Correlation Between Videofluoroscopic Swallowing Study and Esophageal Manometry Parameters in Assessing Oropharyngeal Dysphagia

Abstract

Introduction: Oropharyngeal dysphagia is characterized by difficulty initiating a swallow and transferring food from the mouth to the pharynx and esophagus. There is limited data available evaluating the correlation between high resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) findings. We sought to evaluate correlations between upper esophageal manometric parameters and findings on VFSS and their relation with esophageal dysmotility. Methods: This was a retrospective chart review of 51 adult patients (pts) at Loyola University Medical Center who underwent both VFSS and HRM within1 yearbetween January 2012 and December 2015. Demographics included age, gender, and HRM final diagnosis. The UES and pharyngeal HRM parameters and VFSS variables were recorded. Statistical analysis was completed with Student's t-test, Wilcoxon rank sum test and Fisher's exact test. HRM parameters were compared to normal (nl)and abnormal (abnl)oral, pharyngeal, and esophageal phases to assess for a correlation. Final manometric diagnosis was compared tonl or abnl oral and pharyngeal phase to assess for correlation. Results: There was a significant difference in the pharyngeal mean peak pressure between pts with nl esophageal phase and abnl esophageal phase (p = 0.02). There was a significant difference in the pts with esophageal dysmotility found to have a nl pharyngeal phase (9/23 or 39%) compared to those with an abnl pharyngeal phase (p = 0.04). There were no significant correlations between UES dysfunction and oral or pharyngeal phase. Using pharyngeal mean peak pressure alone, an ROC curve was generated which found the probability of correctly determining whether a pt has nl or abnl esophageal phase to be 71%(95% CI: 0.54 - 0.88). A cut off pharyngeal mean peak pressure of 14.4 mmHg maximized sensitivity and specificity. (Fig 1-3).Figure 1Figure 2Figure 3Conclusion: Pts with abnl esophageal phase had a significantly higher pharyngeal mean peak pressure. Further, pts with esophageal dysmotility were more likely to have an abnormal pharyngeal phase.A stronger pharyngeal contraction may be required to push against increased resistance downstream. Pharyngeal peak pressure greater than 14.4 mmHg could prove useful in predicting an underlying motility disorder. These findings suggest that not all pts with UES dysfunction diagnosed on HRM will have abnl VFSS. Therefore, HRM and VFSS are complementary in assessing oropharyngeal dysphagia.