Characterization of pharyngeal hypocontractility patterns during deglutition: High Resolution Impedance Manometry findings

Introduction High resolution impedance manometry (HRIM) provides an objective measure of pharyngeal pressurization and bolus flow and can be analysed using pressure flow analysis (PFA). The aim of the study is to investigate different types of pharyngeal hypocontractility and their distribution in patients with pharyngeal dysphagia. Material and Methods A cohort study was conducted on patients with dysphagia referred for HRIM. Inclusion criteria were abnormal (<5th percentile) pharyngeal contractile integral (PhCI) or abnormal regional contractile integrals (velo- or meso- or hypo-pharyngeal integrals). PFA was performed on 10ml liquid swallows using the Swallow GatewayTM open access analysis portal. Patients were classified based on a proposed HRIM scheme. The distribution of PFA metrics was compared between patients with normal and abnormal PhCI using the chi-squared test. Results In total 38 patients were studied and 137 swallows were analysed. Absent pharyngeal contractility was found in 5.3% (2/38) of the patients, ineffective pharyngeal contractility in 68.4% (26/38), and fragmented pharyngeal contractility in 26.3% (10/38). Regional weakness was mainly observed in the mesopharynx (94.7% of the patients), followed by the hypopharynx (50%) and the velopharynx (15.8%). A combined disorder of pharyngeal propulsion and UES restriction was seen in 44.7% (17/38) of the patients. Patients with a normal PhCI (fragmented pharyngeal contractility) were more likely to present an abnormal integrated relaxation pressure at the level of the upper esophageal sphincter (\u3c72=14.56, p=0.001) Conclusion Based on the pharyngeal contractile integrals, two main types of pharyngeal hypocontractility are present in the clinical population of patients: ineffective and fragmented pharyngeal contractility. Totally absent peristalsis in uncommon. In almost half of the patients, pharyngeal propulsion disorders are combined to disorders of UES restriction

Bolus residue scale: an easy-to-use and reliable videofluoroscopic analysis tool to score bolus residue in patients with dysphagia

Background. We aimed to validate an easy-to-use videofluoroscopic analysis tool, the bolus residue scale (BRS), for detection and classification of pharyngeal retention in the valleculae, piriform sinuses, and/or the posterior pharyngeal wall. Methods. 50 randomly selected videofluoroscopic images of 10 mL swallows (recorded in 18 dysphagia patients and 8 controls) were analyzed by 4 experts and 6 nonexpert observers. A score from 1 to 6 was assigned according to the number of structures affected by residue. Inter- and intrarater reliabilities were assessed by calculation of intraclass correlation coefficients (ICCs) for expert and nonexpert observers. Sensitivity, specificity, and interrater agreement were analyzed for different BRS levels. Results. Intrarater reproducibility was almost perfect for experts (mean ICC 0.972) and ranged from substantial to almost perfect for nonexperts (mean ICC 0.835). Interjudge agreement of the experts ranged from substantial to almost perfect (mean ICC 0.780), but interrater reliability of nonexperts ranged from substantial to good (mean 0.719). BRS shows for experts a high specificity and sensitivity and for nonexperts a low sensitivity and high specificity. Conclusions. The BRS is a simple, easy-to-carry-out, and accessible rating scale to locate pharyngeal retention on videofluoroscopic images with a good specificity and reproducibility for observers of different expertise levels.Nathalie Rommel, Charlotte Borgers, Dirk Van Beckevoort, Ann Goeleven, Eddy Dejaeger, and Taher I. Omar

Automatische Impedantie Manometrie (AIM): objectieve diagnostiek van oro-faryngale dysfagie

Dit overzichtsartikel wil het klinisch potentieel aantonen van Automatische Impedantie Manometrie (AIM) als nieuwe, nietradiologische techniek voor screening en diagnostiek van faryngale dysfagie, zijnde slikstoornissen in de mond, keelholte en bovenste slokdarm. Deze AIM-techniek maakt gebruik van een katheter met druksensoren en impedantie-elektroden om slikken kwantitatief te beschrijven. Een geïntegreerde – eerder dan afzonderlijke – analyse van de gemeten druk- en impedantiepatronen die ontstaan bij het doorslikken van een voedselbolus, kan een zinvolle aanvulling zijn op de dynamische beeldvormingsonderzoeken die vandaag de dag als gouden standaard worden gezien. Belangrijke voordelen zijn het objectieve karakter van de techniek en de geautomatiseerde berekening van diverse slikparameters. Een globale maat voor de slikfunctie kan worden bekomen (Slik Risico Index, SRI) en houdt verband met (de ernst van) het aspiratierisico van de patiënt en de aanwezigheid van bolusresidu. Zo kan een accurate detectie van aspiratie met een sensitiviteit van 0,88 en specificiteit van 0,96 niet via radiologisch onderzoek bereikt worden. Verschillende slikparameters zijn ook voldoende gevoelig om veranderingen in voedselconsistentie te detecteren en om de effecten van slikmanoeuvres objectief te beschrijven. Recent werd ook aangetoond dat deze AIM-analyse snel en betrouwbaar kan worden uitgevoerd door clinici met variërende ervaring en opleiding. Bovendien worden in verschillende patiëntengroepen andere patronen van afwijkende slikparameters aangetroffen. Of deze observatie aanleiding kan geven tot specifieke slikdiagnoses en dus meer gerichte behandelingen is momenteel onderwerp van onderzoek

Alcohol affects the emotional modulation of cognitive control: an event-related brain potential study

OBJECTIVE: The present study aimed to determine whether alcohol affects the emotional modulation of cognitive control and its underlying neural mechanisms, which is pivotal to an understanding of the socially maladaptive behaviors frequently seen in alcohol-intoxicated individuals. METHOD: Event-related potentials (ERPs) were recorded in male participants receiving either a moderate dose of alcohol (0.65 g/kg alcohol; n = 32) or a non-alcoholic placebo beverage (n = 32) while performing an emotional Go/No-Go task that required response execution (Go trials) to pictures of a “target” emotional facial expression (angry, happy, neutral) and response inhibition (No-Go trials) to a different “non-target” expression. RESULTS: Overall, N200 and P300 amplitudes were more enhanced during No-Go than Go trials. Interestingly, alcohol-intoxicated individuals displayed larger No-Go N200 amplitudes across all emotional conditions than controls, accompanied by decreased task performance (i.e., more errors), particularly in response to angry faces. P300 amplitude in the alcohol group was significantly reduced for both Go and No-Go trials, but only following angry and happy emotional expressions. CONCLUSIONS: These results suggest that alcohol-intoxicated individuals need to effortfully activate more cognitive resources during the early inhibition process in order to regulate a response than controls. Moreover, alcohol affected the emotional modulation of both response inhibition and execution in the later stages of cognitive control. Alcohol dampened emotional responsiveness, which may restrict the availability of attentional resources for cognitive control. Yet, these findings may underlie the lack of control in alcohol-intoxicated individuals when faced with emotionally or socially challenging situations