Upper Esophageal Sphincter Dysfunction in Gastroesophageal Reflux Disease

The Manometric Representation of the Upper Esophageal Sphincter During the Resting State: A Descriptive Study

The upper esophageal sphincter (UES) is the high-pressure zone marking the transition between the hypopharynx and esophagus. There is limited research surrounding the resting UES using pharyngeal high-resolution manometry (HRM) and existing normative data varies widely. This study describes the manometric representation of the resting UES using a clinically accessible method of measurement. Data were obtained from 87 subjects in a normative database of pharyngeal HRM with simultaneous videofluoroscopy. The resting UES manometric region was identified and ten measurement segments of this region were taken throughout the duration of the study using the Smart Mouse function within the manometry software. Intraclass correlation coefficients (ICC) were used to analyze within-subject reliability across measurements. Linear mixed-effects regression models were used to analyze how subject characteristics and manometric conditions influence resting UES pressure. There was excellent within-subject reliability between resting UES mean pressures (ICC = 0.96). In bivariate analysis, there were significant effects of age, number of sensors contained within the resting UES, and preceding swallow volume on mean resting UES pressure. For every 1 unit increase in age, there was a 0.19 unit decrease in resting UES pressure (p = 0.008). For every 1 unit increase in number of sensors contained within the resting UES, there was a 3.71 unit increase in resting UES pressure (p < 0.001). This study presents normative data for the resting UES, using a comprehensive and clinically accessible protocol that can provide standard comparison for the study of populations with swallowing disorders, particularly UES dysfunction, and provides support for UES-directed interventions.

Esophageal Pressure and Clinical Assessments in the Gastroesophageal Reflux Disease Patients with Laryngopharyngeal Reflux Disease

Laryngopharyngeal reflux disease (LPRD) might be associated with reflux symptoms, and its severity is correlated with the Reflux Symptoms Index. Diagnosis is often challenging because of a lack of accurate diagnostic tools. Although an association between LPRD and gastroesophageal reflux disease (GERD) exists, the extent to which esophageal pressure changes in patients with LPRD with GERD has been unknown. Therefore, this study surveys the clinical assessments and extent of esophageal pressure changes in LRPD patients with various GERD severities, and compares esophageal sphincter pressures between ages, genders, and body mass index (BMI). This observational study assessed patients with LPRD and GERD. High-resolution esophageal manometry was used to gather data pertaining to the area pressure on the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), and the correlation between such pressure and symptom severity was determined. We compared the esophageal pressure of different UES and LES levels in the following categories: gender, age, BMI, and GERD severity. We analyzed correlations between esophageal pressure and clinical assessments among 90 patients with throat globus with laryngitis with LPRD. LPRD was measured using laryngoscopy, and GERD was measured using esophagoscopy and 24 h PH monitoring. There were no significant differences in the clinical assessments among the four grades of GERD. The LPRD patients with serious GERD had a lower UES and LES pressure. The lowest pressure and longer duration of LES and UES were also observed among patients with LPRD of grade D GERD. No significant differences in UES and LES pressures among ages, genders, or BMIs were noted.

Oesophageal screening during videofluoroscopy: International practices and perspectives of speech-language pathologists

Purpose: The aim of this study was to investigate international oesophageal screening (OS) practices during videofluoroscopy (VFS) amongst speech-language pathologists (SLPs) and to establish SLP perspectives regarding OS during VFS.Method: A 25-item online survey was developed and disseminated internationally. Respondents were SLPs with dysphagia and VFS experience. Information was sought on OS practices and perspectives. Descriptive statistics were used to analyse results.Result: A total of 202 SLPs completed the survey from USA, UK, Ireland, New Zealand, Australia and Austria. Fifty-eight per cent (n = 117/202) of SLPs internationally include an OS during VFS. This rate varies across USA (81%; 91/113), UK (69%; 18/26) and Ireland (60%; 18/30). Only 25% (29/117) of SLPs use a validated OS protocol. Most SLPs perform an OS in an anterior-posterior view (55%; 64/117) with patients seated (54%; 64/117). Bolus consistencies administered vary greatly. SLPs evaluate oesophageal bolus clearance (81% (95/117), bolus redirection (64%; 75/117), oesophageal transit time (49%; 57/117) and oesophageal pathology (11%; 13/117). Perceived challenges include scope of practice, patient positioning, protocol uncertainty and multidisciplinary support.Conclusion: Over half of SLPs internationally responding to the survey include an OS during VFS. Few follow validated protocols and analysis practices vary. OS guidelines and training opportunities are needed to ensure validated OS protocols are adopted into clinical practice.

ORAL AND PHARYNGEAL TRANSIT IN FUNCTIONAL HEARTBURN

BACKGROUND

Gastroesophageal reflux disease is associated with slower transit of the bolus through the pharynx and upper esophageal sphincter. Functional heartburn has similar symptoms to gastroesophageal reflux disease, however, the symptoms are not caused by reflux.

OBJECTIVE

The aim of this investigation was to evaluate oral and pharyngeal transit in patients with functional heartburn, with the hypothesis that, similar to patients with gastroesophageal reflux disease, they have changes in pharyngeal and upper esophageal sphincter transit time.

METHODS

Oral and pharyngeal transit was evaluated by videofluoroscopy in eight women with functional heartburn, five with mild dysphagia for solid foods, and 12 female controls. Controls and patients swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses.

RESULTS

No difference in the oral or pharyngeal transit time was found between patients and controls. No aspiration of bolus into the airways was detected in any individual. Pharyngeal residues were detected in the same proportion of swallows, in patients (12.5%) and controls (15.0%), after swallows of 10 mL paste bolus.

CONCLUSION

Oral, pharyngeal and upper esophageal sphincter transit time are similar in patients with functional heartburn to healthy controls.