The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment. Issue 12 (11th July 2017)

• Record Type: Journal Article
• Authors: O'Rourke, A.; Humphries, K.; Lazar, A.; Martin‐Harris, B.
• Is Part Of: Neurogastroenterology & motility. Volume 29:Issue 12(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-07-11
• Subjects: dysphagia -- manometry -- pharynx; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13144
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: A limitation to the expanded use of high‐resolution pharyngeal manometry (HRPM) in clinical practice is the lack of useful pharyngeal parameters that are easy to interpret, generalizable between patients, and do not require specialized software. In this study, we sought to test the relationship between the pharyngeal contractile integral (PhCI) with videofluoroscopic abnormalities as assessed with the Modified Barium Swallow Impairment Profile © ™. Methods: Adult dysphagic patients were recruited to undergo simultaneous HRPM and videofluoroscopy during a standardized swallowing protocol. Key Results: Thirty‐six patients were included in the study. The mean PhCI was 247 mm Hg·cm·s (range 2‐488 mm Hg·cm·s). The lower pharyngeal total (PT) group (N=20; mean PT=3.9) had a mean PhCI of 299 mm Hg·cm·s, while the higher PT group (N=16; mean PT=12.7) had a mean PhCI score of 188 mm Hg·cm·s ( P =.01). There was also a significant negative correlation between normalized PhCI to PT scores ( r =−.47; P =.004). Patients with higher PhCIs exhibited less severe penetration‐aspiration scores on thin liquids (1.44 vs 3.78; P =.03) and all consistencies combined (1.21 vs 1.99; P =.03). Conclusions & Inferences: The PhCI is a useful indicator of the presence of pharyngeal swallowing impairment and is technically simple to calculate with currently available software programs. Advancement of software is necessary to refine the clinical value of this parameter. High‐resolution pharyngeal manometry has the potential to be a valuable adjunct procedure for the evaluation and treatment of dysphagic individuals. Abstract : In this study, we sought to test the relationship between a clinically practical high‐resolution pharyngeal manometry parameter, the pharyngeal contractile integral, with videofluoroscopic observations. Lower pharyngeal contractile integral scores correlated with higher degrees of impairment and increased risk for aspiration or penetration. Our data support the potential utility for incorporation of high‐resolution pharyngeal manometry to aid in assessment of pharyngeal swallowing and to identify physiologic targets for behavioral or surgical interventions.