Effects of Effortful Swallow on Esophageal Function in Patients with Presumed Esophageal Motility Disorders

Abstract

Objectives: (1) Describe the changes in esophageal amplitude and swallow duration during an effortful swallow in patients with esophageal pathology. (2) Understand the utility of the effortful swallow in rehabilitation of esophageal dysmotility disorders. Methods: Prospective case control study in which 10 patients referred for esophageal manometry were enrolled. Each participant performed 20 swallow trials (10 effortful and 10 normal) where amplitude and duration of swallow were measured at 4 different sensors (1 striated, 1 mixed, and 2 smooth muscle sites). The effects of the swallow condition (effortful vs noneffortful), sensor site, and sex on esophageal peak pressure and swallow duration were examined. Results: The study included 10 participants (8 females, 2 males). There were several patients in whom the effortful swallow showed a statistically significant increase in peak swallow pressure or duration of the measured swallow at a particular sensor. This was not consistent across all patients nor across a particular sensor. There were more statistically significant changes in males compared with females. Conclusions: Despite clear evidence in previous studies demonstrating that volitional manipulation of the oropharyngeal phase of swallowing affects esophageal physiology in healthy individuals, a small study of patients with esophageal pathology is unable to demonstrate similar results. In future studies, we will aim to include a greater number of patients with diagnosed esophageal dysmotility.