Pharyngeal high-resolution manometry – impedance – “new kid on the block” in the management of oropharyngeal dysphagia
Martin Ďuriček Orcid.org 1, Iveta Fillová2, Peter Lipták1, Martin Vojtko1, Štefan Plutko1, Branislav Malý1, Peter Bánovčin1
+ Affiliation
Summary
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.
Keywords
dysphagia, high-resolution manometry, impedance, swallowing, upper esophageal sphincterTo read this article in full, please register for free on this website.
Benefits for subscribers
Benefits for logged users
Literature
1. Kahrilas PJ, Bredenoord AJ, Fox M et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27(2): 160– 174. doi: 10.1111/ nmo.12477.
2. Hyrdel R, Bánovčin P, Ďuriček M. Esophageal motility disorders – The Chicago classification, v3.0. Gastroent Hepatol 2015; 69(2): 130– 138. doi: 10.14735/ amgh2015130.
3. Kahrilas PJ. Pharyngeal structure and function. Dysphagia 1993; 8(4): 303– 307. doi: 10.1007/ BF01321767.
4. Rosen SP, Jones CA, McCulloch TM. Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry. Laryngoscope 2017; 127(9): 1989– 1995. doi: 10.1002/ lary.26483.
5. Jones CA, Lagus JF, Abdelhalim SZ et al. Normative high-resolution pharyngeal manometry: impact of age, size of system, and sex on primary metrics and pressure stability. Dysphagia 2024; 39(4): 648– 665. doi: 10.1007/ s00455-023- 10647-1.
6. Omari T, Cock C, Wu P et al. Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders. Neurogastroenterol Motil 2023; 35(1): e14461. doi: 10.1111/ nmo.14461.
7. Omari TI, Maclean JC, Cock C et al. Defining pharyngeal and upper esophageal sphincter disorders on high-resolution manometry-impedance: the Leuven consensus. Neurogastroenterol Motil 2025; e70042. doi: 10.1111/ nmo.70042.
8. Omari TI, Szczesniak MM, Maclean J et al. Correlation of esophageal pressure-flow analysis findings with bolus transit patterns on videofluoroscopy. Dis Esophagus 2016; 29(2): 166– 173. doi: 10.1111/ dote.12300.
9. Fremundová L, Balihar K, Koželuhová J. Manometrie jícnu. Gastroent Hepatol 2013; 67(4): 250– 260.
10. Ferris L, Doeltgen S, Cock C et al. Modulation of pharyngeal swallowing by bolus volume and viscosity. Am J Physiol Gastrointest Liver Physiol 2021; 320(1): G43– G53. doi: 10.1152/ ajpgi.00270.2020.
11. Cichero JA, Lam P, Steele CM et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia 2017; 32(2): 293– 314. doi: 10.1007/ s00455-016-9758-y.
12. Omari TI, Ciucci M, Gozdzikowska K et al. High-resolution pharyngeal manometry and impedance: protocols and metrics-recommendations of a high-resolution pharyngeal manometry International Working Group. Dysphagia 2020; 35(2): 281– 295. doi: 10.1007/ s00455-019-10023-y.
13. Omari TI, Zifan A, Cock C et al. Distension contraction plots of pharyngeal/ esophageal peristalsis: next frontier in the assessment of esophageal motor function. Am J Physiol Gastrointest Liver Physiol 2022; 323(3): G145– G156. doi: 10.1152/ ajpgi.00124.2022.
14. Ashford J, McCabe D, Wheeler-Hegland K et al. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Part III – impact of dysphagia treatments on populations with neurological disorders. J Rehabil Res Dev 2009; 46(2): 195– 204.
15. Wheeler-Hegland K, Ashford J, Frymark T et al. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Part II – impact of dysphagia treatment on normal swallow function. J Rehabil Res Dev 2009; 46(2): 185– 194.
16. Ra JY, Hyun JK, Ko KR et al. Chin tuck for prevention of aspiration: effectiveness and appropriate posture. Dysphagia 2014; 29(5): 603– 609. doi: 10.1007/ s00455-014-9551-8.
17. Kelly EA, Koszewski IJ, Jaradeh SS et al. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol 2013; 122(2): 100– 108. doi: 10.1177/ 000348941312200205.
18. Belafsky PC. Dilation of the upper esophageal sphincter. J Am Foregut Soc 2024; 4(4): 487– 496. doi: 10.1177/ 26345161241282299.
19. Albéniz E, Estremera-Arevalo F, Rosón PJ et al. Cricopharyngeal peroral endoscopic myotomy for achalasia of the cricopharynx: “to do or not to do”. Endoscopy 2022; 54(7): E382– E383. doi: 10.1055/ a-1544-7677.
20. Albéniz E, Estremera-Arevalo F. Cricopharyngeal achalasia and upper oesophageal endoscopic myotomy (CP-POEM). Best Pract Res Clin Gastroenterol 2024; 71: 101937. doi: 10.1016/ j. bpg.2024.101937.
21. Wu PI, Szczesniak MM, Omari T et al. Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson‘s disease. Endosc Int Open 2021; 9(11): E1811– E1819. doi: 10.1055/ a-1562-7107.