Effect of Bolus Volume and Viscosity on Pharyngeal Automated Impedance Manometry Variables Derived for Broad Dysphagia Patients

Omari, Taher; Dejaeger, Eddy; Tack, Jan; Beckevoort, Dirk Van; Rommel, Nathalie

doi:10.1007/s00455-012-9423-z

Cited by 44 publications

(65 citation statements)

References 13 publications

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“…[18][19][20] Similarly, no increase in nadir pressure at UES with increasing viscosity in the present study also coincides with previous observations. 5,18 However, our findings were not always consistent with previous findings. Concerning pharyngeal contractility, greater mesopharyngeal CI for water swallowing was noted than that for yogurt or barium swallowing.…”

Section: Discussionsupporting

confidence: 92%

“…Values of UES relaxation interval, nadir pressure and intrabolus pressure of a previous report were quite similar to ours, and the finding that intrabolus pressure at UES was significantly increased with increased viscosity was also consistent with our results. 18 In regard to UES relaxation interval, although some researchers have reported an increase in UES relaxation time with increasing viscosity, 5 others have described no increase in UES relaxation. [18][19][20] Similarly, no increase in nadir pressure at UES with increasing viscosity in the present study also coincides with previous observations.…”

Section: Discussionmentioning

confidence: 99%

“…18 In regard to UES relaxation interval, although some researchers have reported an increase in UES relaxation time with increasing viscosity, 5 others have described no increase in UES relaxation. [18][19][20] Similarly, no increase in nadir pressure at UES with increasing viscosity in the present study also coincides with previous observations. 5,18 However, our findings were not always consistent with previous findings.…”

Section: Discussionmentioning

confidence: 99%

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Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

Yoon

Park

et al. 2014

J Neurogastroenterol Motil

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Background/AimsThe purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results. MethodsManometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 19-81 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg ‧ cm ‧ sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB. ResultsMesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05). ConclusionsManometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

Yoon

Park

et al. 2014

J Neurogastroenterol Motil

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“…High resolution solid state manometry with impedance (HRIM) is a catheter-based diagnostic modality which overcomes some of the inherent limitations of existing assessment techniques. Used as an adjunct to videofluoroscopy swallow studies (VFSS), HRIM enhances biomechanical evaluation of oropharyngeal swallowing and furthermore, pressure and impedance recordings generated during HRIM-measured swallows can be analysed using Pressure-Flow Analysis (PFA) (2,13,(15)(16)(17)(18)(19)(20). Published studies in adults and, to a lesser extent in children with pharyngeal dysphagia, have shown individual PFA measures and a global composite score of swallowing dysfunction, called the Swallow Risk Index (SRI), are able to discriminate consequences of swallowing pathophysiology, such as aspiration risk, the presence of post-swallow residue and abnormal pharyngeal distensioncontraction timing in circumstances of poor oral containment and/or delayed swallow trigger (2,13,19,20).…”

Section: Introductionmentioning

confidence: 99%

Pressure-Flow Analysis for the Assessment of Pediatric Oropharyngeal Dysphagia

Ferris

Rommel

Doeltgen

et al. 2016

The Journal of Pediatrics

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“…47,48 The SRI is a global measure of swallow effectiveness and aspiration risk derived through the combination of AIM variables associated with the occurrence of deglutitive aspiration on videofluoroscopy and has recently been proven have clinical utility for assessing deglutitive aspiration risk to liquid boluses in adult patients. [49][50][51] Using a similar approach, Myer's et al examined a range of esophageal AIM variables for potential associations with the occurrence of esophageal dysphagia in adults. 45 They identified three variables linked to dysphagia: intrabolus pressure (IBP), IBP slope and TNadImp-PeakP (time between nadir impedance to peak pressure).…”

Section: B the Essentials Of Aim Pressure Flow Analysis Based On Timmentioning

confidence: 99%

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

Smits

Loots

Benninga

et al. 2013

Curr Gastroenterol Rep

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Introduction Gastroesophageal reflux disease and treatment in childrenGastroesophageal reflux disease (GERD) in children is common, it affects approximately (?)3% of infants and <1% of older children. 1 GERD is clinically diagnosed when gastroesophageal reflux (GER) causes troublesome symptoms, and is a source of stress for both patients and caregivers. In infants, GERD is often mild and short lived, with >90% being free of GERD symptoms at the age of 18 months. 2,3 'Symptomatic GERD', that is a clinical diagnosis of GERD without corroborative evidence such as endoscopic evidence of esophagitis, can be challenging to treat. Standard treatment consists firstly of conservative measures: lifestyle changes, excess weight reduction, no exposure to tobacco smoke. In specific cases allergies are associated with GERD, and avoidance of allergens may relieve symptoms.If pharmacological therapy is considered, acid suppression is the first choice and using proton pump inhibitors (PPIs) is favored above H2-antagonists and on demand buffering agents. 2 However, acid suppression therapy in infants and children is now widely discouraged as PPIs, whilst proven effective in increasing gastric pH, do not reduce GERD symptoms. 4 The lack of therapeutic efficacy of acid suppressive therapy might be explained by the fact that acid suppression does not target the underlying mechanism of reflux which is transient lower sphincter relaxation (TLESR). 3,5 Acid suppression only turns acid GER into weakly acid GER, which may still cause troublesome symptoms. Although other therapeutic agents are being developed for adult GERD treatment (especially GABA(B) agonists and mGLUR5 antagonists), these have many sideeffects and are not yet tested in children. 6,7 Therefore, no pharmacological interventions aimed a reducing TLESRs are available.In patients with objective evidence of acid-related GERD, based on upper endoscopy, pH-metry and/or pH impedance measurement (pHMII), who experience severe symptoms or have esophagitis refractory to optimal medical therapy, anti-reflux surgery (fundoplication) may be a treatment of last resort. 8Indications for fundoplication are poorly defined in children 2,9,10 and there is no uniformity between hospitals in the approach to infants and children with pharmacological therapy resistant GERD. 11 Neurologically impaired children, children with a history of esophageal atresia 12 and children with respiratory alarm symptoms considered GERD-related (e.g. apnea, bronchiectasis, recurrent pneumonia) are more prone to undergo fundoplication. Fundoplication techniquesThe primary goal of anti-reflux surgery is to reduce GER without preventing passage into the stomach of swallowed substances. These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique. In addition prospective evidence is limited in terms of efficacy and complication rates between partial and total fundoplication. 19 Efficacy and safety of fundoplicationEfficacy and safety o...

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Effect of Bolus Volume and Viscosity on Pharyngeal Automated Impedance Manometry Variables Derived for Broad Dysphagia Patients

Cited by 44 publications

References 13 publications

Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

Pressure-Flow Analysis for the Assessment of Pediatric Oropharyngeal Dysphagia

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

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