Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia

Abstract

Stasis of both liquid and solid boluses occurs frequently in patients and in controls and can be regarded as physiological. Motility patterns can predict the effectiveness of bolus transit and level of stasis to some degree but the relationship between esophageal motility and transit is complex and far from perfect. Esophageal manometry is therefore currently deemed unfit to be used for the prediction of bolus transit, and should rather be used for the identification of treatable esophageal motility disorders.

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

“…In the current study we also could not demonstrate a relation between incomplete bolus liquid transit and perception. This is consistent with what has been previously described 8,10,11 . To date, there is no evidence to support that weak peristalsis, nor any of its consequences (peristaltic breaks and incomplete bolus transit), can explain bolus perception.…”

“…It could be that the evaluated mechanism is nonspecific for dysphagia. An example is incomplete bolus transit, which has been reported in healthy volunteers in 40% for liquid and in 80% for solid swallows 10 . When a putative mechanism is highly prevalent in healthy individuals, its positive predictive value diminishes.…”

Impedance as an adjunct to manometric testing to investigate symptoms of dysphagia: What it has failed to do and what it may tell us in the future

“…46,47 Additionally, bolus stasis is frequently observed in controls and therefore is not pathological when considered in isolation. 48 A clinically useful motility investigation should be able to distinguish patients with hypersensitivity from patients with true motor dysfunctions. Whilst studies have linked chest pain with hypertensive motor disorders, 19 the association of heightened perception of swallowed boluses and other types of motor abnormalities is less clear.…”

Usefulness of low- and high-volume multiple rapid swallowing during high-resolution manometry

“…It is known that 10 symptoms and hypotensive peristalsis [6], and MRS can be useful for predicting the development of dysphagia in patients who have undergone anti-reflux surgery [7]. In addition to motor inhibition and after-contraction, 200 mL MRS could also be used to detect increased oesophageal resistance to outflow, as assessed by the oesophago-gastric pressure gradient because of the high volume of water flowing through the oesophagus.…”

“…Various tests have been proposed as a means of further characterising patients with oesophageal symptoms and detecting motor abnormalities in those with normal oesophageal manometry findings, including low (10 mL) or high volume (200 mL) multiple rapid swallowing (MRS) [5][6][7][8] and the ingestion of a solid bolus [8][9][10].…”