Abstract
Esophageal manometry (EM) could serve as an objective method for the detection of esophageal peristalsis in patients with amyotrophic lateral sclerosis (ALS). In this group of patients, biofeedback training (BT) using the EM procedure is a promising method for the rehabilitation of swallowing function. A total of 20 ALS patients with clinical evidence of dysphagia and who met WFN criteria were recruited for this study. The standard transnasal EM with solid-state transducers was performed, and swallows with water and saliva were initiated in all subjects and repeated at 30-s intervals. The median upper esophageal contractile amplitude, duration, and velocity results during the wet and dry swallows were evaluated and compared in both the ALS and the control groups. In ALS patients, in contrast to the control, significant abnormalities in all EM parameters were recorded, which implies a specific pattern of esophageal peristalsis. Twelve months after BT, the body mass index (BMI) of ALS patients who underwent BT (ALSBT) was compared to the BMI of those who did not (ALS1)—compared to the ALS1 group, ALSBT patients showed a slightly smaller drop in BMI value. We presume that BT using EM can be a promising tool for the improvement of the swallowing mechanism in ALS patients.
Highlights
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease
The median upper esophageal contractile amplitude values for ALS vs. control subjects were 99 ± 58 (95%CI = 73.6−124.4) vs. 60 ± 22 mmHg (95%CI = 50.4−69.6) (p = 0.009), respectively; the median upper esophageal contractile duration values for ALS vs. control subjects were 3.91 ± 1.4 (95%CI = 3.3−4.5) vs. 2.7 ± 0.7 s (95%CI = 2.4−3.0) (p = 0.001), respectively; and the median upper esophageal contractile velocity values for ALS vs. control subjects were 4.6 ± 1.8 (95%CI = 3.8−5.4) vs. 2.8 ± 0.4 cm/s (95%CI = 2.6−3.0) (p < 0.001), respectively (Figures 1–3)
The median upper esophageal contractile amplitude values for ALS vs. control subjects were 96 ± 59 (95%CI = 70.1−121.9) vs. 44 ± 25 mmHg (95%CI = 33.0−55.0) (p < 0.001), respectively; the median upper esophageal contractile duration values for ALS vs. control subjects were 4.8 ± 1.9 (95%CI = 4.0−5.6) vs. 2.5 ± 1.7 s (95%CI = 1.8−3.2) (p < 0.001), respectively; and the median upper esophageal contractile velocity values for ALS vs. control subjects were 5.4 ± 2.0 (95%CI = 4.5−6.3) vs. 3.9 ± 0.5 cm/s (95%CI = 3.7−4.1) (p = 0.002), respectively (Figures 4–6)
Summary
Swallowing disturbances in ALS patients are difficult to assess objectively. There are only a few techniques available to reliably assess the stages of ALS swallowing dysfunction, which include videofluoroscopy (VF), fiberoptic endoscopic examination of swallowing (FEES), and various clinical scales based on symptomatology (e.g., ALSSS and ALSFRS-R) [2,3,4]. The swallowing mechanism in ALS patients has not been systematically studied, whereas bedside examination and clinical evaluation do not ensure accuracy. Esophageal manometry (EM) is an objective manometric method for esophageal peristalsis failure detection and rehabilitation in ALS patients. In order to improve the swallowing function in ALS patients with symptoms of dysphagia, we used the biofeedback (BF) method for the rehabilitation of the disturbed mechanism of the esophageal phase of swallowing (i.e., the rehabilitation of the upper one-third of the esophageal striated muscles)
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