Diagnosis of Swallowing Disorders: How We Interpret Pharyngeal Manometry

被引:47
作者
Cock C. [1 ,2 ]
Omari T. [2 ,3 ]
机构
[1] Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide
[2] Department of Gastroenterology & Hepatology, School of Medicine, Flinders University of South Australia, Flinders Medical Centre, Flinders Drive, Bedford Park
[3] Human Physiology, Medical Science and Technology, Flinders University of South Australia, Bedford Park
关键词
Deglutition; Dysphagia; High-resolution manometry; Impedance; Pharynx; Pressure;
D O I
10.1007/s11894-017-0552-2
中图分类号
学科分类号
摘要
Purpose of review: We provide an overview of the clinical application of novel pharyngeal high-resolution impedance manometry (HRIM) with pressure flow analysis (PFA) in our hands with example cases. Recent findings: In our Centre, we base our interpretation of HRIM recordings upon a qualitative assessment of pressure-impedance waveforms during individual swallows, as well as a quantitative assessment of averaged PFA swallow function variables. We provide a description of two global swallowing efficacy measures, the swallow risk index (SRI), reflecting global swallowing dysfunction (higher SRI = greater aspiration risk) and the post-swallow impedance ratio (PSIR) detecting significant post-swallow bolus residue. We describe a further eight swallow function variables specific to the hypopharynx and upper esophageal sphincter (UES), assessing hypo-pharyngeal distension pressure, contractility, bolus presence and flow timing, and UES basal tone, relaxation, opening and contractility. Summary: Pharyngeal HRIM has now come of age, being applicable for routine clinical practice to assess the biomechanics of oropharyngeal swallowing dysfunction. In the future, it may guide treatment strategies and allow more objective longitudinal follow-up on clinical outcomes. © 2017, The Author(s).
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共 28 条
[1]  
Omari T.I., Jones C.A., Hammer M.J., Cock C., Dinning P., Wiklendt L., Et al., Predicting the activation states of the muscle governing upper esophageal sphincter relaxation and opening, Am J Physiol Gastrointest Liver Physiol, 310, pp. G359-G366, (2016)
[2]  
Modulation of upper esophageal sphincter (UES) relaxation and opening during volume swallowing, Sensory modulation of swallowing assessed by pressure-flow analysis, (2016)
[3]  
Cook I.J., Dodds W.J., Dantas R.O., Kern M.K., Massey B.T., Shaker R., Et al., Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing, Dysphagia, 4, pp. 8-15, (1989)
[4]  
Cook I.J., Dodds W.J., Dantas R.O., Massey B., Kern M.K., Lang I.M., Et al., Opening mechanisms of the human upper esophageal sphincter, Am J Physiol, 257, pp. G748-G759, (1989)
[5]  
Omari T.I., Dejaeger E., Tack J., Van Beckevoort D., Rommel N., Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients, Dysphagia, 28, pp. 146-152, (2013)
[6]  
Rosenbek J.C., Robbins J.A., Roecker E.B., Coyle J.L., Wood J.L., A penetration-aspiration scale, Dysphagia, 11, 2, pp. 93-98, (1996)
[7]  
Molfenter S.M., Steele C.M., The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale, Dysphagia, 28, pp. 494-500, (2013)
[8]  
Pal A., Williams R.B., Cook I.J., Brasseur J.G., Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow, Am J Physiol Gastrointest Liver Physiol, 285, pp. G1037-G1048, (2003)
[9]  
Williams R.B., Wallace K.L., Ali G.N., Cook I.J., Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia, Am J Physiol Gastrointest Liver Physiol, 283, pp. G16-G26, (2002)
[10]  
Olsson R., Nilsson H., Ekberg O., Simultaneous videoradiography and computerized pharyngeal manometry – videomanometry, Acta Radiol, 35, pp. 30-34, (1994)