High-resolution manometry improves dysphagia management

Last Updated: 2017-04-18

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - High-resolution manometry (HRM) can help identify the best feeding methods for patients with dysphagia and predict their risk of aspiration pneumonia, a new study from Korea reports.

HRM has recently become a useful non-radiological diagnostic tool for evaluating oropharyngeal dysphagia, but how well it can diagnose and predict dysphagia outcome hasn't been well documented, the authors wrote in the American Journal of Gastroenterology, online April 4.

“The HRM test, as an adjunctive method to the videofluoroscopic swallowing study (VFSS) - a gold-standard test for dysphagia - may help us understand the patient's condition,” co-principal investigator Dr. Jung Ho Park of Sungkyunkwan University School of Medicine in Seoul told Reuters Health in an email.

“Dysphagia patients have usually been evaluated by VFSS. However, with some cases, using VFSS to determine feeding methods is difficult . . . . Although HRM is an uncomfortable exam, it gives clinicians meaningful results about high-risk dysphagia patients and may help clinicians prevent aspiration pneumonia, which in dysphagia patients is lethal," added Dr. Kyung Jae Yoon, also a co-principal investigator and also of the Sungkyunkwan University School of Medicine.

Drs. Yoon and Park and their colleagues recruited 120 adults with dysphagia who underwent both HRM and VFSS. The researchers used HRM to estimate pressure events from the velopharynx to the upper esophageal sphincter (UES).

Over a mean follow-up of 18.8 months, 15.8% of patients developed aspiration pneumonia. On multivariate Cox regression analysis, maximal velopharynx pressure (P<0.01) and UES relaxation duration (P<0.05) independently predicted aspiration pneumonia.

Patients with maximal velopharynx pressure below 105.0 mm Hg had a higher cumulative incidence of aspiration pneumonia than those whose maximal velopharynx pressure was 105.0 mm Hg or above (P<0.01).

Also, the cumulative incidence of aspiration pneumonia was higher in patients with UES relaxation duration under 0.45 seconds compared with those with UES relaxation duration 0.45 seconds or longer (P<0.01).

The authors acknowledge limitations to the study, including that it was conducted at a single center, it was not double-blind, and they could not identify the association between HRM parameters and mortality risk. They recommend expanded research to resolve these limitations.

Dr. Yoon pointed out that while this trial included dysphagia patients, healthy elderly people develop presbyphagia, a weakness of swallowing muscles. “In the future, HRM study could be applied in presbyphagic healthy elderly," Dr Yoon said.

Dr. Kevin Ghassemi of the David Geffen School of Medicine at the University of California, Los Angeles said in an email, "The most important finding from this study is that high-resolution manometry (HRM) might offer another option for assessing patients with oropharyngeal dysphagia to determine whether they can be fed safely via the oral route."

But, he noted, "A limitation of this study . . . is that liquid was the only bolus consistency assessed. We know that using viscous and solid boluses can elicit abnormalities in the esophageal body that would not have been seen with liquid boluses alone, so it is possible that using additional bolus consistencies might have better predicted aspiration in this patient population."

SOURCE: http://bit.ly/2oJSco6

Am J Gastro 2017.