4.3 Article

Pharyngeal Swallowing Pressures in Patients with Radiation-Associated Dysphagia

Journal

DYSPHAGIA
Volume 36, Issue 2, Pages 242-249

Publisher

SPRINGER
DOI: 10.1007/s00455-020-10128-9

Keywords

Deglutition; Deglutition disorders; Head and neck cancer; High-resolution manometry; Radiation-associated dysphagia

Funding

  1. National Institute of Health [R33DC011130, T32GM007507]

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Measuring pharyngeal swallowing pressures in patients with radiation-associated dysphagia using HRM can help clinicians form more precise treatment plans, as these patients exhibit alterations in swallowing pressure.
Dysphagia associated with radiotherapy for head and neck cancer is complex and can be difficult to treat. Videofluoroscopic swallow studies (VFSS) are the current gold-standard instrumented swallow assessment. High-resolution manometry (HRM) is an additional approach that provides objective measurements of swallowing-related pressures in the pharynx and esophagus. This can provide functional information on the pressure gradients underlying bolus propulsion, and is relevant for this patient population, where radiation-related fibrosis can lead to weakness and impaired pressure generation. The purpose of this preliminary study was to describe pharyngeal swallowing pressures in patients with radiation-associated dysphagia (RAD) and late radiation-associated dysphagia (LRAD) using HRM. RAD occurs during and immediately following treatment, whereas LRAD is a more recently described phenomenon in which the patient experiences an onset of dysphagia at least 5 years post-treatment. We performed a retrospective analysis of pharyngeal swallowing pressures from 21 patients with RAD or LRAD and 21 healthy sex/age-matched controls. Patients with RAD or LRAD exhibited decreased swallowing pressure durations throughout the pharynx (p <= 0.002), as well as decreased hypopharynx maximum pressure (p = 0.003) and pharyngeal contractile integral ( p < 0.0001). Understanding how pharyngeal pressure generation is altered in patients with a history of radiotherapy can help clinicians form more precise treatment plans.

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