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Effect of Bolus Volume and Viscosity on Pharyngeal Automated Impedance Manometry Variables Derived for Broad Dysphagia Patients

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Abstract

Automated impedance manometry (AIM) analysis measures swallow variables defining bolus timing, pressure, contractile vigour, and bolus presence, which are combined to derive a swallow risk index (SRI) correlating with aspiration. In a heterogeneous cohort of dysphagia patients, we assessed the impact of bolus volume and viscosity on AIM variables. We studied 40 patients (average age = 46 years). Swallowing of boluses was recorded with manometry, impedance, and videofluoroscopy. AIMplot software was used to derive functional variables: peak pressure (PeakP), pressure at nadir impedance (PNadImp), time from nadir impedance to peak pressure (TNadImp-PeakP), the interval of impedance drop in the distal pharynx (flow interval, FI), upper oesophageal sphincter (UES) relaxation interval (UES RI), nadir UES pressure (Nad UESP), UES intrabolus pressure (UES IBP), and UES resistance. The SRI was derived using the formula SRI = (FI * PNadImp)/(PeakP * (TNadImp-PeakP + 1)) * 100. A total of 173 liquid, 44 semisolid, and 33 solid boluses were analysed. The SRI was elevated in relation to aspiration. PeakP increased with volume. SRI was not significantly altered by bolus volume. PNadImp, UES IBP, and UES resistance increased with viscosity. SRI was lower with increased viscosity. In patients with dysphagia, the SRI is elevated in relation to aspiration, reduced by bolus viscosity, and not affected by bolus volume. These data provide evidence that pharyngeal AIM analysis may have clinical utility for assessing deglutitive aspiration risk to liquid boluses.

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Abbreviations

NadUESP:

UES nadir relaxation pressure

PAS:

Penetration–aspiration scale

PeakP:

Peak pressure

PNadImp:

Pressure at nadir impedance

SRI:

Swallow risk index

TNadImp-PeakP:

Time from nadir impedance to peak pressure

UES IBP:

UES intrabolus pressure

UES RI:

UES relaxation interval

UES:

Upper oesophageal sphincter

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Acknowledgments

This study was supported by The Thrasher Research Fund, The National Health and Medical Research Council, and a Methusalem grant from Leuven University to Prof. J. Tack.

Conflict of interest

Dr. Omari has acted as a consultant to Sandhill Scientific Inc. E. Dejaeger, J. Tack, D. Van Beckevoort, and N. Rommel have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Gastroenterology Unit, Women’s and Children’s Health Network, North Adelaide, SA, Australia

    Taher I. Omari

  2. School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia

    Taher I. Omari

  3. Geriatric Medicine, University Hospital Leuven, Leuven, Belgium

    Eddy Dejaeger

  4. Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium

    Jan Tack & Nathalie Rommel

  5. Department of Radiology, University Hospital Leuven, Leuven, Belgium

    Dirk Van Beckevoort

  6. Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium

    Nathalie Rommel

  7. Gastroenterology Unit, Children, Youth & Women’s Health Service, 72 King William Road, North Adelaide, SA, 5006, Australia

    Taher I. Omari

Authors
  1. Taher I. Omari
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  2. Eddy Dejaeger
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  3. Jan Tack
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  4. Dirk Van Beckevoort
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  5. Nathalie Rommel
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Correspondence to Taher I. Omari.

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Omari, T.I., Dejaeger, E., Tack, J. et al. Effect of Bolus Volume and Viscosity on Pharyngeal Automated Impedance Manometry Variables Derived for Broad Dysphagia Patients. Dysphagia 28, 146–152 (2013). https://doi.org/10.1007/s00455-012-9423-z

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  • DOI: https://doi.org/10.1007/s00455-012-9423-z

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