Impedance Analysis Using High-resolution Impedance Manometry Facilitates Assessment of Pharyngeal Residue in Patients With Oropharyngeal Dysphagia

Lee, Tae Hee; Lee, Joon Seong; Hong, Su Jin; Lee, Ji Sung; Jeon, Seong Ran; Kim, Wan Jung; Kim, Hyun Gun; Cho, Joo Young; Kim, Jin Oh; Cho, Jun-Hyung; Kim, Mi Young; Kwon, Sae Min

doi:10.5056/jnm14007

Cited by 15 publications

(5 citation statements)

References 22 publications

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“…The pressure events associated with the swallowing motor response can be recorded using high-resolution pharyngeal manometry (HRPM) (15,17,22,30,33,49,51,52,56) and bolus flow events can be assessed when HRPM is integrated with impedance measurement (4,5,9,14,25,26,37,42,(54)(55)(56). Using this combined technique with automated analysis methods, a rich, objective dataset of pressure and flow measurements can be acquired and used to detect the swallow motor response in relation to bolus characteristics (6,26,31,36,56,57). Most recently, a core outcome set of parameters and protocols for HRPM with impedance assessment has been suggested (39), providing a standardized approach to recording and reporting HRPM measurements.…”

Section: Introductionmentioning

confidence: 99%

Modulation of pharyngeal swallowing by bolus volume and viscosity

Ferris

Doeltgen

Cock

et al. 2021

American Journal of Physiology-Gastrointestinal and Liver Physi

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Background: Oro-pharyngeal swallowing involves complex neuromodulation to accommodate changing bolus characteristics. The pressure events during deglutitive pharyngeal reconfiguration and bolus flow can be assessed quantitatively using high-resolution pharyngeal manometry (HRPM) with impedance. Methods: An 8 French solid-state unidirectional catheter (32 pressure sensors, 16 impedance segments) was used to acquire triplicate swallows of 3- to 20- mls across 3 viscosity levels using a Standardized Bolus Medium (SBMkit) product (Trisco Pty Ltd, Australia). An online platform www.swallowgateway.com (Flinders University, South Australia) was used to semi -automate swallow analysis. Results: 50 healthy adults (29 female, 21 male, mean age 46 years) were studied. Hypopharyngeal intrabolus pressure, upper esophageal sphincter (UES) maximum admittance, UES relaxation pressure and UES relaxation time revealed the most significant modulation effects to bolus volume and viscosity. Pharyngeal contractility and UES post swallow pressures elevated as bolus volumes increased. Bolus viscosity augmented UES preopening pressure only. Conclusion: Describing swallow modulatory effects with quantitative methods in line with a core outcome set of metrics, and a unified analysis system for broad reference contributes to diagnostic frameworks for oropharyngeal dysphagia.

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Section: Introductionmentioning

confidence: 99%

Modulation of pharyngeal swallowing by bolus volume and viscosity

Ferris

Doeltgen

Cock

et al. 2021

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…A recent study that conducted impedance analysis at a threshold of 1500 Ω provided more accurate information for the detection of liquid residue and supported our findings. 29 The calculation of DCIIR1500 may be easily applied to all kinds of esophageal peristalsis or bolus clearance patterns during the liquid swallow test of HRIM. We further demonstrated that DCIIR1500 at a cutoff of < 0.009 mmHg/Ω was predictive of esophageal hypomotility in children.…”

Section: Discussionmentioning

confidence: 99%

Distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective esophageal motility disorder

Chung

Tseng

et al. 2018

Pediatr Res

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We investigated the diagnostic utility of distal contractile integral (DCI) to esophageal impedance integral (EII) ratio (DCIIR) in high-resolution impedance manometry (HRIM) of ineffective esophageal motility (IEM) in children. METHODS: We performed HRIM in 31 children with dysphagia, odynophagia, chronic vomiting, chest pain, or heartburn sensation. Based on the Chicago classification version 3.0, 20 subjects were diagnosed with IEM, and 11 subjects were normal. We analyzed the EII and DCIIR using MATLAB software. RESULTS: The DCIIR calculated at the impedance cutoff at 1500 Ω (DCIIR1500) were significantly lower in IEM group than patients with normal motility (P = 0.007). Receiver operating characteristic (ROC) curve analysis showed that a DCIIR1500 < 0.009 mmHg/Ω best predicted IEM in children (P < 0.001). A DCIIR1500 < 0.008 mmHg/Ω is associated with significant body weight loss > 10% within 6 months in children. (P < 0.001). CONCLUSIONS: The calculation of DCIIR1500 may assist the automatic analysis of bolus transit in HRIM study to diagnose IEM in children. An DCIIR1500 < 0.009 mmHg/Ω may assist in the diagnosis of IEM in children, and DCIIR1500 < 0.008 mmHg/Ω correlated with significant body weight loss. The calculation of DCIIR may serve as possible parameters for HRIM.

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“…Quantitative assessments of the amount of pharyngeal residue have been conducted with impedance manometry 5‐8 and scintigraphy 9 . Omari et al 6 had attempted a quantitative evaluation of the amount of pharyngeal residue using integrated nadir impedance to impedance ratio (iZn/Z) measured by impedance manometry.…”

Section: Introductionmentioning

confidence: 99%

Estimation of pharyngeal residue after swallowing by retronasal aroma

Okawa

Hori

Fujiwara

et al. 2020

J of Oral Rehabilitation

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Background Pharyngeal residue can trigger aspiration and choking after swallowing. Various studies to assess the amount of pharyngeal residue have been conducted; however, an easy and quantitative method is yet to be established. The aroma released from the pharyngeal residue is thought to be delivered from the pharynx to the nasal cavity via velopharynx by expiration, that is, retronasal pathway. Objective This study verified that the amount of pharyngeal residue could be estimated by aroma intensity. Methods Ten healthy adult subjects had tubes in from the oral cavity to the pharynx. Varying amounts of essence were dispensed into the pharynx through the tube either at rest or after swallowing the essence. Pharyngeal residue was simulated by retention essence in the pharynx without swallowing. An odour sensor was placed in the nostril, and the aroma intensity of the retained essence was measured over time. Results The aroma intensity level flattened after a certain period of time had elapsed, and a significant correlation was found between the amount of essence dispensed and the flattened aroma intensity, both at rest and after swallowing. Furthermore, to estimate in a short period of time, changes in aroma intensity over time were estimated by fitting to a decay curve. The estimated intensity at convergence, calculated from the fitted curve from 80 to 120 seconds after swallowing, was significantly correlated to the measured intensity. Conclusion The amount of pharyngeal residue can be estimated in a short period of time by measuring the aroma intensity.

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Impedance Analysis Using High-resolution Impedance Manometry Facilitates Assessment of Pharyngeal Residue in Patients With Oropharyngeal Dysphagia

Cited by 15 publications

References 22 publications

Modulation of pharyngeal swallowing by bolus volume and viscosity

Modulation of pharyngeal swallowing by bolus volume and viscosity

Distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective esophageal motility disorder

Estimation of pharyngeal residue after swallowing by retronasal aroma

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