Modulation of pharyngeal swallowing by bolus volume and viscosity

Ferris, Lara; Doeltgen, Sebastian; Cock, Charles; Rommel, Nathalie; Schar, Mistyka; Carrión, Sílvia; Scholten, Ingrid; Omari, Taher

doi:10.1152/ajpgi.00270.2020

Cited by 28 publications

(48 citation statements)

References 65 publications

(74 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In lieu of a pharyngeal equivalent to the Chicago esophageal HRM classification 27 , we selected patients for C-POEM using stringent manometric criteria based on statistically-defined laboratory normative data. We defined UES IRP > 2.9 mm Hg (95 th percentile) as the main diagnostic criterion for incomplete UES relaxation 22 . Furthermore, patients had to demonstrate at least one additional abnormal UES metric: either increased flow resistance (i. e. IBP), or reduced UES opening (defined by either abnormal UES Maximal Admittance, or reduced UES RT), to be eligible for C-POEM.…”

Section: Discussionmentioning

confidence: 99%

“…1 ): 1) UES Integrated Relaxation Pressure (IRP) quantifies the lowest non-consecutive 0.25 seconds of UES relaxation during deglutition; 2) Hypopharyngeal Intrabolus Pressure (IBP) measures (indirectly) the UES restriction to bolus flow; 3) UES Maximal Admittance (MaxAd) is a surrogate marker for maximal deglutitive luminal cross-sectional area; and 4) UES relaxation time (RT) measures the deglutitive UES relaxation duration. Abnormality was defined as values outside of 95 % reference range interval established from historical laboratory controls studied using identical equipment 22 .…”

Section: Methodsmentioning

confidence: 99%

“…UES dysfunction, for the purpose of the study, was defined as impaired UES relaxation (i. e., IRP > 2.9 mm Hg) 22 , and the presence of one or more of the following measures of the biomechanical consequences of impaired UES relaxation: increased trans-sphincteric resistance (i. e. raised IBP); reduced UES opening diameter (i. e. reduced MaxAd), or reduced UES opening duration (i. e. reduced RT) during 10-mL thin liquid bolus swallows.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Szczęśniak

Omari

et al. 2021

Endosc Int Open

Self Cite

View full text Add to dashboard Cite

Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Szczęśniak

Omari

et al. 2021

Endosc Int Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…5ml and 10ml) should be included. In addition, completing more than one viscocity would be beneficial to determine the impact of the effortful swallow across bolus conditions (Ferris et al, 2021).…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Heslin

Regan

2021

International Journal of Speech-Language Pathology

View full text Add to dashboard Cite

Purpose: Evidence base to support use of the effortful swallow in clinical populations with dysphagia is currently lacking. This study aims to quantify the effects of effortful swallowing on pharyngeal swallowing biomechanics in adults with dysphagia using pharyngeal high-resolution manometry (PHRM).Method: ManoScan HRM equipment with a 4.2 mm pressure catheter was used.Participants completed duplicate 10ml baseline and 10ml effortful liquid (IDDSI Level 0) swallows in randomized order. PHRM data were analysed using a semiautomated online platform (www.swallowgateway.com).Result: Fifteen adults (8 males; range 45-86 years) with mixed aetiology dysphagia (Functional Oral Intake Scale Level 2-5) were included. Median pharyngeal contractile (156.81 mmHg cm s; IQR 80.62) increased significantly (213.50 mmHg cm s; IQR 117.2) during effortful swallowing (p = 0.002). Significant increases were also observed in velopharyngeal pressure (p = 0.001), mesopharyngeal pressure (p = 0.027), hypopharyngeal pressure (p = 0.003) and UOS relaxation duration (p = 0.002). UOS IRP was not significantly altered with effortful swallowing (p = 0.233). Conclusion:Effortful swallowing induced significant biomechanical changes to swallowing in adults with dysphagia. Increases in global pharyngeal rigor, tongue base pressure and UOS opening duration were captured by PHRM during effortful swallowing. Further investigation in larger homogeneous clinical populations is needed to verify the physiological effects of this frequently employed intervention.

show abstract

“…7 Due to its non-radiological approach, the latter method offers greater scope for testing with an expanded range of bolus challenges. [11][12][13] On P-HRM-I, different pharyngeal bolus flow and pressurization pattern subtypes can be recognized. Some of these patterns are suggestive of pharyngeal outflow obstruction and may reflect either sustained bolus pressurization between the PEJ and the pharyngeal stripping contraction, or un-sustained, transient pressurization (TP) phenomena (Figure 1).…”

mentioning

confidence: 99%

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

Omari

Rommel

Tack

et al. 2021

Neurogastroenterology Motil

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Modulation of pharyngeal swallowing by bolus volume and viscosity

Cited by 28 publications

References 65 publications

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

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

Contact Info

Product

Resources

About