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Objective: Upper esophageal sphincter (UES) opening dysfunction has a wide range of underlying pathophysiologies. An accurate diagnosis of these pathophysiologies is critical for providing appropriate treatment, which can prevent aspiration and reduced material passing into the esophagus. The aim of this study is to explore the relationship between high resolution manometry impedance (HRMI) and videofluoroscopy (VFSS) in the evaluation of UES opening. Material & methods: 117 patients (65 M) with suspicion of UES opening dysfunction were enrolled in this study. A Swallow GatewayTM analysis of 10 ml liquid swallows was performed based on pressure flow analysis (PFA) metrics and compared to VFSS assessment. Results: We found that maximum admittance and pharyngeal peak pressure on HRMI correlated strongly to UES opening on VFSS. A significant negative correlation was shown between the PFA metric bolus presence time and UES opening on radiology. In this study, more patients with a UES opening dysfunction were detected using impedance than when using VFSS. PAS scores corresponded variably with swallow risk index (SRI), UES integrated relaxation pressure (IRP) and maximum admittance. Decreased maximum admittance and increased UES IRP, while no aspiration was detected on VFSS, occurred in respectively 23.93% and 45.30% of the patients. In 8.55% of the patients aspiration occurred, despite a normal SRI. Discussion: There seems to be some correspondence between HRMI and VFSS. However, we only examined UES opening in patients who swallow 10 ml liquid boluses. When looking at different consistencies and volumes, it is possible other results will arise.

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Background and aims: Flow across the EGJ is mainly determined by its distensibility in response to increased intraluminal pressure. Indeed, it has been shown that EGJ distensibility correlates with stasis and symptoms in healthy volunteers and patients with achalasia. Recently, integrated pressure-flow analysis (PFA), was developed to derive novel measures designed to quantify bolus transport. In the present study, therefore, we investigate the correlation between distensibility measurement of the EGJ and PFA analysis. Methods: We measured distensibility of the EGJ using an endoscopic functional luminal imaging probe (EndoFLIP®) in 16 achalasia patients (m=9, age 52.6±3.8). Patients were also assessed by HRIM and PFA analysis was performed. At the same time a timed barium esophagogram was performed and symptom scores were assessed using the Eckardt score, with a score <4 indicating treatment success. The relation between distensibility, PFA parameters (Distention pressure during emptying (DPE), Impendance ratio (IR) and EGJ relaxation (IRP4)) and esophageal stasis and symptoms scores was analyzed. Results: In total, 37 concurrent EndoFLIP® and PFA studies were compared. Baseline EGJ distensibility was impaired in all patients (mean 0.8±0.1 mm2/mmHg at 40 ml volume distension, n=13). Moreover a significant correlation with Eckardt (r=-0.6, p<0.0001, Pearson’s correlation) and stasis (r=-0.4, p=0.009, Pearson’s correlation) was present. Also DPE was impaired at baseline (mean 30.1±5.1 mmHg). DPE was also significantly correlated with Eckardt score (r=0.5, p=0.003, Pearson’s correlation) and stasis (r=0.5, p=0.002, Pearson’s correlation). Moreover a significant correlation between distensibility and DPE was present (r=-0.37, p=0.03, Pearson correlation). No correlation was found with IRP4 or IR. Conclusion: EGJ distensibility is impaired in patients with achalasia and is associated with esophageal emptying and clinical response. This can be objectified using the PFA metric DPE ,which correlated significantly with esophageal emptying om RX, clinical symptoms and EGJ distensibility using endoFLIP. Therefore, we conclude that pressure flow analysis can be used as an alternative for EndoFLIP® measurement in the evaluation of achalasia patients.

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Background: The pharyngeal swallowing function is a complex process due to combination of various anatomical structures involved in the process. The diagnosis of patients with pharyngeal contractile dysfunction is difficult due to interaction of various processes involved in pharyngeal swallow. There is a need to define ways to assess these processes in order to diagnose contractile function. The aim of the study is to assess swallowing in patients with contractile dysfunction with the help of videomanometry impedance and videfluoroscopic studies. Methods: The study consist of 68 patients with pharyngeal contractile dysfunction assessed using videomanometry impedance and videofluoroscopic studies in the adult swallow clinic, University hospitals, Leuven, Belgium. The data considered two bolus sizes i.e 5ml and 10ml was analysed separately in the form of pressure flow analysis(PFA) for impedance manometry considering 11 metrics and radiologically based on pharyngeal and UES region clinically. Key results: There was significant difference seen on various metrics of PFA interacting with videofluoroscopic swallow studies on these patients. The swallow risk index being global variable seen significant in almost all parameters. The various contractile integrals of pharynx showed significant difference in various parameters of pharyngeal region. Thus explaining the anatomical region showing pharyngeal weakness in these patients. Conclusion: Combined approach of video-manometry impedance and videofluoroscopy swallow studies help us to describe the interaction of different parameters involved in swallow process of patients with pharyngeal contractile dysfunction.

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Background: High-resolution impedance manometry (HRIM) can be used to objectively evaluate esophageal bolus flow and pressurization. HRIM adds detailed information on the biomechanics of swallowing dysfunction by providing a visual depiction as well as objective variables of pressure flow analysis (PFA) during esophageal deglutition, without the need for radiology. The aim of this study was to assess esophageal intra- and interrater reliability of an open access PFA-analysis portal by raters with different expertise. Methods: Six observers, divided into three levels of expertise, analysed 20 HRIM studies (n = 15 subjects with esophageal dysphagia and n = 5 healthy control subjects, mean age 55, range 22-80 years). Subjects with esophageal disorders were selected from a university hospital database. Raters analysed the studies twice using an online pressure flow analysis (PFA) portal. Intra- and interrater reliability was calculated with the intra-class correlation coefficient (ICC). Key Results: Interrater results of the metrics derived from the online platform show excellent ICC (ICC > 0,90). Four metrics show good inter-rater ICC (PFI, DCL, DCV, SDL; 0,75 < ICC < 0,90), RP shows moderate ICC (0,50 < ICC < 0,75). Intra-rater reliability results show excellent ICC, three metrics show good ICC (DL, SDL & PCI). Two metrics show moderate ICC (IRP4 & DCV) and three metrics show poor ICC (PFI, DCL & RP; ICC < 0,5). Intra-rater ICC values show no consistent pattern that expertise of the raters influences the reliability. Conclusions & Inferences: The online PFA-analysis portal is a reliable software that can be used for the manometric impedance analysis of esophageal function. Keywords: High-resolution impedance manometry; esophageal motility disorders; online analysis; reliability

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Objective: The main goal of this paper is to classify pharyngeal dysphagia patients through a pharyngeal HRM classification scheme. This also enables quantifying the number of patients in each category and determining the relation of the diagnoses with etiology and age. Design: This study includes 174 patients with an age range from 18 to 90 years old and a mean age of 63 years old. A total number of 760 10ml liquid swallows were classified using a pharyngeal HRM classification scheme and each patient was given an overall diagnosis based on the most seen pattern out of four swallows. Results: Disorders of UES restriction are most common. These restrictions are mostly propulsive. Disorders of pharyngeal propulsion with a normal UES relaxation show more fragmented than ineffective or absent contractions. Looking at etiology, no clear patterns could be discovered. Pharyngeal disorders are more often present in the older age groups. Conclusion: A pharyngeal HRM classification scheme can be useful when taking the metrics as well as the manometric images into account. Future research should focus on defining a cut-off for absent pharyngeal contractility, take a closer look at delayed UES relaxation and further elaborated testing of the classification scheme.