Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube–fed patients

Jiao, Hongmei; Mei, Ling; Liang, Chenyang; Dai, Yun; Fu, Zhanli; Wu, Lihong; Sanvanson, Patrick; Shaker, Reza

doi:10.1002/lary.26895

Cited by 6 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies found an increased UES tone, and a mechanism of aspiration protection has been hypothesized. [25,26]. Our results, which show higher values of Basal UES-CI and UES-RP, might confirm the hypothesis of a protective mechanism of reflux-related aspiration.…”

Section: Discussionsupporting

confidence: 86%

Upper Esophageal Sphincter Metrics across Eosinophilic Esophagitis, Gastroesophageal Reflux Disease and Functional Dysphagia: A Pilot Study

Ruggiero,

Iovino,

Gargano

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Recent studies have evaluated the upper esophageal sphincter (UES) with high-resolution manometry (HRM) in some esophageal diseases, but not eosinophilic esophagitis (EoE). The aim of our study was to evaluate the function of the UES across EoE, gastroesophageal reflux disease (GERD), functional dysphagia (FD), and the relationship with esophageal symptoms, esophageal body contraction, and esophagogastric junction (EGJ) metrics. Methods: HRM was performed on 30 EoE, 18 GERD, and 29 FD patients according to the Chicago Classification 3.0. The study data were exported to the online analysis platform Swallow Gateway. The UES was assessed in terms of UES Resting Pressure (UES-RP), UES Basal Pressure (UES-BP), UES Integrated Relaxation Pressure (UES-IRP), UES Relaxation Time (UES-RT), Basal UES Contractile Integral (Basal UES-CI), Post-Deglutitive UES Contractile Integral (Post-Deglutitive UES-CI), and Proximal Contractile Integral (PCI). Results: ANOVA analysis showed significantly higher values of Post-Deglutitive UES-CI in EoE patients compared with FD patients (p = 0.001). Basal UES-CI and UES-RP showed significantly higher values in EoE (p = 0.002, p = 0.038) and GERD (p < 0.001, p = 0.001) patients compared with FD patients. Correlations between LES-CI and Post-Deglutitive UES-CI, Basal UES-CI, and UES-RP (p ≤ 0.001, p = 0.027, p = 0.017, respectively), and between LES-BP and Post-Deglutitive UES-CI (p = 0.019), independent of diagnosis, were shown. No correlations have been demonstrated between the UES, EGJ metrics, and esophageal symptoms. Conclusions: Some differences in UES metrics in the three different diseases were found. Further studies are needed to confirm the results of our pilot study and possible applications in clinical practice.

show abstract

Section: Discussionsupporting

confidence: 86%

Upper Esophageal Sphincter Metrics across Eosinophilic Esophagitis, Gastroesophageal Reflux Disease and Functional Dysphagia: A Pilot Study

Ruggiero,

Iovino,

Gargano

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…A retrospective study that compared suspected LPR patients with typical GERD patients has revealed that LPR was characterized by higher UES residual pressure . Findings on UES motility were further supported by the efficacy of UES assist device in the patients with laryngeal symptoms . However, another retrospective study that included 22 esophageal symptom patients, 22 extraesophageal symptom patients, and 44 healthy controls have found that both esophageal symptom patients and extraesophageal symptom patients had lower UES basal pressure and shorter UES length than healthy controls .…”

Section: Discussionmentioning

confidence: 99%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim: Laryngopharyngeal reflux (LPR) is caused by the reflux of gastric contents beyond the esophagus into the larynx and pharynx. However, upper esophageal sphincter (UES) motility and proximal esophagus reflux parameters are poorly studied. This study aims to explore the characteristics of UES motility and reflux parameter among LPR patients. Methods: Patients with laryngopharyngeal symptoms only (L), patients with laryngopharyngeal symptoms and typical esophageal symptoms (L + E), patients with typical esophageal symptoms only (E), and healthy controls (H) were retrospectively included. Physiological profiles were studied and compared among groups using both high-resolution manometry and pH-impedance monitoring, including UES basal pressure, residual pressure, relaxation duration time, recovery time, the time to nadir pressure, UES length, proximal contractile integral, and proximal mean nocturnal baseline impedance (MNBI). Patients' symptom outcomes were also analyzed. Results: A total of 242 patients were included. Proximal MNBI was significantly lower in patients with both laryngopharyngeal and esophageal symptoms (17 cm above low esophageal sphincter [LES]: L vs L + E vs E vs H = 3689.7 vs 2500.0 vs 3073.0 vs 3996.0; 15 cm above LES: L vs L + E vs E vs H = 3155.9 vs 2553.4 vs 3198.9 vs 2985.2; P < 0.001). Patients responded to proton pump inhibitor treatment also had lower proximal MNBI than those who did not (17 cm above LES: 1834.0 vs 3500.0; 15 cm above LES: 1946.5 vs 3432.6; P < 0.001). Conclusion: Decreased proximal MNBI can not only identify LPR patients but also predict patients' symptom outcomes.

show abstract

“…8 The device has also been shown to reduce reflux events across the UES in patients receiving long-term nasogastric tube feeds. 9 The feasibility of the UESAD has not been specifically assessed in the LTx population.…”

mentioning

confidence: 99%

“…In addition, significant reductions in salivary pepsin were seen in those with >50% reflux symptom improvement with the UESAD 8 . The device has also been shown to reduce reflux events across the UES in patients receiving long-term nasogastric tube feeds 9 . The feasibility of the UESAD has not been specifically assessed in the LTx population.…”

mentioning

confidence: 99%

Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients

Iyer

Afshar

Golts

et al. 2022

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

Goals: We aimed to evaluate a novel upper esophageal sphincter (UES) assist device loaner program for the prevention of acute cellular rejection and chronic lung allograft dysfunction among lung transplant (LTx) recipients. Background: Laryngopharyngeal reflux can lead to chronic microaspiration and LTx rejection. The UES assist device applies external pressure at the level of UES to decrease reflux. Study: We prospectively enrolled and issued UES assist devices to consecutive transplant patients referred for gastrointestinal motility testing from 2016 to 2020. Device tolerability was defined by successful utilization as a bridge to ambulatory pH monitoring and/or antireflux procedure, or as permanent therapy. Incidence of rejection was analyzed before, during, and after device implementation. Results: Twenty-six participants were issued devices (15 pathologic, 5 physiological, 6 unknown reflux status), none of whom developed acute rejection episodes or chronic lung allograft dysfunction while using the device. Thirteen adopted the device promptly after transplantation (mean 1.7 mo) and remained free of rejection episodes over a mean 24.7 months of follow-up. Among those with pathologic reflux, lag time to device adoption strongly correlated with the development of rejection (r=0.8, P=0.0006). There was no such correlation among those with physiological reflux. Five developed acute rejection after device return. Conclusions: The device was tolerated by a majority of LTx patients and appears feasible as a barrier measure in the prevention of rejection. Delayed treatment of laryngopharyngeal reflux may lead to early allograft failure; therefore, the UES assist device should be given important consideration in transplant protection.

show abstract

Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube–fed patients

Abstract: 4. Laryngoscope, 128:1310-1315, 2018.

Cited by 6 publications

References 29 publications

Upper Esophageal Sphincter Metrics across Eosinophilic Esophagitis, Gastroesophageal Reflux Disease and Functional Dysphagia: A Pilot Study

Upper Esophageal Sphincter Metrics across Eosinophilic Esophagitis, Gastroesophageal Reflux Disease and Functional Dysphagia: A Pilot Study

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients

Contact Info

Product

Resources

About