Volitional control of the upper esophageal sphincter with high-resolution manometry driven biofeedback

Introduction Dysfunction of the upper esophageal sphincter (UES) is associated with swallow dysfunction and globus pharyngeus. Although volitional augmentation of the UES has been previously documented, the ability of individuals to control UES pressure with high-resolution manometry (HRM) driven biofeedback has not been assessed. Purpose To evaluate the ability of patient driven HRM biofeedback to control UES basal pressure. Methods HRM data was collected from 10 patients undergoing esophageal manometry. Participants were trained on real-time HRM-driven biofeedback to both elevate and reduce UES pressure. Measures of baseline UES minimum, mean and maximum pressures (mmHg) were compared to biofeedback-driven volitional increases and decreases in UES pressures. Pre- and post-biofeedback data were compared with paired sample T-tests. Results The mean age (+/- standard deviation) of the cohort was 68 (+/- 12.7) years. Sixty percent (6/10) were female. The mean UES baseline pressure increased from 30.1 (+/- 15.3) mmHg to 44.8 (+/- 25.03) mmHg (P = .02) with biofeedback-driven UES augmentation (P < .05). Maximum UES pressures were also increased from 63.84 (+/- 24.1) mmHg to 152.4 (+/- 123.7) (P = .04). Although some individuals were able to successfully decrease basal UES tone with the HRM biofeedback, no statistically significant group differences were observed (P > .05). Conclusion Volitional control of UES pressure is possible with HRM-driven biofeedback. Patients vary in their ability to intentionally control UES pressure and some may require further training aimed at lowering UES pressure with HRM-guided biofeedback. These data may have significant implications for the future treatment of UES disorders and warrant further investigation. Level of Evidence 4