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Anwar A, Khalifa Y, Lucatorto E, Coyle JL, Sejdic E. Towards a comprehensive bedside swallow screening protocol using cross-domain transformation and high-resolution cervical auscultation. Artif Intell Med 2024; 154:102921. [PMID: 38991399 DOI: 10.1016/j.artmed.2024.102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
High-resolution cervical auscultation (HRCA) is an emerging noninvasive and accessible option to assess swallowing by relying upon accelerometry and sound sensors. HRCA has shown tremendous promise and accuracy in identifying and predicting swallowing physiology and biomechanics with accuracies equivalent to trained human judges. These insights have historically been available only through instrumental swallowing evaluation methods, such as videofluoroscopy and endoscopy. HRCA uses supervised learning techniques to interpret swallowing physiology from the acquired signals, which are collected during radiographic assessment of swallowing using barium contrast. Conversely, bedside swallowing screening is typically conducted in non-radiographic settings using only water. This poses a challenge to translating and generalizing HRCA algorithms to bedside screening due to the rheological differences between barium and water. To address this gap, we proposed a cross-domain transformation framework that uses cycle generative adversarial networks to convert HRCA signals of water swallows into a domain compatible with the barium swallows-trained HRCA algorithms. The proposed framework achieved a cross-domain transformation accuracy that surpassed 90%. The authenticity of the generated signals was confirmed using a binary classifier to confirm the framework's capability to produce indistinguishable signals. This framework was also assessed for retaining swallow physiological and biomechanical properties in the signals by applying an existing model from the literature that identifies the opening and closure of the upper esophageal sphincter. The outcomes of this model showed nearly identical results between the generated and original signals. These findings suggest that the proposed transformation framework is a feasible avenue to advance HCRA towards clinical deployment for water-based swallowing screenings.
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Affiliation(s)
- Ayman Anwar
- Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada.
| | - Yassin Khalifa
- Center for Research Computing, University of Pittsburgh, Pittsburgh, PA, USA; Information Technology Analytics, University of Pittsburgh, Pittsburgh, PA, USA; Systems and Biomedical Engineering, Cairo University, Giza, Egypt.
| | - Erin Lucatorto
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ervin Sejdic
- Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada.
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Ambrocio KR, Ramsey R, O’Rourke A, Beall J, (Focht) Garand KL. Normal Variations in Upper Esophageal Sphincter Function During Deglutition: A Secondary Analysis of Videofluoroscopic Data. Laryngoscope 2024; 134:2306-2315. [PMID: 37962100 PMCID: PMC11006589 DOI: 10.1002/lary.31173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/01/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Cricopharyngeal dysfunction is a common potential cause of pharyngoesophageal dysphagia. Contextual factors (i.e., personal demographics and bolus properties) appear to impact upper esophageal sphincter (UES) function but have yet to be assessed collectively in a large-scale study using psychometrically sound swallow task procedures. Using a standardized and validated videofluoroscopic approach, we investigated the collective effects of age, sex, and swallow task on UES opening duration (UESOdur) and UES maximum distension (UESmax) in a large sample of healthy adults. METHODS UESOdur and UESmax data were analyzed from existing videofluoroscopic images of 195 healthy adults (21-89 years old) across seven swallow tasks (thin liquid to viscous liquids, puree, and a solid). Generalized estimating equation modeling captured the effects of the aforementioned contextual factors (α = 0.05). RESULTS UESOdur significantly increased with age, while UESmax had an inverse relationship. Females had significantly wider UESmax. UESOdur of 5 mL thin liquid was significantly shorter than all other liquid swallow tasks, while solid had an inverse effect. Compared to 5 mL thin liquid, all other swallow tasks resulted in significantly wider UESmax. Mildly and moderately thick liquid significantly increased UESOdur when isolating viscosity. UESmax was significantly wider with mildly and moderately thick liquid and puree than thin liquid. When isolating volume, cup sip thin liquid increased both measures significantly relative to 5 mL. CONCLUSION Age, sex, and swallow task can influence the normal timing and extent of UES movement. These collective effects contribute to normal variability in UES function and should be considered for clinical decision-making. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2306-2315, 2024.
