The Balloon-Based Manometry Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis

Abstract

The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS) patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC) and the upper oesophageal sphincter pressure (UESP), and the hypopharyngeal suction pump (HSP) as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT), pharyngeal transit time (PTT), hypopharyngeal transit time (HTT) and average pharyngeal bolus velocity (APBV), respectively). Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.

Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS)

“…Our results demonstrate that measures of pharyngeal constriction area in patients with ALS are markedly larger (ie, reduced constriction) compared to published data from healthy adults . These data support previous descriptions of swallowing inefficiency from videofluoroscopy as well as studies using manometry that have demonstrated reduced pharyngeal swallowing pressures in individuals with ALS . Our data suggest that the degree to which pharyngeal constriction is reduced is more pronounced in bulbar‐onset ALS patients compared to spinal‐onset and is associated with ALSFRS‐R bulbar subscores.…”

“…The authors identified differences in pharyngeal pressure generation during swallowing for patients with a bulbar‐onset, within 6 months following the onset of symptoms. Similarly, Tomik et al identified reduced base of tongue pressure and prolonged bolus transit times in patients with bulbar ALS . Using combined manometry and videofluoroscopy, Goeleven and colleagues reported converging evidence of low tongue driving force and reduced pharyngeal contraction amplitudes during swallowing, and noted co‐occurrence of these impairments and the presence of postswallow pharyngeal residue .…”

Microbiome-Gut-Brain Axis and Toll-Like Receptors in Parkinson’s Disease

“…GI dysfunctions are generally experienced by most patients with PD and usually include hypersalivation, dysphagia, delayed gastric emptying, nausea, constipation and altered bowel habits. Disturbances in oral and pharyngeal swallowing have been shown in other neurological diseases, such as amyotrophic lateral sclerosis, and manometric endoscopy of the upper GI tract was a useful procedure for the assessment of the severity of deglutition disorders among these patients [ 54 ].…”

Potential Role of Humoral IL-6 Cytokine in Mediating Pro-Inflammatory Endothelial Cell Response in Amyotrophic Lateral Sclerosis

“…B-CNS-B impairment has been detected in ALS, suggesting that barrier breakdown is a significant contributor to disease progression [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Besides determining systemic biomarkers associated with ALS, it is also important to evaluate detrimental effect(s) of humoral factors on endothelium homeostasis since ECs comprise the first lining of cells separating the blood compartment from CNS tissues [ 53 , 54 ].…”

“…However, regardless of the part of the body first affected by the disease, muscle weakness and atrophy spread to other parts of the body as the disease progresses. Developing specific tools for evaluation of clinical symptoms in ALS patients is very important not only for early diagnosis but also for measuring disease progression, i.e., monitoring swallowing or dysphagia [ 18 , 19 ]. In spite of intensive research on ALS pathogenesis, numerous intrinsic and extrinsic factors in motor neuron death (reviewed in [ 15 , 20 , 21 , 22 , 23 , 24 ]) limit therapeutic options.…”