, but less reliable test-retest results for contractile pressure-based metrics.

16.

•• Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, et al. Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction. Neurogastroenterol Motil. 2016;28:225–33. Paper describing Max UES Adm as a marker for UES dysfunction in older subjects, subjects with motor neurone disease and subjects with cricopharyngeal bar, which were often shown to be non-obstructive in nature.

17.

Omari TI, Ferris L, Dejaeger E, Tack J, Van Beckevoort D, Rommel N. Upper esophageal sphincter impedance as a marker of sphincter opening diameter. Am J Physiol Gastrointest Liver Physiol. 2012;302:G909–13.CrossRefPubMed

18.

• Zhang T, Szczesniak M, Maclean J, Betrand P, Wu PI, Omari T, et al. Biomechanics of pharyngeal deglutitive function following total laryngectomy. Otolanrygol Head Neck Surg. 2016;155:295–302. Paper describing the use of radiologically guided IBP to determine obstruction in a cohort of treated head and neck cancer patients.CrossRef

19.

Cook IJ, Gabb M, Panagopoulos V, Jamieson GG, Dodds WJ, Dent J, et al. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103:1229–35.CrossRefPubMed

20.

Williams RB, Grehan MJ, Hersch M, Andre J, Cook IJ. Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia. Gut. 2003;52:471–8.CrossRefPubMedPubMedCentral

21.

• Doeltgen S, Omari TI, Savilampi J. Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure-impedance analysis. Am J Physiol Gastrointest Liver Physiol. 2016;310:G1176–82. Paper describing a reduction in the duration of UES relaxation following administration of the mu-opioid receptor agonist, remifentanil.

22.

• Ferris L, Omari T, Selleslach M, Dejaeger E, Tack J, Vanbeckevoort D, et al. Pressure flow analysis in the assessment of preswallow pharyngeal bolus presence in dysphagia. Int J Otolaryngol. 2015;2015:764709. doi:10.1155/2015/764709. Paper showing increased bolus presence time and shorter pharyngeal distention contraction latency in subjects with radiological premature bolus spillage.PubMedPubMedCentral

23.

•• Omari TI, Dejaeger E, Van Beckevoort D, Goeleven A, Davidson GP, Dent J, et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140:1454–63. Description of the swallow risk index during pressure-flow analysis, as a composite measure of global swallowing dysfunction and aspiration risk.

24.

•• Omari TI, Dejaeger E, Tack J, Van Beckevoort D, Rommel N. An impedance-manometry based method for non-radiological detection of pharyngeal post-swallow residue. Neurogastroenterol Motil. 2012;24:e277–84. Description of the determination of hypo-pharyngeal post-swallow bolus presence during pressure-flow analysis.CrossRefPubMed

25.

Weijenborg PW, Kessing BF, Smout AJPM, Bredenoord AJ. Normal values for solid state esophageal high-resolution manometry in a European population: an overview of all current metrics. Neurogastroenterol Motil. 2014;26:654–9.CrossRefPubMed

26.

• Nativ-Zelzer N, Logemann JA, Zecker SG, Kahrilas PJ. Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography—a normative study of younger and older adults. Neurogastroenterol Motil. 2016;28:721–31. Study describing pressure-based metrics for use during pharyngeal manometry. UES IRP is described as being increased with aging.CrossRef

27.

Lee TH, Lee JS, Park JW, Cho SJ, Hong SJ, Jeon SR, et al. High resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms. Dis Esophagus. 2014;27:220–9.CrossRefPubMed

28.

Savilampi J, Omari T, Magnuson A, Ahlstrand R. Effects of remifentanil on pharyngeal swallowing. Eur J Anaesthesiol. 2016;33:1–11.CrossRef

Title: Diagnosis of Swallowing Disorders: How We Interpret Pharyngeal Manometry
Authors: Charles Cock
Taher Omari
Publication date: 01-03-2017
Publisher: Springer US
Published in: Current Gastroenterology Reports / Issue 3/2017
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI: https://doi.org/10.1007/s11894-017-0552-2

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