Researchers Identify Differences in Motor Dynamics of Swallowing Over Time

The motor dynamics of swallowing change from the neonatal period to adulthood, according to findings from a study presented at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting and Postgraduate Course.

Motor abnormalities of pharyngeal muscle contraction or upper esophageal sphincter (UES) relaxation can lead to feeding or swallowing problems.

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Researchers have evaluated pharyngeal and UES motor function via high-resolution esophageal manometry (HREM) in healthy adults and infants, but there are no published data of children.

To address this, researchers from Cincinnati Children’s Hospital in Cincinnati, Ohio, reviewed the electronic medical records and HREM data of children aged 18 years or younger to determine whether they had a history of swallowing problems or UES dysfunction.

The researchers divided the participants into 2 groups: a normal group comprising 142 children with no history of swallowing problems or UES dysfunction and normal videofluoroscopic swallowing study (VFSS) results, and an abnormal group comprising 19 children with known pharyngeal or UES dysfunction and abnormal VFSS results. 

Among the children in the normal group, 41.5% were boys; 59.2% had dysphagia; and 20.4% were being tube-fed. The mean age of the children in the normal group was 141.40  59.70 months.

Among the children in the abnormal group, 57.9% were boys; 94.7% had dysphagia; and more (68.4%) were being tube-fed than in the normal group. The mean age of the children in the abnormal group was 87.21  71.83 months.

Results showed the following UES metrics among the normal group:

• Median UES-integrated relaxation pressure (UES-IRP) at 0.2 seconds, 1.00 mm Hg (interquartile range [IQR], -2.50 to 6.50 mm Hg)
• Median UES-IRP at 0.4 seconds, 4.00 mm Hg (IQR, 0.00-9.50 mm Hg)
• Median UES-IRP at 0.6 seconds, 11.00 mm Hg (IQR, 5.00-16.00 mm Hg)
• Median UES-IRP at 0.8 seconds, 18.00 mm Hg (IQR, 11.00-25.75 mm Hg)
• Median upper resting pressure (URP), 53.50 mm Hg (IQR, 41.25-72.75 mm Hg)
• Median upper nadir pressure (UNP), -1.00 mm Hg (IQR, -5.38 to 4.00 mm Hg)

Results showed the following UES metrics among the abnormal group:

• Median UES-IRP at 0.2 seconds, 10.00 mm Hg (IQR, 4.25-16.75 mm Hg)
• Median UES-IRP at 0.4 seconds, 13.00 mm Hg (IQR, 8.75-22.50 mm Hg)
• Median UES-IRP at 0.6 seconds, 21.00 mm Hg (IQR, 15.50-28.50 mm Hg)
• Median UES-IRP at 0.8 seconds, 25.50 mm Hg (IQR, 18.50-33.75 mm Hg)
• Median URP, 47.00 mm Hg (IQR, 41.00-69.50 mm Hg)
• Median UNP, 8.00 mm Hg (IQR, 3.00-11.75 mm Hg)

The UES-IRP, URP, and UNP were all higher among the abnormal group.

The researchers also evaluated pharyngeal metrics of all patients who had the entire pharyngeal region included in the HREM, of whom 58 were in the normal group and 10 were in the abnormal group.

Among the patients with entire pharyngeal region data, 62.2% in the normal group had dysphagia compared with 90% in the abnormal group; more patients in the abnormal group were boys (70.0%) compared with the normal group (46.6%).

The median peak velopharyngeal pressure was 210.50 mm Hg (IQR, 161.00-298.25 mm Hg) in the normal group and 188.50 mm Hg (100.12-247.88 mm Hg) in the abnormal group.

The median meso-hypopharyngeal pressure was 144.75 mm Hg (IQR, 119.50-209.50 mm Hg) in the normal group and 110.00 mm Hg (IQR, 74.38-120.12 mm Hg) in the abnormal group.

The peak pharyngeal and meso-hypopharyngeal pressures were higher among the normal group.

“This is the largest study reporting UES metrics and pharyngeal pressure changes during swallow in children,” the authors concluded. “We plan to use our normative data to enhance the interpretation of high-resolution pharyngeal manometry and help guide management, in children presenting with dysphagia or feeding disorders.” 

—Melinda Stevens

Reference:

Damrongmanee A, El-Chammas K, Fei L, Zang H, Santucci N, Kaul A. Pharyngeal and upper esophageal sphincter motor dynamics during swallow in children [abstract 671]. Presented at: NASPGHAN Annual Meeting and Postgraduate Course; October 17-19, 2019; Chicago, IL. 

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