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Affiliation(s)
- Kevin Renz Ambrocio
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Reagan Ramsey
- Department of Speech Pathology & Audiology, University of South Alabama, Mobile, AL
| | - Ashli O’Rourke
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jonathan Beall
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Dai M, Qiao J, Chen H, Shi Z, Liu B, Dou ZL. Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome. Dysphagia 2024; 39:255-266. [PMID: 37584721 DOI: 10.1007/s00455-023-10607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
To assess the severity and timing of penetration and aspiration (PA) of severe dysphagia after lateral medullary syndrome (LMS) and its association with temporal characteristics. We performed videofluoroscopic swallowing studies (VFSS) in 48 patients with LMS and severe dysphagia and 26 sex- and age-matched healthy subjects. The following temporal measures were compared between groups: velopharyngeal closure duration (VCD); hyoid bone movement duration (HMD); laryngeal vestibular closure duration (LCD); upper esophageal sphincter (UES) opening duration (UOD); stage transition duration (STD) and the interval between laryngeal vestibular closure and UES opening (LC-UESop). The association between temporal measures and Penetration-Aspiration Scale (PAS) scores was analyzed. Differences in timing measures were compared between subgroups (safe swallows, and swallows with PA events during and after the swallow). PAS scores ≥ 3 were seen in 48% of swallows (4% occuring before, 35% occurred during and 61% after the swallow) from the LMS patients. Significantly longer STD and LC-UESop were found in the patients compared to the healthy subjects (p < 0.05). Significant negative correlations with PA severity were found for HMD, LCD, and UOD. Short UOD was the strongest predictor with an area under the receiver-operating-characteristic curve of 0.66. UOD was also significantly shorter in cases of PA after the swallow (p < 0.01). Patients with LMS involving severe dysphagia exhibit a high frequency of PA (mostly during and after swallowing). PA events were associated with shorter UOD, HMD, and LCD. Notably, shortened UOD appears to be strongly associated with PA.
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Affiliation(s)
- Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Jiao Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Huayu Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Zhonghui Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Binbin Liu
- Mingxin Rehabilitation Center, No. 1, Wushan Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Zu-Lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China.
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Li M, Huang S, Ding Y, Li X, Cui Y, Chen S. The effectiveness of chin-down manoeuvre in patients with dysphagia: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:762-774. [PMID: 38030571 DOI: 10.1111/joor.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
AIM The chin-down posture is a widely used compensatory manoeuvre for patients with dysphagia. The aim of this study was designed to systematically measure the effectiveness of chin-down manoeuvre application. METHODOLOGY We retrieved the PubMed, Web of Science, Embase, Cochrane Library, EBSCO, Medline, CNKI, WANFANG, VIP and SinoMed databases from inception to 30 August 2022. Raters independently screened literature according to inclusion and exclusion criteria. The quality of the included literature was evaluated, and data were extracted. The software Review Manager software 5.3 was used for statistical analysis. RESULTS Fourteen studies with a total of 571 patients were included in this meta-analysis. The meta-analysis indicated that chin-down manoeuvre could significantly reduce the risk of aspiration (MD = -1.35, 95% CI [-2.25, -0.44], Z = 2.92, p < .01), decrease the chin angle (MD = -12.20, 95% CI [-14.61, -9.79], Z = 9.91, p < .001), shorten oral transit time (MD = -0.81, 95% CI [-1.20, -0.43], Z = 4.17, p < .001), reduce the maximum swallowing pressure at upper oesophageal sphincter (MD = -82.07, 95% CI [-112.77, -51.37], Z = 5.24, p < .001) and decrease pharyngeal residue. CONCLUSIONS Existing evidence indicated that chin-down manoeuvre could reduce the risk of aspiration and pharyngeal residue, decrease the maximum swallowing pressure at UES. More large-sample, high-quality clinical trials are still needed in the future to further ascertain the results of this research.
