Abstract
To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.
Highlights
The esophageal swallowing phase begins with a temporary drop in pressure in the esophageal sphincter, which allows food to pass from the throat to the esophagus
Dysphagia was assessed according to the amyotrophic lateral sclerosis (ALS) swallowing severity scale (ALSSSS), which is a 10-point scale comprising a part of the ALSSSS used to evaluate symptoms of swallowing in ALS patients [15]
Esophageal peristalsis was estimated in 28 ALS patients with mild or moderate dysphagia by using esophageal manometry and compared with the results obtained from the control subjects
Summary
The esophageal swallowing phase begins with a temporary drop in pressure in the esophageal sphincter, which allows food to pass from the throat to the esophagus. A peristaltic wave begins and travels through the body of the esophagus from the area of increased pressure to the area distally of lower pressure. This causes a characteristic pressure change called swallowing syndrome. The pressure of the wave produced in the esophagus differs from the pressure in the throat. As the wave travels through the lower esophagus, its sphincter relaxes, and the pressure in it drops, but never below gastric pressure [1]
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