Kunieda Kenjiro, Suzuki Saori, Naganuma Satoe, Okamoto Keishi, Ohno Tomohisa, Shigematsu Takashi, Yagi Naomi, Oku Yoshitaka, Fujishima Ichiro
Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan.
Dysphagia. 2025 Apr;40(2):399-406. doi: 10.1007/s00455-024-10741-y. Epub 2024 Aug 17.
Vacuum swallowing is a unique method for improving the pharyngeal passage of a bolus by creating subatmospheric negative pressure in the esophagus. However, whether healthy individuals and other patients with dysphagia can reproduce vacuum swallowing remains unclear. Therefore, this study aimed to assess whether healthy individuals verified using high-resolution manometry (HRM) could reproduce vacuum swallowing and evaluate its safety using a swallowing and breathing monitoring system (SBMS). Two healthy individuals who mastered vacuum swallowing taught this method to 12 healthy individuals, who performed normal and vacuum swallowing with 5 mL of water five times each. The minimum esophageal pressure and the maximum pressure of the lower esophageal sphincter (LES) were evaluated during each swallow using the HRM. Additionally, respiratory-swallowing coordination was evaluated using the SBMS. Ten individuals reproduced vacuum swallowing, and a total of 50 vacuum swallows were analyzed. The minimum esophageal pressure (-15.0 ± 4.9 vs. -46.6 ± 16.7 mmHg; P < 0.001) was significantly lower, and the maximum pressure of the LES (25.4 ± 37.7 vs. 159.5 ± 83.6 mmHg; P < 0.001) was significantly higher during vacuum swallowing. The frequencies of the I-SW and SW-I patterns in vacuum swallowing were 38.9% and 0%, respectively, using the SBMS. Vacuum swallowing could be reproduced safely in healthy participants with instruction. Therefore, instructing exhalation before and after vacuum swallowing is recommended to prevent aspiration.
真空吞咽是一种通过在食管中产生低于大气压的负压来改善食团咽部通过的独特方法。然而，健康个体和其他吞咽困难患者是否能够重现真空吞咽仍不清楚。因此，本研究旨在评估经高分辨率测压法（HRM）验证的健康个体是否能够重现真空吞咽，并使用吞咽与呼吸监测系统（SBMS）评估其安全性。两名掌握真空吞咽的健康个体将此方法传授给12名健康个体，这些个体分别用5毫升水进行5次正常吞咽和真空吞咽。在每次吞咽过程中，使用HRM评估食管最小压力和食管下括约肌（LES）的最大压力。此外，使用SBMS评估呼吸-吞咽协调性。10名个体重现了真空吞咽，共分析了50次真空吞咽。在真空吞咽期间，食管最小压力（-15.0±4.9 vs. -46.6±16.7 mmHg；P<0.001）显著降低，LES最大压力（25.4±37.7 vs. 159.5±83.6 mmHg；P<0.001）显著升高。使用SBMS，真空吞咽中I-SW和SW-I模式的频率分别为38.9%和0%。在有指导的情况下，健康参与者能够安全地重现真空吞咽。因此，建议在真空吞咽前后指导呼气以防止误吸。
