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Omari T, Rommel N, Jan T, et al. Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?. Neurogastroenterol Motil. 2021;e14276doi: 10.1111/nmo.14276.
Omari, T., Rommel, N., Jan, T., Szczesniak, M., Wu, P., Schar, M., Doeltgen, S., & Cock, C. (2021). Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, e14276. https://doi.org/10.1111/nmo.14276
Omari, Taher, et al. "Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?." Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society vol. (2021): e14276. doi: https://doi.org/10.1111/nmo.14276
Omari T, Rommel N, Jan T, Szczesniak M, Wu P, Schar M, Doeltgen S, Cock C. Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?. Neurogastroenterol Motil. 2021 Oct 04;e14276. doi: 10.1111/nmo.14276. Epub 2021 Oct 04. PMID: 34606649.
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Neurogastroenterol Motil. 2021 Oct 04;e14276. doi: 10.1111/nmo.14276. Epub 2021 Oct 04.

Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?.

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

Taher Omari, Nathalie Rommel, Tack Jan, Michal Szczesniak, Peter Wu, Mistyka Schar, Sebastian Doeltgen, Charles Cock

Affiliations

  1. Flinders Health and Medical Research Institute (FHMRI) & College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
  2. Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
  3. Deglutology, Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium.
  4. Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.
  5. Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Belgium.
  6. Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
  7. Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.

PMID: 34606649 DOI: 10.1111/nmo.14276

Abstract

INTRODUCTION: In oropharyngeal dysphagia, impaired pharyngoesophageal junction (PEJ) opening is reflected by an elevated hypopharyngeal intrabolus pressure (IBP), quantifiable using pharyngeal high-resolution manometry with impedance (P-HRM-I). Transient intrabolus pressurization (TP) phenomena are not sustained and last for only a brief period. We hypothesized that TP patterns reflect impaired coordination between timing of hypopharyngeal bolus arrival and PEJ relaxation.

METHODS: A retrospective audit was conducted of P-HRM-I datasets; 93 asymptomatic Controls and 214 Patients with differing etiological/clinical backgrounds were included. TP patterns were examined during 10ml liquid swallows. TP was defined by a simultaneous, non-sustained, pressurization wave spanning from the velo-/meso-pharynx to PEJ. The coordination between deglutitive pharyngeal bolus distension and PEJ relaxation timing was assessed using timing variables; (i) Distention-Contraction Latency (DCL, s) and (ii) PEJ Relaxation Time (RT, s). Resultant flow resistance was quantified (IBP, mmHg).

RESULTS: TP swallows were observed in 87 (28%) cases. DCL was not significantly different in relation to TP, while PEJ relaxation time was shorter, and IBP was higher during TP swallows. In Patients RT-DCL time difference correlated with IBP (r -0.368, p < 0.01).

CONCLUSION: Bolus distension and PEJ relaxation were miss-timed during TP swallows, impeding bolus flow and leading to a brief period of pressurization of the pharyngeal chamber by muscular propulsive forces. While TP swallows were identified in both Controls and Patients, increased IBPs were most apparent for Patient swallows indicating that the extent of IBP increase may differentiate pathological TP swallows.

© 2021 John Wiley & Sons Ltd.

