Utility of High-Resolution Esophageal Manometry in the Evaluation of Presumed Oropharyngeal Dysphagia.

Abstract

Objective: Evaluate the utility of high-resolution esophageal manometry (HREM) in patients with symptoms of oropharyngeal dysphagia (OD) but unremarkable Modified Barium Swallow Studies (MBSS).

Study design: Retrospective cohort study.

Setting: Tertiary academic center.

Methods: A retrospective review was conducted on patients with symptoms of oropharyngeal dysphagia from January 2021 to December 2024. Demographics, symptoms, and Charlson Comorbidity Index scores were recorded. Patients with unremarkable MBSS then underwent HREM. HREM data based on the Chicago Classification V 3.0 were analyzed, including mean residual upper esophageal sphincter (UES) pressure, median lower esophageal sphincter (LES) pressure, and ineffective swallow rates, using T-tests, and Chi-Squared tests.

Results: Among 29 patients (mean age 53.2 years, 48.7% female), HREM findings showed mean residual UES pressure of -0.5 mmHg, median residual LES pressure of 13.9 mmHg, and 22.9% ineffective swallows. Esophageal pathologies (ineffective esophageal motility or esophagogastric junction outflow obstruction) were identified in 58.6% of cases. Symptom-specific differences in esophageal motility disorders were not statistically significant.

Conclusion: HREM identified esophageal pathologies in 58.6% of patients with OD symptoms and normal MBSS, highlighting its value in the diagnostic workup of oropharyngeal dysphagia. The overlap of symptoms between oropharyngeal and esophageal motility disorders supports integrating HREM for comprehensive evaluation.

Level of evidence: 4.