Pharyngeal high-resolution manometry – impedance – “new kid on the block” in the management of oropharyngeal dysphagia

Abstract

Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel dia­gnostic modality that is applied in the management of patients with oropharyngeal dysphagia. Based on the principle of esophageal high-resolution manometry, extended by the possibility of impedance measurement that enables a comprehensive assessment of the swallowing process, particularly pharyngeal contractility and upper esophageal sphincter (UES). This review article presents clinical applications of P-HRM-I based on the recent Leuven Consensus, which standardizes the protocol of the procedure and provides an analysis and interpretation of the findings. The article discusses the role of P-HRM-I in the dia­gnostic process, key manometric and impedance metrics and their interpretation, and related therapeutic implications. The Leuven consensus distinguishes two major categories of pharyngeal motility disorders: UES dysfunction and pharyngeal contractile dysfunction. P-HRM-I enhances the dia­gnostic yield in patients with oropharyngeal dysphagia by identifying the underlying pathophysiology of swallowing dysfunction, thereby allowing a personalized therapeutic approach.