Esophagram is useful in the assessment of anatomic abnormalities but is a poor screening examination for the detection of esophageal dysmotility. Patients with suspected esophageal dysphagia should be referred for HRM to evaluate motility disorders and identify potential treatment targets, regardless of esophagram results.

Background A limitation to the expanded use of high-resolution pharyngeal manometry in clinical practice is the lack of useful pharyngeal parameters that are easy to interpret, generalizable between patients and do not require specialized software. In this study we sought to test the relationship between the pharyngeal contractile integral with videofluoroscopic abnormalities as assessed with the Modified Barium Swallow Impairment Profile©™. Methods Adult dysphagic patients were recruited to undergo simultaneous high-resolution pharyngeal manometry and videofluoroscopy during a standardized swallowing protocol. Key Results 36 patients were included in the study. The mean pharyngeal contractile integral was 247 mmHg-sec-cm (range 2–488 mmHg-s-cm). The lower pharyngeal total group (N=20; mean PT=3.9) had a mean pharyngeal contractile integral of 299 mmHg-s-cm while the higher pharyngeal total group (N = 16; mean PT=12.7) had a mean pharyngeal contractile integral score of 188 mmHg-s-cm (p=0.01). There was also a significant negative correlation between normalized pharyngeal contractile integral to pharyngeal total scores (r=−0.47, p=0.004). Patients with higher pharyngeal contractile integrals exhibited less severe penetration-aspiration scores on thin liquids (1.44 versus 3.78; p=0.03) and all consistencies combined (1.21 versus 1.99; p=0.03). Conclusions & Inferences The pharyngeal contractile integral is a useful indicator of the presence of pharyngeal swallowing impairment and is technically simple to calculate with currently available software programs. Advancement of software is necessary to refine the clinical value of this parameter. High-resolution pharyngeal manometry has the potential to be a valuable adjunct procedure for the evaluation and treatment of dysphagic individuals.