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Accuracy of High-Resolution Pharyngeal Manometry Metrics for Predicting Aspiration and Residue in Oropharyngeal Dysphagia Patients with Poor Pharyngeal Contractility

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Abstract

Several physiological metrics can be derived from pharyngeal high-resolution impedance manometry (HRPM), but their clinical relevance has not been well established. We investigated the diagnostic performance of these metrics in relation to videofluoroscopic (VFS) assessment of aspiration and residue in patients with oropharyngeal dysphagia. We analyzed 263 swallows from 72 adult patients (22–91 years) with diverse medical conditions. Metrics of contractility, upper esophageal sphincter (UES) opening and relaxation, flow timing, intrabolus distension pressure, and a global Swallow Risk Index (SRI) were derived from pressure-impedance recordings using pressure-flow analysis. VFS data were independently scored for airway invasion and pharyngeal residue using the Penetration-Aspiration Scale and the Normalized Residue Ratio Scale, respectively. We performed multivariate logistic regression analyses to determine the relationship of HRPM metrics with radiological outcomes and receiver-operating characteristic (ROC) analysis to evaluate their diagnostic accuracy. We identified aspiration in 25% and pharyngeal residue in 84% of the swallows. Aspiration was independently associated with hypopharyngeal peak pressure < 65 mmHg (HypoPeakP) [adjusted odds ratio (OR) 5.27; 95% Confidence Interval (CI) (0.99–28.1); p = 0.051], SRI > 15 [OR 4.37; 95% CI (1.87–10.2); p < 0.001] and proximal esophageal contractile integral (PCI) < 55 mmHg·cm·s [OR 2.30; 95% CI (1.07–4.96); p = 0.034]. Pyriform sinus residue was independently predicted by HypoPeakP < 65 mmHg [OR 7.32; 95% CI (1.93–27.7); p = 0.003], UES integrated relaxation pressure (UES-IRP) > 3 mmHg [OR 2.96; 95% CI (1.49–5.88); p = 0.002], and SRI > 15 [OR 2.17; 95% CI (1.04–4.51); p = 0.039]. Area under ROC curve (AUC) values for individual HRPM metrics ranged from 0.59 to 0.74. Optimal cut-off values were identified. This study demonstrates the diagnostic value of certain proposed and adjunct HRPM metrics for identifying signs of unsafe and inefficient bolus transport in patients with oropharyngeal dysphagia.

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Abbreviations

BPT:

Hypopharyngeal bolus presence time

DCL:

Hypopharyngeal distension to contraction latency

HCI:

Hypopharyngeal contractile integral

HRPM:

High-resolution pharyngeal manometry

HypoPeakP:

Hypopharyngeal mean peak pressure

IBP:

Hypopharyngeal intrabolus pressure

IRP:

Integrated relaxation pressure

MaxAd:

Maximum admittance

MBSImP:

Modified Barium Swallow Impairment Profile

MCI:

Mesopharyngeal contractile integral

NRRSp:

Normalized residue ratio scale (pyriform sinus residue)

NRRSv:

Normalized residue ratio scale (vallecular residue)

OPD:

Oropharyngeal dysphagia

PAS:

Penetration-Aspiration Scale

PCI:

Proximal esophageal contractile integral

PFA:

Pressure-flow analysis

PhCI:

Pharyngeal contractile integral

RT:

Relaxation time

SRI:

Swallow risk index

UES:

Upper esophageal sphincter

VCI:

Velopharyngeal contractile integral

VFS:

Videofluoroscopy

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Acknowledgements

Part of this study was completed as a master’s dissertation to fulfill the requirements for the degree of Master of Deglutology at the Faculty of Medicine, KULeuven. This dissertation was written by the first author (HB), who received a scholarship grant from the Department of Science and Technology—Science Education Institute (DOST-SEI) of the Republic of the Philippines to study in Leuven, Belgium.

Funding

No funds, grants, or other support was received for conducting this study.

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Authors and Affiliations

  1. Department of Neurosciences, Experimental Otorhinolaryngology, Deglutology, Faculty of Medicine, University of Leuven, Herestraat 49, PO box 721, 3000, Leuven, Belgium

    Howell Henrian G. Bayona, Ann Goeleven & Nathalie Rommel

  2. Department of Speech Pathology, College of Allied Medical Professions, University of the Philippines Manila, Manila, Philippines

    Howell Henrian G. Bayona

  3. Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy

    Nicole Pizzorni

  4. Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium

    Jan Tack & Nathalie Rommel

  5. Department of Gastroenterology, Neurogastroenterology and Motility, University Hospital Leuven, Leuven, Belgium

    Jan Tack & Nathalie Rommel

  6. Department of Otorhinolaryngology, Head & Neck Surgery, MUCLA, University Hospital Leuven, Leuven, Belgium

    Ann Goeleven

  7. College of Medicine and Public Health, Flinders University, Adelaide, Australia

    Taher Omari

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  1. Howell Henrian G. Bayona
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Contributions

HHGB—conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, writing—original draft, writing—review & editing. NP—conceptualization, formal analysis, investigation, writing—original draft. AG—investigation, resources. JT—resources—review & editing. TO—conceptualization, software, supervision, writing—review & editing. NR—conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—original draft, writing—review & editing.

Corresponding author

Correspondence to Nathalie Rommel.

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Conflict of interest

Nathalie Rommel and Taher Omari hold a patent on the AIM software used for pressure-flow analysis. The other authors have no conflicts of interest to declare in relation to this study.

Ethical Approval

The study protocol was approved by the Research Ethics Committee of University Hospitals Leuven, Belgium.

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All subjects provided written and verbal consent to allow their anonymized clinical data to be used for research purposes.

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Bayona, H.H.G., Pizzorni, N., Tack, J. et al. Accuracy of High-Resolution Pharyngeal Manometry Metrics for Predicting Aspiration and Residue in Oropharyngeal Dysphagia Patients with Poor Pharyngeal Contractility. Dysphagia 37, 1560–1575 (2022). https://doi.org/10.1007/s00455-022-10417-5

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