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Affiliation(s)
- Mengchao Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | | | - Yaping Ding
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Cui
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
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Kim JM, Park JE, Baek SJ, Yang SN. Quantitative Analysis of Temporal Parameters Correlated with Aspiration and Lesion Location in Stroke Patients. Dysphagia 2023; 38:1487-1496. [PMID: 37072634 PMCID: PMC10611597 DOI: 10.1007/s00455-023-10575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
The purpose of this study was to identify differences in temporal parameters correlating to the presence of aspiration and the severity of penetration-aspiration scale (PAS) in patients with dysphagia after stroke. We also investigated whether there was a significant difference in temporal parameters based on the location of the stroke lesion. A total of 91 patient videofluoroscopic swallowing study (VFSS) videos of stroke patients with dysphagia were retrospectively analyzed. Various temporal parameters including oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, upper esophageal sphincter opening duration and upper esophageal sphincter reaction time were measured. Subjects were grouped by the presence of aspiration, PAS score, and location of the stroke lesion. Pharyngeal response time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration were significantly prolonged in the aspiration group. These three factors showed positive correlation with PAS. In terms of stroke lesion, oral phase duration was significantly prolonged in the supratentorial lesion group, while upper esophageal sphincter opening duration was significantly prolonged in the infratentorial lesion group. We have demonstrated that quantitative temporal analysis of VFSS can be a clinically valuable tool identifying dysphagia pattern associated with stroke lesion or aspiration risk.
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Affiliation(s)
- Jeong Min Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Ji Eun Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Seung Jun Baek
- Department of Computer Science and Engineering, Korea University, Seoul, 02841, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
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Sun F, Qiao J, Huang X, He Z, Dou Z. Characteristics of post-stroke dysphagia: A retrospective study based on FEES. Brain Behav 2023; 13:e3161. [PMID: 37475645 PMCID: PMC10454255 DOI: 10.1002/brb3.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD). METHODS Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function. RESULTS A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p < .001), PAS scores (p < .05), MSS scores (p < .05), and vocal fold mobility (p < .001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p < .05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5 versus PAS > 5, PR ≥ 3 versus PR < 3, and normal vocal fold mobility versus vocal fold motion impairment group (p < .05). CONCLUSIONS The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS > 5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.
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Affiliation(s)
- Fang Sun
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicinePeople' Hospital of YangjiangGuangzhouP. R. China
| | - Jia Qiao
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Xiaoyan Huang
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Zitong He
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Zulin Dou
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
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Shu K, Perera S, Mahoney AS, Mao S, Coyle JL, Sejdić E. Temporal Sequence of Laryngeal Vestibule Closure and Reopening is Associated With Airway Protection. Laryngoscope 2023; 133:521-527. [PMID: 35657100 PMCID: PMC9718890 DOI: 10.1002/lary.30222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Upper esophageal sphincter opening (UESO), and laryngeal vestibule closure (LVC) are two essential kinematic events whose timings are crucial for adequate bolus clearance and airway protection during swallowing. Their temporal characteristics can be quantified through time-consuming analysis of videofluoroscopic swallow studies (VFSS). OBJECTIVES We sought to establish a model to predict the odds of penetration or aspiration during swallowing based on 15 temporal factors of UES and laryngeal vestibule kinematics. METHODS Manual temporal measurements and ratings of penetration and aspiration were conducted on a videofluoroscopic dataset of 408 swallows from 99 patients. A generalized estimating equation model was deployed to analyze association between individual factors and the risk of penetration or aspiration. RESULTS The results indicated that the latencies of laryngeal vestibular events and the time lapse between UESO onset and LVC were highly related to penetration or aspiration. The predictive model incorporating patient demographics and bolus presentation showed that delayed LVC by 0.1 s or delayed LVO by 1% of the swallow duration (average 0.018 s) was associated with a 17.19% and 2.68% increase in odds of airway invasion, respectively. CONCLUSION This predictive model provides insight into kinematic factors that underscore the interaction between the intricate timing of laryngeal kinematics and airway protection. Recent investigation in automatic noninvasive or videofluoroscopic detection of laryngeal kinematics would provide clinicians access to objective measurements not commonly quantified in VFSS. Consequently, the temporal and sequential understanding of these kinematics may interpret such measurements to an estimation of the risk of aspiration or penetration which would give rise to rapid computer-assisted dysphagia diagnosis. LEVEL OF EVIDENCE 2 Laryngoscope, 133:521-527, 2023.