Keywords: dysphagia; high resolution manometry; impedance; pharynx; swallowing

References

  1. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. J Physiological Reviews. 2001;81(2):929-969. - PubMed
  2. Miller AJ. Overview of deglutition and digestion. In: Peter CB, Gregory NP, Caryn E, eds. Principles of Deglutition. Springer; 2013:3-17. - PubMed
  3. Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259. - PubMed
  4. Shaw D, et al. Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum. Gut. 1996;38(6):806-811. - PubMed
  5. Ali GN, Wallace KL, Laundl TM, Hunt DR, deCarle DJ, Cook IJ. Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia. Dysphagia. 1997;12(3):133-139. - PubMed
  6. Pal A, Williams RB, Cook IJ, Brasseur JG. Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow. Am J Physiol-Gastrointes Liver Physiol. 2003;285(5):G1037-G1048. - PubMed
  7. Szczesniak M, et al. The critical importance of pharyngeal contractile forces on the validity of intrabolus pressure (IBP) as a predictor of impaired pharyngo-esophageal junction compliance. Neurogastroenterol Mot (submitted), 2018;30(10):e13374. - PubMed
  8. Omari TI, Ciucci M, Gozdzikowska K et al. High-resolution pharyngeal manometry and impedance: protocols and metrics-recommendations of a high-resolution pharyngeal manometry International working group. Dysphagia. 2020;35(2):281-295. - PubMed
  9. Zhang T, Szczesniak M, Maclean J et al. Biomechanics of pharyngeal deglutitive function following total laryngectomy. Otolaryngol-Head Neck Surg. 2016;155(2):295-302. - PubMed
  10. Walczak CC, Jones CA, McCulloch TM. Pharyngeal pressure and timing during bolus transit. Dysphagia. 2017;32(1):104-114. - PubMed
  11. Cock C, Jones CA, Hammer MJ, Omari TI, McCulloch TM. Modulation of upper esophageal sphincter (UES) relaxation and opening during volume swallowing. Dysphagia. 2017;32(2):216-224. - PubMed
  12. Ferris L, Schar M, McCall L et al. Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter. The Laryngoscope. 2018;128(6):1328-1334. - PubMed
  13. Ferris L, Doeltgen S, Cock C, et al. Modulation of pharyngeal swallowing by bolus volume and viscosity. Am J Physiol-Gastroint Liver Physiol. 2021;320(1):G43-G53. - PubMed
  14. McConnel FM, Cerenko D, Jackson RT, Guffin TN. Timing of major events of pharyngeal swallowing. Arch Otolaryngol-Head Neck Surg. 1988;114(12):1413-1418. - PubMed
  15. Szczesniak MM, Maclean J, Zhang T, Liu R, Cook IJ. The normative range for and age and gender effects on the Sydney Swallow Questionnaire (SSQ). Dysphagia. 2014;29(5):535-538. - PubMed
  16. Omari T. Swallow Gateway™ for High Resolution Pharyngeal and Esophageal Manometry. 2020 [June 16, 2020]; Available from: . - PubMed
  17. Singendonk M, et al. Reliability of an online analysis platform for pharyngeal high-resolution impedance manometry recordings. Speech, Language and Hearing; 2018;22(4):1-9. - PubMed
  18. Cook IJ, Dodds WJ, Dantas RO, et al. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol-Gastroint Liver Physiol. 1989;257(5):G748-G759. - PubMed
  19. Omari TI, et al. Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening. Front Syst Neurosci. 2015;8:241. - PubMed
  20. Zifan A, Ledgerwood-Lee M, Mittal RK. Measurement of peak esophageal luminal cross-sectional area utilizing nadir intraluminal impedance. Neurogastroenterol Motil. 2015;27(7):971-980. - PubMed
  21. Cock C, Besanko L, Kritas S, et al. Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction. Neurogastroenterol Motil. 2016;28(2):225-233. - PubMed
  22. Wu PI, et al. Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease. Endos Int Open; 2021;09:E1-E9. In Press. - PubMed
  23. Sokol EM, Heitmann P, Wolf BS, Cohen BR. Simultaneous cineradiography and manometric study of the pharynx, hypopharynx, and cervical esophagus. Gastroenterology. 1966;51(6):960-974. - PubMed
  24. Ertekin C, Aydogdu I, Yüceyar N, Kiylioglu N, Tarlaci S, Uludag B. Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis. Brain. 2000;123(1):125-140. - PubMed
  25. Omari T, Ferris L, Schar M, Cock C, Doeltgen S. Multiple swallow behaviour during high resolution pharyngeal manometry: prevalence and sub-typing in healthy adults. Speech, Language and Hearing. 2020;1-7. - PubMed
  26. Doeltgen SH, Ong E, Scholten I, Cock C, Omari T. Biomechanical quantification of Mendelsohn maneuver and effortful swallowing on pharyngoesophageal function. Otolaryngology-Head and Neck Surgery. 2017;157(5):816-823. - PubMed

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