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Type: Journal article
Title: A method to objectively assess swallow function in adults with suspected aspiration
Author: Omari, T.
Dejaeger, E.
Van Beckevoort, D.
Goeleven, A.
Davidson, G.
Dent, J.
Tack, J.
Rommel, N.
Citation: Gastroenterology, 2011; 140(5):1454-1463
Publisher: W B Saunders Co
Issue Date: 2011
ISSN: 0016-5085
Statement of
Taher I. Omari, Eddy Dejaeger, Dirk Van Beckevoort, Ann Goeleven, Geoffrey P. Davidson, John Dent, Jan Tack, and Nathalie Rommel
Abstract: BACKGROUND & AIMS: Pharyngeal manometry and impedance provide information on swallow function. We developed a new analysis approach for assessment of aspiration risk. METHODS: We studied 20 patients (30-95 years old) with suspected aspiration who were referred for videofluoroscopy, along with controls (ages 24-47 years). The pharyngeal phase of liquid bolus swallowing was recorded with manometry and impedance. Data from the first swallow of a bolus and subsequent clearing swallows were analyzed. We scored fluoroscopic evidence of aspiration and investigated a range of computationally derived functional variables. Of these, 4 stood out as having high diagnostic value: peak pressure (PeakP), pressure at nadir impedance (PNadImp), time from nadir impedance to peak pressure (TNadImp-PeakP), and the interval of impedance drop in the distal pharynx (flow interval). RESULTS: During 54 liquid, first swallows and 40 clearing swallows, aspiration was observed in 35 (13 patients). Compared to those of controls, patient swallows were characterized by a lower PeakP, higher PNadImp, longer flow interval, and shorter TNadImp-PeakP. A Swallow Risk Index (SRI), designed to identify dysfunctions associated with aspiration, was developed from iterative evaluations of variables. The average first swallow SRI correlated with the average aspiration score (r = 0.846, P < .00001 for Spearman Rank Correlation). An average SRI of 15, when used as a cutoff, predicted aspiration during fluoroscopy for this cohort (κ = 1.0). CONCLUSIONS: Pressure-flow variables derived from automated analysis of combined manometric/impedance measurements provide valuable diagnostic information. When combined into an SRI, these measurements are a robust predictor of aspiration.
Keywords: Manometry Impedance; Esophagus; Clinical Trial; Swallowing Defects
Rights: Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
RMID: 0020110769
DOI: 10.1053/j.gastro.2011.02.051
Appears in Collections:Paediatrics publications

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