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Affiliation(s)
- Kechen Shu
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda S. Mahoney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James L. Coyle
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdić
- Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
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Khalifa Y, Mahoney AS, Lucatorto E, Coyle JL, Sejdić E. Non-Invasive Sensor-Based Estimation of Anterior-Posterior Upper Esophageal Sphincter Opening Maximal Distension. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 11:182-190. [PMID: 36873304 PMCID: PMC9976940 DOI: 10.1109/jtehm.2023.3246919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Dysphagia management relies on the evaluation of the temporospatial kinematic events of swallowing performed in videofluoroscopy (VF) by trained clinicians. The upper esophageal sphincter (UES) opening distension represents one of the important kinematic events that contribute to healthy swallowing. Insufficient distension of UES opening can lead to an accumulation of pharyngeal residue and subsequent aspiration which in turn can lead to adverse outcomes such as pneumonia. VF is usually used for the temporal and spatial evaluation of the UES opening; however, VF is not available in all clinical settings and may be inappropriate or undesirable for some patients. High resolution cervical auscultation (HRCA) is a noninvasive technology that uses neck-attached sensors and machine learning to characterize swallowing physiology by analyzing the swallow-induced vibrations/sounds in the anterior neck region. We investigated the ability of HRCA to noninvasively estimate the maximal distension of anterior-posterior (A-P) UES opening as accurately as the measurements performed by human judges from VF images. METHODS AND PROCEDURES Trained judges performed the kinematic measurement of UES opening duration and A-P UES opening maximal distension on 434 swallows collected from 133 patients. We used a hybrid convolutional recurrent neural network supported by attention mechanisms which takes HRCA raw signals as input and estimates the value of the A-P UES opening maximal distension as output. RESULTS The proposed network estimated the A-P UES opening maximal distension with an absolute percentage error of 30% or less for more than 64.14% of the swallows in the dataset. CONCLUSION This study provides substantial evidence for the feasibility of using HRCA to estimate one of the key spatial kinematic measurements used for dysphagia characterization and management. Clinical and Translational Impact Statement: The findings in this study have a direct impact on dysphagia diagnosis and management through providing a non-invasive and cheap way to estimate one of the most important swallowing kinematics, the UES opening distension, that contributes to safe swallowing. This study, along with other studies that utilize HRCA for swallowing kinematic analysis, paves the way for developing a widely available and easy-to-use tool for dysphagia diagnosis and management.
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Affiliation(s)
- Yassin Khalifa
- Department of Biomedical EngineeringCairo UniversityGiza12613Egypt
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15260USA
- Case Western Reserve University School of MedicineClevelandOH44106USA
- University Hospitals Harrington Heart and Vascular InstituteClevelandOH44106USA
| | - Amanda S. Mahoney
- Department of Communication Science and DisordersUniversity of PittsburghPittsburghPA15260USA
| | - Erin Lucatorto
- Department of Communication Science and DisordersUniversity of PittsburghPittsburghPA15260USA
| | - James L. Coyle
- Department of Communication Science and DisordersUniversity of PittsburghPittsburghPA15260USA
- Department of OtolaryngologyUniversity of PittsburghPittsburghPA15260USA
| | - Ervin Sejdić
- The Edward S. Rogers Sr. Department of Electrical and Computer EngineeringFaculty of Applied Science and EngineeringUniversity of TorontoTorontoONM5S 1A1Canada
- North York General HospitalTorontoONM2K 1E1Canada
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Park CH, Kim K, Hwang JT, Choi JH, Lee YT, Park YS, Park JH, Yoon KJ. Comparison of methods for evaluation of upper esophageal sphincter (UES) relaxation duration: Videofluoroscopic swallow study versus high-resolution manometry. Medicine (Baltimore) 2022; 101:e30771. [PMID: 36181078 PMCID: PMC9524913 DOI: 10.1097/md.0000000000030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aims to compare the 2 methods of upper esophageal sphincter (UES) relaxation measurement and determine which method has better diagnostic value in UES relaxation impairment The study included 140 patients with pharyngeal dysphagia who underwent both videofluoroscopic swallow study (VFSS) and high-resolution manometry (HRM). Feeding method was determined to oral or non-oral feeding based on the severity of dysphagia; 103 patients were in oral feeding group and 37 were in non-oral feeding group. UES relaxation duration was measured using VFSS and HRM, respectively. Receiver-operating characteristic curve analysis was conducted to validate the UES relaxation duration in determination of feeding method. UES relaxation duration was more decreased in non-oral feeding group than in oral feeding group on both VFSS and HRM. Receiver-operating characteristic analysis revealed that the optimal cutoff value of UES relaxation duration to determine feeding method (oral or non-oral feeding) was 0.42 seconds on VFSS and 0.44 seconds on HRM. The sensitivity for feeding method was higher in VFSS than HRM (83.5% vs 70.9%), while the specificity was higher in HRM than VFSS (48.6% vs 54.1%). VFSS and HRM have complementary ability in evaluating UES relaxation duration in patients with oropharyngeal dysphagia.
