Omari Taher, Cock Charles, Wu Peter, Szczesniak Michal Marcin, Schar Mistyka, Tack Jan, Rommel Nathalie
Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
Neurogastroenterol Motil. 2023 Jan;35(1):e14461. doi: 10.1111/nmo.14461. Epub 2022 Sep 19.
Oro-pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high-resolution manometry impedance (P-HRM-I). We aimed to establish methodology to diagnose disorders utilizing P-HRM-I, hypothesizing that the objective measures could be used to diagnose disordered deglutition evidenced by greater aspiration scores.
Patients (n = 509, 18-91 years) were compared to controls (n = 120, 20-94 years). Variables measuring UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contractile strength were derived for 10 ml liquid swallows. Three associated pharyngeal pressurization patterns, which may be indicative of obstructed flow, were characterized: pan-pressurization (Type 1), distal compartmentalized pressurization (Type 2), and transient pressurization (Type 3). Deglutitive aspiration was determined from video fluoroscopy.
UES relaxation pressure was best able to differentiate patients from controls (T 6.528, p < 0.0001). Patients with abnormal relaxation pressure (>8 mmHg) more frequently exhibited pharyngeal pressurization patterns and had adjunct evidence of reduced luminal distensibility (high intrabolus pressure and/or reduced UES opening). Utilizing this information, a diagnostic scheme was devised identifying 138 patients with UES disorder. A further 96 patients without evidence of UES disorder had abnormally weak pharyngeal pressures, confirming propulsive disorder. Amongst a sub-sample of 320 patients undergoing video fluoroscopy, those with pharyngeal pressurizations and adjunct evidence of reduced UES relaxation and/or distensibility had higher aspiration scores (Chi-square 60.169, p < 0.0001).
P-HRM-I can provide evidence for UES disorder based on pharyngeal pressurization patterns and abnormal findings for UES relaxation pressure, UES opening, and intrabolus pressure. Measuring pharyngeal contractility requires further optimization.
口咽病理生理学，包括食管上括约肌（UES）和咽部疾病，可通过咽部高分辨率测压阻抗（P-HRM-I）进行评估。我们旨在建立利用P-HRM-I诊断疾病的方法，假设客观测量可用于诊断吞咽障碍，其表现为更高的误吸评分。
将患者（n = 509，18 - 91岁）与对照组（n = 120，20 - 94岁）进行比较。针对10毫升液体吞咽，得出测量UES松弛、UES开口程度、团块内压力和咽部收缩强度的变量。确定了三种可能表明流动受阻的相关咽部增压模式：全增压（1型）、远端分区增压（2型）和短暂增压（3型）。通过视频荧光透视法确定吞咽误吸情况。
UES松弛压力最能区分患者与对照组（T = 6.528，p < 0.0001）。松弛压力异常（>8 mmHg）的患者更频繁地表现出咽部增压模式，并有管腔扩张性降低的辅助证据（高团块内压力和/或UES开口减小）。利用这些信息，设计了一种诊断方案，识别出138例UES疾病患者。另有96例无UES疾病证据的患者咽部压力异常微弱，证实存在推进障碍。在接受视频荧光透视法检查的320例患者的子样本中，有咽部增压以及UES松弛和/或扩张性降低辅助证据的患者误吸评分更高（卡方值 = 60.169，p < 0.0001）。
P-HRM-I可根据咽部增压模式以及UES松弛压力、UES开口和团块内压力的异常结果为UES疾病提供证据。测量咽部收缩力需要进一步优化。
