Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Figures & data

Figure 1. Pharyngeal and upper oesophageal sphincter (UOS) metrics.

Table I. Pharyngeal high-resolution manometry metrics.

Metric	Unit	Definition
Pharyngeal contractile integral (PhCI)	mmHg cm s	Sum of pharyngeal pressures >20 mmHg from the velopharynx to the UOS proximal margin over the period from UOS opening to 0.5 s after UOS closure.
Velopharyngeal contractile integral (VCI)	mmHg cm s	A measure of contractile vigour within the velopharyngeal region only.
Mesopharyngeal contractile integral (MCI)	mmHg cm s	A measure of contractile vigour within the mesopharyngeal region only.
Hypopharyngeal contractile integral (HPCI)	mmHg cm s	A measure of contractile vigour within the hypopharyngeal region only.
UOS relaxation time (UOS RT)	s	A measure of duration of pressure drop at UOS 50% below baseline or 35 mmHg (lowest figure selected).
UOS integrated relaxation pressure (UOS IRP)	mmHg	A measure of the extent of UOS relaxation – median of the lowest non-consecutive 0.20−0.25 s of pressure.

mmHg cm s: millimetres of mercury; s: seconds; UOS: upper oesophageal sphincter.

Table II. Participant demographics.

Sex	Age (years)	Diagnosis	Dysphagia severity (Functional Oral Intake Scale)
Male	45	Multiple sclerosis	5
Female	45	Unknown	4
Male	52	Multiple sclerosis	3
Female	55	Auto-immune disease	4
Female	56	Respiratory failure	5
Female	57	Gastro-oesophageal reflux disease	5
Male	58	Lung cancer	5
Female	61	Unknown	5
Male	62	Chronic obstructive pulmonary disease	5
Male	70	Stroke	2
Male	70	Stroke	4
Male	74	Achalasia	4
Female	78	Motor neurone disease	3
Male	82	Motor neurone disease	4
Female	86	Stroke	5

Figure 2. Pharyngeal contractile integral (PhCI) at baseline and during effortful swallow (n = 15).

Table III. Pharyngeal metrics.

Metric	Baseline swallow (10ml IDDSI level 0) Median (IQR)	Effortful swallow (10ml IDDSI level 0) Median (IQR)	Z score	p-value (Wilcoxon signed-rank test)
PhCI (mmHg cm s)	156.81 (80.62)	213.50 (117.2)	–3.124	0.002*
VCI (mmHg cm s)	46.27 (22.71)	62.86 (22.71)	–3.408	0.001*
MCI (mmHg cm s)	53.79 (20.71)	69.02 (106.61)	–2.215	0.027*
HPCI (mmHg cm s)	68.11 (56.64)	98.13 (72.38)	–2.953	0.003*
UOS RT (s)	0.56 (0.50–0.66)	0.7 (0.63–0.88)	–3.171	0.002*
UOS IRP (mmHg)	4.28 (9.88)	6.68 (9.14)	–1.193	0.233

IQR: interquartile range; PhCI: pharyngeal contractile integral; VCI: velopharyngeal contractile integral; MCI: mesopharyngeal contractile integral; HPCI: hypopharyngeal contractile integral; UOS IRP: upper oesophageal sphincter integrated relaxation pressure; UOS RT: upper oesophageal sphincter relaxation time. *Statistically significant p-values (<0.05).

Figure 3. Velopharyngeal contractile integral (VCI) at baseline and during effortful swallow (n = 15).

Figure 4. Mesopharyngeal contractile integral (MCI) at baseline and during effortful swallow (n = 15).

Figure 5. Hypopharyngeal contractile integral (HPCI) at baseline and during effortful swallow (n = 15).

Figure 6. Upper oesophageal sphincter relaxation time (UOS RT) at baseline and during effortful swallow (n = 15).

Figure 7. Upper oesophageal sphincter integrated relaxation pressure (UOS IRP) at baseline and during effortful swallow (n = 15).