Premium
The dysphagia stress test for rapid assessment of swallowing difficulties in esophageal conditions
Author(s) -
Taft Tiffany H.,
Kern Emily,
Starkey Kristen,
Craft Jenna,
Craven Meredith,
Doerfler Bethany,
Keefer Laurie,
Kahrilas Peter,
Pandolfino John
Publication year - 2019
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.13512
Subject(s) - dysphagia , swallowing , medicine , eosinophilic esophagitis , achalasia , gerd , bolus (digestion) , anxiety , physical therapy , high resolution manometry , esophagus , gastroenterology , disease , reflux , surgery , psychiatry
Background Esophageal dysphagia is a common symptom in gastroenterology practice. Current rapid assessment tools are limited to oropharyngeal dysphagia and do not translate well to esophageal conditions. We aim to create a novel tool, the dysphagia stress test (DST), to evaluate swallowing in patients with esophageal disease characterized by dysphagia. Methods Adults with eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), achalasia, and dysphagia not otherwise specified (NOS) participated. Patient controls with non‐esophageal diagnoses and healthy controls were also recruited. Participants completed the DST with five bolus challenges: water, applesauce, rice, bread, barium tablet and rated their swallowing difficulty and pain. A study clinician observed and documented water use and refusal of any challenges. Participants also completed measures of esophageal symptoms, hypersensitivity, and symptom anxiety to evaluate the DST validity. Collinearity of bolus challenges guided item reduction. Key Results A total of 132 subjects participated. Both control groups and GERD patients had the best swallowing ability, while achalasia, EOE, and dysphagia NOS scored poorer. About 90% of patients were able to attempt or pass each of the bolus challenges, suggesting high acceptability. Construct validity of the DST is evidenced by modest negative correlations with symptom severity, hypersensitivity, and anxiety. The DST does not appear to be influenced by brain‐gut processes. Applesauce, rice, and bread demonstrated collinearity; thus, the DST was reduced to three challenges. Conclusions & Inferences The DST is the first rapid assessment tool designed for gastroenterology clinics with direct observation of swallowing ability across several conditions to mitigate issues related to patient self‐report of esophageal symptoms.