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Affiliation(s)
- Chul-Hyun Park
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kunwoo Kim
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Hwang
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hyung Choi
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Sook Park
- Department of Physical & Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- *Correspondences: Jung Ho Park, Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of KoreaKyung Jae Yoon, Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea (e-mail: and )
| | - Kyung Jae Yoon
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- *Correspondences: Jung Ho Park, Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of KoreaKyung Jae Yoon, Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea (e-mail: and )
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Everton LF, Benfield JK, Michou E, Hamdy S, Bath PM. Reliability of the Penetration-Aspiration Scale and Temporal and Clearance Measures in Poststroke Dysphagia: Videofluoroscopic Analysis From the Swallowing Treatment using Electrical Pharyngeal Stimulation Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:858-868. [PMID: 35114799 PMCID: PMC9150745 DOI: 10.1044/2021_jslhr-21-00083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Information on reliability of outcome measures used to assess the effectiveness of interventions in dysphagia rehabilitation is lacking, particularly when used by different research groups. Here, we report on reliability of the penetration-aspiration scale (PAS) and temporal and clearance measures, determined using videofluoroscopy. METHOD Secondary analysis used videofluoroscopies from the Swallowing Treatment using Electrical Pharyngeal Stimulation trial in subacute stroke. PAS scores (719 scores from 18 participants) were evaluated and compared to the original PAS scores from the trial. Five conditions were assessed, including reliability for every swallow and overall mean of the worst PAS score. Operational rules for assessing temporal and clearance measures were also developed using the same data, and reliability of these rules was assessed. Reliability of component-level and derivative-level scores was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. RESULTS Image quality was variable. Interrater reliability for the overall mean of the worst PAS score was excellent (ICC = .914, 95% confidence interval [CI] [.853, .951]) but moderate for every swallow in the bolus (ICC = .743, 95% CI [.708, .775]). Intrarater reliability for PAS was excellent (all conditions). Excellent reliability (both inter- and intrarater > .90) was seen for temporal measures of stage transition duration (ICC = .998, 95% CI [.993, .999] and ICC = .995, 95% CI [.987, .998], respectively) as well as initiation of laryngeal closure and pharyngeal transit time and all individual swallow events. Strong scores were obtained for some clearance measures; others were moderate or weak. CONCLUSIONS Interrater reliability for PAS is acceptable but depends on how the PAS scores are handled in the analysis. Interrater reliability for most temporal measures was high, although some measures required additional training. No clearance measures had excellent reliability. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19090088.
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Affiliation(s)
- Lisa F. Everton
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom
- Speech and Language Therapy, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Jacqueline K. Benfield
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, United Kingdom
| | - Emilia Michou
- Gastrointestinal Sciences, Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, The University of Manchester and the Manchester Academic Health Science Centre, United Kingdom
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece
| | - Shaheen Hamdy
- Gastrointestinal Sciences, Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, The University of Manchester and the Manchester Academic Health Science Centre, United Kingdom
| | - Philip M. Bath
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom
- Stroke Medicine, Nottingham University Hospitals NHS Trust, United Kingdom
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Dai M, Qiao J, Wei X, Chen H, Shi Z, Dou Z. Increased cortical-medulla functional connectivity is correlated with swallowing in dysphagia patients with subacute infratentorial stroke. NEUROIMAGE: CLINICAL 2022; 35:103104. [PMID: 35792418 PMCID: PMC9421453 DOI: 10.1016/j.nicl.2022.103104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with infratentorial stroke showed increased cortex-medulla connectivity. The cortex-medulla functional connectivities were related to swallowing function. The identified regions may be candidates for non-invasive strategies for dysphagia. FC mapping using the medulla as a seed is useful in swallowing network research.
