Failed Swallows on High-Resolution Manometry Independently Correlates With Severity of LPR Symptoms

Lawrence F Borges; Sanjay Salgado; Kelly E Hathorn; Natan Feldman; Thomas L Carroll; Walter W Chan

doi:10.1016/j.jvoice.2020.09.003

Failed Swallows on High-Resolution Manometry Independently Correlates With Severity of LPR Symptoms

J Voice. 2022 Nov;36(6):832-837. doi: 10.1016/j.jvoice.2020.09.003. Epub 2020 Sep 29.

Authors

Lawrence F Borges¹, Sanjay Salgado², Kelly E Hathorn¹, Natan Feldman³, Thomas L Carroll⁴, Walter W Chan⁵

Affiliations

¹ Divisions of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
² Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
³ Divisions of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.
⁴ Harvard Medical School, Boston, Massachusetts; Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts.
⁵ Divisions of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: wwchan@bwh.harvard.edu.

PMID: 33008724
DOI: 10.1016/j.jvoice.2020.09.003

Abstract

Background: Abnormal esophageal motility is prevalent in gastroesophageal reflux disease patients; however, its relationship with laryngopharyngeal reflux (LPR) symptom severity remains unclear. Altered esophageal transit may contribute to LPR symptoms. We aimed to examine the relationship between reflux symptom index (RSI), a validated questionnaire for LPR symptoms, and abnormal esophageal motility on high-resolution manometry (HRM).

Methods: A total of 133 consecutive patients (55.9 ± 14.6 years, 69.9% female) with suspected LPR referred for HRM and multichannel intraluminal impedance-pH study (MII-pH) at a tertiary center from March 2015 to October 2017 were included. RSI questionnaire was prospectively collected prior to motility testing. Authors analyzing HRM and MII-pH were blinded to RSI findings. Statistical analyses were performed using Student's t test or Pearson's correlation (univariate) and general linear regression (multivariable).

Results: Mean RSI was higher among patients with ineffective esophageal motility than those with normal motility (23.7 vs 18.6, P = 0.01). Significant positive correlation was found between RSI and percent failed swallows (R² = 0.21, P = 0.03), but not percent weak swallows. On multivariable analysis, percent ineffective (failed or weak) swallows was significantly associated with RSI (β-coefficient: 0.072, P = 0.05) after controlling for age, gender, BMI, smoking, prior PPI use, and reflux on MII-pH. When analyzed separately, percent failed swallows (β-coefficient: 0.095, P= 0.02), but not percent weak swallows, independently predicted higher RSI.

Conclusions: Ineffective swallows, particularly failed swallows, are independently associated with higher RSI in patients with suspected LPR, even after controlling for reflux on MII-pH. Esophageal dysmotility may play a role in suspected LPR symptoms independent of reflux. HRM should be routinely considered in evaluating these patients.

Keywords: Esophageal manometry; Failed swallows; Gastroesophageal reflux; Ineffective esophageal motility; Laryngopharyngeal reflux.

MeSH terms

Animals
Electric Impedance
Esophageal pH Monitoring
Female
Humans
Laryngopharyngeal Reflux* / complications
Laryngopharyngeal Reflux* / diagnosis
Male
Manometry
Swallows*