Perception of dysphagia: lack of correlation with objective measurements of esophageal function

Authors

  • A. Lazarescu,

    1. Centre for Gastroenterological Research, KU Leuven, Leuven, Belgium
    2. Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
    Search for more papers by this author
  • G. Karamanolis,

    1. Centre for Gastroenterological Research, KU Leuven, Leuven, Belgium
    2. Gastroenterology Unit, 2nd Propaudeutic Internal Medicine, University of Athens, “ATTIKON” UGH, Athens, Greece
    Search for more papers by this author
  • L. Aprile,

    1. Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
    Search for more papers by this author
  • R. B. De Oliveira,

    1. Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
    Search for more papers by this author
  • R. Dantas,

    1. Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
    Search for more papers by this author
  • D. Sifrim

    1. Centre for Gastroenterological Research, KU Leuven, Leuven, Belgium
    2. Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
    Search for more papers by this author

  • Dr Adriana Lazarescu and Dr George Karamanolis share the first authorship and both have contributed equally to the study.

Address for Correspondence
Daniel Sifrim, MD, PhD, Wingate Institute of Neurogastroenterology, 26 Ashfield Street, London E1 2AJ, UK.
Tel: +44 (0) 20 7882 2631; fax: +44 (0) 20 7375 2103; e-mail: d.sifrim@qmul.ac.uk

Abstract

Background  The mechanism underlying increased perception of food bolus passage in the absence of esophageal mechanical obstruction has not been completely elucidated. A correlation between the intensity of the symptom and the severity of esophageal dysfunction, either motility (manometry) or bolus transit (impedance) has not been clearly demonstrated. The aim of this study was to analyze the correlation between objective esophageal function assessment (with manometry and impedance) and perception of bolus passage in healthy volunteers (HV) with normal and pharmacologically-induced esophageal hypocontractility, and in patients with gastro-esophageal reflux disease (GERD) with and without ineffective esophageal motility (IEM).

Methods  Combined manometry-impedance was performed in 10 HV, 19 GERD patients without IEM and nine patients with IEM. Additionally, nine HV were studied after 50 mg sildenafil, which induced esophageal peristaltic failure. Perception of each 5 mL viscous swallow was evaluated using a 5-point scale. Manometry identified hypocontractility (contractions lower than 30 mmHg) and impedance identified incomplete bolus clearance.

Key Results  In HV and in GERD patients with and without IEM, there was no association between either manometry or impedance and perception on per swallow analysis (OR: 0.842 and OR: 2.017, respectively), as well as on per subject analysis (P = 0.44 and P = 0.16, respectively). Lack of correlation was also found in HV with esophageal hypocontractility induced by sildenafil.

Conclusions & Inferences  There is no agreement between objective measurements of esophageal function and subjective perception of bolus passage. These results suggest that increased bolus passage perception in patients without mechanical obstruction might be due to esophageal hypersensitivity.

Ancillary