Patients with infratentorial stroke (IS) exhibit more severe dysphagia and a higher risk of aspiration than patients with supratentorial stroke. Nevertheless, a large proportion of patients with IS regain swallowing function within 6 months; however, the neural mechanism for this recovery remains unclear. We aimed to investigate possible neuroplastic changes involved using functional magnetic resonance imaging (fMRI) and their relation to swallowing function. We assessed 21 patients with IS (mean age: 59.9 ± 11.1 years) exhibiting dysphagia in the subacute phase and 21 healthy controls (mean age: 57.1 ± 7.8 years). Patient evaluations were based on the functional oral intake scale (FOIS), videofluoroscopic swallow study (VFSS), and fMRI. Temporal swallowing measures and the penetration-aspiration scale (PAS) were obtained using VFSS. Whole-brain–medulla resting-state functional connectivity (rsFC) was calculated and compared between patients and healthy controls. The rsFCs were also correlated with functional measures within the patient group. In patients with IS, whole-brain–medulla rsFCs were significantly higher in the precuneus, the left and right precentral gyrus, and the right supplementary motor area compared to those in healthy controls (P < 0.001, family-wise error-corrected cluster-level P < 0.05). The rsFCs to the medulla for the left (r = −0.507, P = 0.027) and right side (r = −0.503, P = 0.028) precentral gyrus were negatively correlated with the PAS. The rsFC between the left (r = 0.470, P = 0.042) and right (r = 0.459, P = 0.048) precentral gyrus to the medulla was positively correlated with upper esophageal sphincter opening durations (UOD). In addition, PAS was also correlated with UOD (r = −0.638, P = 0.003) whereas the laryngeal closure duration was correlated with the hyoid bone movement duration (r = 0.550, P = 0.015). Patients with IS exhibited overall modulation of cortical-medulla connectivity during the subacute phase. Patients with higher connectivities showed better swallowing performance. These findings support that there is cortical involvement in swallowing regulation after IS and can aid in determining potential treatment targets for dysphagia.
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Affiliation(s)
- Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Huayu Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zhonghui Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China.
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12
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Shu K, Coyle JL, Perera S, Khalifa Y, Sabry A, Sejdić E. Anterior-posterior distension of maximal upper esophageal sphincter opening is correlated with high-resolution cervical auscultation signal features. Physiol Meas 2021; 42. [PMID: 33601360 DOI: 10.1088/1361-6579/abe7cb] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
Objective. Adequate upper esophageal sphincter (UES) opening is essential during swallowing to enable clearance of material into the digestive system, and videofluoroscopy (VF) is the most commonly deployed instrumental examination for assessment of UES opening. High-resolution cervical auscultation (HRCA) has been shown to be an effective, portable and cost-efficient screening tool for dysphagia with strong capabilities in non-invasively and accurately approximating manual measurements of VF images. In this study, we aimed to examine whether the HRCA signals are correlated to the manually measured anterior-posterior (AP) distension of maximal UES opening from VF recordings, under the hypothesis that they would be strongly associated.Approach. We developed a standardized method to spatially measure the AP distension of maximal UES opening in 203 swallows VF recording from 27 patients referred for VF due to suspected dysphagia. Statistical analysis was conducted to compare the manually measured AP distension of maximal UES opening from lateral plane VF images and features extracted from two sets of HRCA signal segments: whole swallow segments and segments excluding all events other than the duration of UES is opening.Main results. HRCA signal features were significantly associated with the normalized AP distension of the maximal UES opening in the longer whole swallowing segments and the association became much stronger when analysis was performed solely during the duration of UES opening.Significance. This preliminary feasibility study demonstrated the potential value of HRCA signals features in approximating the objective measurements of maximal UES AP distension and paves the way of developing HRCA to non-invasively and accurately predict human spatial measurement of VF kinematic events.
