The Relationship between Upper Esophageal Sphincter Manometry Function and Esophageal Motility Disorders

Juliette Hall; Milli Gupta; Michelle Buresi; Dorothy Li; Yasmin Nasser; Christopher N Andrews; Matthew Woo; Derrick R Randall

doi:10.1002/ohn.993

The Relationship between Upper Esophageal Sphincter Manometry Function and Esophageal Motility Disorders

Otolaryngol Head Neck Surg. 2024 Sep 30. doi: 10.1002/ohn.993. Online ahead of print.

Authors

Juliette Hall¹, Milli Gupta², Michelle Buresi², Dorothy Li², Yasmin Nasser², Christopher N Andrews², Matthew Woo², Derrick R Randall³

Affiliations

¹ Faculty of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

PMID: 39350508
DOI: 10.1002/ohn.993

Abstract

Objective: High-resolution manometry (HRM) provides measures of esophageal function which are used to classify esophageal motility disorders based on the Chicago Classification system. Upper esophageal sphincter (UES) measures are obtained from HRM, but are not included in the classification system, rendering the relationship between UES measures and esophageal motility disorders unclear. Furthermore, changes in the acceptable amount of esophageal dysfunction between versions of this classification system has created controversy. The objective of this study was to determine the relationship between UES measures and esophageal function.

Study design: Cross-sectional study.

Setting: Referral centre.

Methods: HRM studies from the Calgary Gut Motility Center were reviewed for UES mean basal pressure, mean residual pressure, relaxation time-to-nadir, relaxation duration, and recovery time. Patients were grouped by number of failed swallows according to different iterations of the Chicago Classification: 0 to 4 (Group 1), 5 to 7 (Group 2), and 8 to 10 (Group 3).

Results: 2114 patients (65.1% female, median age 56 y) were included. There were significant increases in UES mean basal pressure (P < .001), mean residual pressure (P < .001), relaxation duration (P < .001), and recovery time (P < .001) between groups. Positive correlations existed between number of failed swallows and UES mean basal pressure (r = 0.143; P < .001), mean residual pressure (r = 0.201; P < .001), relaxation duration (r = 0.145; P < .001), and recovery time (r = 0.168; P < .001).

Conclusions: Differences in UES measures exist among patients with failed swallows, with a positive correlation between UES dysfunction and increasing dysmotility. Our findings illustrate that UES measures are closely related to esophageal function, and that even minor esophageal dysfunction is related to UES dysfunction.

Keywords: Chicago Classification; esophageal function; high‐resolution manometry; upper esophageal sphincter.