Ability of High-Resolution Manometry to Determine Feeding Method and to Predict Aspiration Pneumonia in Patients With Dysphagia

Park, Chul-Hyun; Lee, Yong Taek; Yi, Youbin; Lee, Jung-Sang; Park, Jung Ho; Yoon, Kyung Jae

doi:10.1038/ajg.2017.81

Cited by 23 publications

(27 citation statements)

References 38 publications

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“…Park et al reported that aspiration and penetration observed during a videofluoroscopic swallow study and high-resolution manometry were predictors of aspiration pneumonia among patients with dysphagia. 23 Almirall et al reported that oropharyngeal dysphagia is a risk factor for CAP among elderly patients. 24 Moreover, dysphagia related to stroke and Parkinson’s disease is a risk factor of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Tsai

Yang

Liu

et al. 2018

Otolaryngol.--head neck surg.

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Objective To investigate pneumonia risk among patients with unilateral vocal fold paralysis (UVFP). Study Design Retrospective population-based cohort study. Setting This study used data from the National Health Insurance Research Database of Taiwan, a nationwide population-based database. Subjects and Methods A total of 419 patients newly diagnosed with UVFP between January 1, 1997, and December 31, 2013, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients. Moreover, 1676 patients without UVFP were matched to patients with UVFP at a 1:4 ratio based on age, sex, socioeconomic status, urbanization level, and site-specific cancers. Patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of pneumonia. Results The cumulative incidence of pneumonia was significantly higher for patients with UVFP than those without UFVP ( P < .001). The adjusted Cox proportional hazard model showed that UVFP was significantly associated with a higher incidence of pneumonia (hazard ratio, 1.97; 95% CI, 1.35-2.86; P < .001). Subgroup analyses demonstrated that UVFP was an independent risk factor of pneumonia for 4 subgroups: young (18-50 years), older (≥51 years), male, and cancer. Conclusion This is the first nationwide population-based cohort study to investigate the association between UVFP and pneumonia. The findings indicate that UVFP is an independent risk factor of pneumonia. Given the study results, physicians should be aware of the potential for pneumonia occurrence following UVFP.

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Section: Discussionmentioning

confidence: 99%

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Tsai

Yang

Liu

et al. 2018

Otolaryngol.--head neck surg.

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“…Proximal contractile integral reflects oro-pharyngeal functional competency 18 , 34 , 46 . UES and LES Basal tone mmHg.cm.s Continuous ✓ Contractile integral (amplitude*length* duration) calculated during a 2 s window at rest prior to basal swallow 36 , 37 UES and LES Relaxation reflex occurrence % Categorical ✓ Relaxation defined as > 50% decrease from basal tone 34 , 35 UES Contractile reflex % Categorical ✓ Contraction defined as > 50% increase from basal tone- definition adapted from previous works 32 , 33 Esophagus Esophageal contractile vigor mmHg.cm.s Continuous ✓ ✓ ✓ Contractile integral (amplitude*length* duration) of esophageal regions. Proximal esophagus: lower UES border to transition zone.…”

Section: Participants Study Design and Methodsmentioning

confidence: 99%

Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

Jadcherla

Hasenstab

Osborn

et al. 2021

Sci Rep

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Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76–94%] in study (N = 60) vs. 63% [50–77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.

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“…Abnormal HRMF metrics in the UES and proximal esophagus were identified using the following criteria: impaired UES relaxation pressure/duration (relaxation pressure >12 mmHg/<0.45 s), hypertensive resting UES pressure (>104 mmHg), and hypotensive resting UES pressure (<34 mmHg) ( 13 , 14 ). Proximal esophageal contraction integral above 0 mmHg during UES opening (an early response occurring concurrently with UES opening) was also defined as abnormal, a phenomenon observed in this study among MSA patients.…”

Section: Methodsmentioning

confidence: 99%

High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

et al. 2018

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Introduction: Multiple system atrophy (MSA) has detrimental effects on swallowing function. The swallowing function of patients with MSA has not been systematically characterized and the underlying pathophysiological mechanisms of dysphagia remain poorly understood.Objectives: To investigate the characteristics of swallow function in MSA using high-resolution manofluorography (HRMF).Methods: We conducted a retrospective review of twenty-five MSA patients who underwent HRMF from 2016 to 2017. HRMF was utilized on patients with only oral diet (Functional Oral Intake Scale (FOIS) >3). Pharyngoesophageal and proximal esophageal pressure profiles were evaluated and compared to established normative data. The frequency and characteristics of upper esophageal sphincter (UES) and proximal esophageal abnormalities during rest and swallow were calculated.Results: The ages of patient cohort in our study ranged from 48–81 years (median 65 years) with male predominance (68%). We observed a distinct abnormal deglutitive proximal esophageal contraction (ADPEC) in 14 (56% of patients), which appears to reflect a discoordinated response of the striated muscle esophagus. Deficient UES relaxation duration, impaired UES relaxation, hypertensive resting UES pressure and hypotensive resting UES pressure were detected in 8 patients (32%), 3 patients (12%), 1 patient (4%), and 11 patients (44%) respectively.Conclusions: In patients with MSA, abnormal UES resting pressure is common. A discoordinated proximal esophageal pressure response was identified and may be a pathognomonic manometry finding for MSA. These findings may serve as indications of early stage swallowing dysfunction in patients with MSA.

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Ability of High-Resolution Manometry to Determine Feeding Method and to Predict Aspiration Pneumonia in Patients With Dysphagia

Abstract: We first established the optimal thresholds for HRM parameters to determine feeding method and predict the development of aspiration pneumonia in patients with oropharyngeal dysphagia.

Cited by 23 publications

References 38 publications

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality

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