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Affiliation(s)
- Kechen Shu
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, Department of Otolaryngology, School of Medicine, University of Pittsburgh, PA, 15260, United States of America
| | - Subashan Perera
- Division of Geriatrics, Department of Medecine, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - Aliaa Sabry
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, 15260, United States of America
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, Department of Bioengineering, Swanson School of Engineering, Department of Biomedical informatics, School of Medecine, Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, PA, 15260, United States of America
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13
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Khalifa Y, Donohue C, Coyle JL, Sejdic E. Upper Esophageal Sphincter Opening Segmentation With Convolutional Recurrent Neural Networks in High Resolution Cervical Auscultation. IEEE J Biomed Health Inform 2021; 25:493-503. [PMID: 32750928 DOI: 10.1109/jbhi.2020.3000057] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Upper esophageal sphincter is an important anatomical landmark of the swallowing process commonly observed through the kinematic analysis of radiographic examinations that are vulnerable to subjectivity and clinical feasibility issues. Acting as the doorway of esophagus, upper esophageal sphincter allows the transition of ingested materials from pharyngeal into esophageal stages of swallowing and a reduced duration of opening can lead to penetration/aspiration and/or pharyngeal residue. Therefore, in this study we consider a non-invasive high resolution cervical auscultation-based screening tool to approximate the human ratings of upper esophageal sphincter opening and closure. Swallows were collected from 116 patients and a deep neural network was trained to produce a mask that demarcates the duration of upper esophageal sphincter opening. The proposed method achieved more than 90% accuracy and similar values of sensitivity and specificity when compared to human ratings even when tested over swallows from an independent clinical experiment. Moreover, the predicted opening and closure moments surprisingly fell within an inter-human comparable error of their human rated counterparts which demonstrates the clinical significance of high resolution cervical auscultation in replacing ionizing radiation-based evaluation of swallowing kinematics.
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Donohue C, Khalifa Y, Perera S, Sejdić E, Coyle JL. How Closely do Machine Ratings of Duration of UES Opening During Videofluoroscopy Approximate Clinician Ratings Using Temporal Kinematic Analyses and the MBSImP? Dysphagia 2020; 36:707-718. [PMID: 32955619 DOI: 10.1007/s00455-020-10191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Clinicians evaluate swallow kinematic events by analyzing videofluoroscopy (VF) images for dysphagia management. The duration of upper esophageal sphincter opening (DUESO) is one important temporal swallow event, because reduced DUESO can result in pharyngeal residue and penetration/aspiration. VF is frequently used for evaluating swallowing but exposes patients to radiation and is not always feasible/readily available. High resolution cervical auscultation (HRCA) is a non-invasive, sensor-based dysphagia screening method that uses signal processing and machine learning to characterize swallowing. We investigated HRCA's ability to annotate DUESO and predict Modified Barium Swallow Impairment Profile (MBSImP) scores (component #14). We hypothesized that HRCA and machine learning techniques would detect DUESO with similar accuracy as human judges. Trained judges completed temporal kinematic measurements of DUESO on 719 swallows (116 patients) and 50 swallows (15 age-matched healthy adults). An MBSImP certified clinician completed MBSImP ratings on 100 swallows. A multi-layer convolutional recurrent neural network (CRNN) using HRCA signal features for input was used to detect DUESO. Generalized estimating equations models were used to determine statistically significant HRCA signal features for predicting DUESO MBSImP scores. A support vector machine (SVM) classifier and a leave-one-out procedure was used to predict DUESO MBSImP scores. The CRNN detected UES opening within a 3-frame tolerance for 82.6% of patient and 86% of healthy swallows and UES closure for 72.3% of patient and 64% of healthy swallows. The SVM classifier predicted DUESO MBSImP scores with 85.7% accuracy. This study provides evidence of HRCA's feasibility in detecting DUESO without VF images.
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Affiliation(s)
- Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA.
