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Maximum upper esophageal sphincter (UES) admittance: a non‐specific marker of UES dysfunction
Author(s) -
Cock C.,
Besanko L.,
Kritas S.,
Burgstad C. M.,
Thompson A.,
Heddle R.,
Fraser R. J. L.,
Omari T. I.
Publication year - 2016
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12714
Subject(s) - medicine , admittance , swallowing , cardiology , gastroenterology , anesthesia , urology , surgery , electrical impedance , electrical engineering , engineering
Background Assessment of upper esophageal sphincter ( UES ) motility is challenging, as functionally, UES relaxation and opening are distinct. We studied novel parameters, UES admittance (inverse of nadir impedance), and 0.2‐s integrated relaxation pressure ( IRP ), in patients with cricopharyngeal bar ( CPB ) and motor neuron disease ( MND ), as predictors of UES dysfunction. Methods Sixty‐six healthy subjects ( n = 50 controls 20–80 years; n = 16 elderly >80 years), 11 patients with CPB (51–83 years) and 16 with MND (58–91 years) were studied using pharyngeal high‐resolution impedance manometry. Subjects received 5 × 5 mL liquid (L) and viscous (V) boluses. Admittance and IRP were compared by age and between groups. A p < 0.05 was considered significant. Key Results In healthy subjects, admittance was reduced (L: p = 0.005 and V: p = 0.04) and the IRP higher with liquids ( p = 0.02) in older age. Admittance was reduced in MND compared to both healthy groups (Young: p < 0.0001 for both, Elderly L: p < 0.0001 and V: p = 0.009) and CPB with liquid ( p = 0.001). Only liquid showed a higher IRP in MND patients compared to controls ( p = 0.03), but was similar to healthy elderly and CPB patients. Only admittance differentiated younger controls from CPB (L: p = 0.0002 and V: p < 0.0001), with no differences in either parameter between CPB and elderly subjects. Conclusions & Inferences The effects of aging and pathology were better discriminated by UES maximum admittance, demonstrating greater statistical confidence across bolus consistencies as compared to 0.2‐s IRP . Maximum admittance may be a clinically useful determinate of UES dysfunction.