Clinical correlates of dysphagia to oesophageal dysmotility: studies using combined manometry and impedance

Abstract

This study aimed to elucidate the mechanism of dysphagia by determining the simultaneous relationships between subjective perception of swallow with oesophageal motility and bolus transport in patients with non-obstructive dysphagia (NOD). Combined oesophageal manometry and impedance was performed in 18 consecutive NOD patients and 14 healthy controls. Swallow was abnormal if the amplitude of distal oesophageal contractions was less than 30 mmHg or simultaneous contractions occurred. Bolus transit was abnormal if bolus exit was not found at one or more of the measuring sites. Perception of each swallow was assessed using a standardized scoring system and was enhanced if score was >1. The prevalence of complete bolus transit was lower in NOD patients compared with healthy controls (P = 0.001). Abnormal liquid bolus transit was found in 40% of patients with normal motility and 38% of patients with abnormal motility, whereas abnormal viscous bolus transit was observed in 38% of patients with normal motility and 70% of patients with abnormal motility. Agreement between enhanced perception and impedance was poor during liquid (kappa = 0.12, 95% CI: -0.003 to 0.233) and viscous swallowing (kappa = 0.12, 95% CI: -0.004 to 0.244). Agreement between enhanced perception and manometry was even poorer during liquid (kappa = -0.16, 95% CI: -0.302 to 0.022) and viscous swallowing (kappa = -0.12, 95% CI: -0.25 to 0.002). NOD patients show poor correlation between dysphagia and oesophageal motility parameters. The results suggest that, in patients with NOD, oesophageal motor dysfunction may play a limited role, if any, in the generation of dysphagia.

Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals

“…This is in concordance with previous reports [7][8][9] . Lazarescu et al failed to demonstrate any correlation between perception and sildenafil-induced hypomotility in healthy volunteers 8 .…”

“…This could be due to lack of effective treatments, but also because such manometric patterns may not be causally related to symptoms. The use of standard pressure-only manometry has repeatedly shown no correlation with bolus passage perception, both in symptomatic and asymptomatic individuals 7,8 . Despite the better spatiotemporal discrimination of HRM, its findings could not be correlated with perception in a large dysphagia cohort 9 .…”

“…When a putative mechanism is highly prevalent in healthy individuals, its positive predictive value diminishes. In fact, dichotomous determination of bolus transit has never been correlated with perception, either evaluated with impedance 7 or fluoroscopy 11 . These findings highlight the importance of including normals in the study of a certain mechanism.…”

High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance

“…These findings are similar to a previous study, where there was a poor correlation between dysphagia symptoms and esophageal dysmotility in terms of contractility and impaired bolus transport. 20 Our study has several limitations. The major one is the retrospective study design.…”

Abnormal Sensory Perception or Peristaltic Dysfunction: Which One Is Associated With Symptoms?

“…3,4 Instead, esophageal motor abnormalities and impaired bolus transits increase in harmony with the severity of gastroesophageal reflux disease.…”