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15
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Kim YK, Cha JH, Lee KY. Comparison of Dysphagia Between Infratentorial and Supratentorial Stroke Patients. Ann Rehabil Med 2019; 43:149-155. [PMID: 31072081 PMCID: PMC6509573 DOI: 10.5535/arm.2019.43.2.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/12/2018] [Indexed: 01/25/2023] Open
Abstract
Objective To compare dysphagia between infratentorial stroke patients and supratentorial stroke patients. Methods Subjects of this study were patients with post-stroke dysphagia (PSD) who were admitted to our medical institution between May 2014 and June 2017. We evaluated a total of 64 patients with PSD. A videofluoroscopic swallowing study (VFSS) was performed to determine dysphagia severity. We measured the following parameters: pharyngeal transit time (PTT), post-swallow pharyngeal remnant, Penetration Aspiration Scale (PAS) scores, and Functional Dysphagia Scale (FDS). We analyzed patient’s results from VFSS performed at admission. All VFSS images were recorded using a camcorder running at 30 frames per second. An AutoCAD 2D screen was used to measure post-swallow pharyngeal remnant. Results In this study, PTT and FDS were similar (p>0.05) between infratentorial stroke patients and supratentorial stroke patients. However, there were significant differences in pharyngeal remnant and PAS scores between the two groups (p<0.01 and p<0.05, respectively). Conclusion Both pharyngeal remnant and PAS score registered higher levels from VFSS test for infratentorial stroke patients than those for supratentorial stroke patients. This suggests greater chances of problems occurring with swallowing, the major functions of pons. Thus, clinicians should pay particular attention to active dysphagia evaluation and treatment in PSD of infratentorial stroke patients.
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Affiliation(s)
- Yong Kyun Kim
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - Jung Hyun Cha
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - Kyun Yeon Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
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16
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Abstract
PURPOSE OF REVIEW The purpose of the review is to examine current research focused on upper oesophageal sphincter (UES) and cricopharyngeus muscle function, and how better understanding UES physiology will translate to improved management. RECENT FINDINGS Although much is known about UES function, new information describing the dynamics of the UES and cricopharyngeus is being identified through manometry, combined fluoromanometry, and anatomic study. Response of the UES to injury, reflux, and surgical interventions is reported. Direct surgical treatment of cricopharyngeus noncompliance with or without diverticuli continues to show benefit and long-term results support a sustained improvement in three-quarters of patients. SUMMARY UES and cricopharyngeus function is complex and dynamic. It is affected by internal signals such as posture and constitution of refluxate, aging, and interventions particularly radiation and surgery. Clear understanding of the triggers and responses of the UES will enable clinicians to choose the correct therapy for their dysphagic patients.
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17
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Shim YK, Kim N, Park YH, Lee JC, Sung J, Choi YJ, Yoon H, Shin CM, Park YS, Lee DH. Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry. J Neurogastroenterol Motil 2017; 23:229-236. [PMID: 28163259 PMCID: PMC5383117 DOI: 10.5056/jnm16104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/19/2016] [Accepted: 01/15/2017] [Indexed: 01/10/2023] Open
Abstract
Background/Aims Disturbances of esophageal motility have been reported to be more frequent the aged population. However, the physiology of disturbances in esophageal motility during aging is unclear. The aim of this study was to evaluate the effects of age on esophageal motility using high-resolution esophageal impedance manometry (HRIM). Methods Esophageal motor function of 268 subjects were measured using HRIM in 3 age groups, < 40 years (Group A, n = 32), 40–65 years (Group B, n = 185), and > 65 years (Group C, n = 62). Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures, integrated relaxation pressure, distal contractile integral, contractile front velocity, distal latency, and pressures and duration of contraction on 4 positions along the esophagus, and complete bolus transit were measured. Results Basal UES pressure was lower in Group C (P < 0.001) but there was no significant difference in the LES pressure among groups. Contractile duration on position 3 (10 cm from proximal LES high pressure zone) was longer in Group C (P = 0.001), and the contractile amplitude on position 4 (5 cm from proximal LES high pressure zone) was lower in Group C (P = 0.005). Distal contractile integral was lower in Group C (P = 0.037). Contractile front velocity (P = 0.015) and the onset velocity (P = 0.040) was lower in Group C. There was no significant difference in impedance values. Conclusions The decrease of UES pressure, distal esophageal motility, and peristaltic velocity might be related with esophageal symptoms in the aged population.
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Affiliation(s)
- Young Kwang Shim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine and Liver Research Institute, Seoul, Korea
| | - Yo Han Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jihee Sung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine and Liver Research Institute, Seoul, Korea
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