Skip to main content

Advertisement

SpringerLink
Log in

Assessing Upper Esophageal Sphincter Function in Clinical Practice: a Primer

  • Esophagus (JO Clarke, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

The upper esophageal sphincter constitutes an important anatomic and functional landmark in the physiology of pharyngeal swallowing. A variety of clinical circumstances may call for a dedicated evaluation of this mechanism, from the etiologic evaluation of indeterminate symptoms to the generation of complex locoregional therapeutic strategies. Multiple diagnostic tools exist for the assessment of pharyngeal swallowing generally and of upper esophageal sphincter function specifically, some well established and others not yet settled into routine practice. This report reviews five specific modalities for use in making this assessment, outlining the strengths, weaknesses, and logistical considerations of each with respect to its potential use in clinical settings. In many cases, these studies will provide complementary information regarding pharyngeal function, suggesting the relative advantage of a multimodal evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Jones CA, Hammer MJ, Hoffman MR, et al. Quantifying contributions of the cricopharyngeus to upper esophageal sphincter pressure changes by means of intramuscular electromyography and high-resolution manometry. Ann Otol Rhinol Laryngol. 2014;123:174–82.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Singh S, Hamdy S. The upper oesophageal sphincter. Neurogastroenterol Motil. 2005;17(1):3–12.

    Article  PubMed  Google Scholar 

  3. Babaei A, Dua K, Naini SR, et al. Response of the upper esophageal sphincter to esophageal distension is affected by posture, velocity, volume, and composition of the infusate. Gastroenterology. 2012;142:734–43. e7.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Schindler A, Mozzanica F, Alfonsi E, et al. Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus. Ann N Y Acad Sci. 2013;1300:250–60.

    Article  PubMed  Google Scholar 

  5. Koufman JA, Belafsky PC, Bach KK, et al. Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Laryngoscope. 2002;112:1606–9.

    Article  CAS  PubMed  Google Scholar 

  6. Wang YT, Yazaki E, Sifrim D. High-resolution manometry: esophageal disorders not addressed by the “Chicago classification”. J Neurogastroenterol Motil. 2012;18:365–72.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Chavez YH, Ciarleglio MM, Clarke JO, et al. Upper esophageal sphincter abnormalities: frequent finding on high-resolution esophageal manometry and associated with poorer treatment response in achalasia. J Clin Gastroenterol. 2015;49:17–23. This study demonstrates that UES abnormalities noted on esophageal HRIM are more frequent among patients with concurrent abnormalities in lower esophageal sphincter relaxation. UES abnormalities were also a significant predictor of poor treatment response among patients with achalasia.

    Article  CAS  PubMed  Google Scholar 

  8. Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19:769–85. viii.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Baijens L, Barikroo A, Pilz W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur J Radiol. 2013;82:1683–95.

    Article  PubMed  Google Scholar 

  10. Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kim HM, Choi KH, Kim TW. Patients’ radiation dose during videofluoroscopic swallowing studies according to underlying characteristics. Dysphagia. 2013;28:153–8.

    Article  PubMed  Google Scholar 

  12. Rodrigues B, Nobrega AC, Sampaio M, et al. Silent saliva aspiration in Parkinson’s disease. Mov Disord. 2011;26:138–41.

    Article  PubMed  Google Scholar 

  13. Fuller SC, Leonard R, Aminpour S, et al. Validation of the pharyngeal squeeze maneuver. Otolaryngol Head Neck Surg. 2009;140:391–4.

    Article  PubMed  Google Scholar 

  14. Merati AL. In-office evaluation of swallowing: FEES, pharyngeal squeeze maneuver, and FEESST. Otolaryngol Clin North Am. 2013;46:31–9.

    Article  PubMed  Google Scholar 

  15. Butler SG, Markley L, Sanders B, et al. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2015;124:480–3.

    Article  PubMed  Google Scholar 

  16. Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117:1723–7.

    Article  PubMed  Google Scholar 

  17. Knigge MA, Thibeault S, McCulloch TM. Implementation of high-resolution manometry in the clinical practice of speech language pathology. Dysphagia. 2014;29:2–16.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ryu JS, Park DH, Kang JY. Application and interpretation of high-resolution manometry for pharyngeal dysphagia. J Neurogastroenterol Motil. 2015;21:283–7.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bhatia SJ, Shah C. How to perform and interpret upper esophageal sphincter manometry. J Neurogastroenterol Motil. 2013;19:99–103.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Lee ST, Ryu JS. High resolution manometry of pharyngeal swallow pressure events associated with food viscosity. Arch Phys Med Rehabil. 2014;95:e101–2.

    Article  Google Scholar 

  21. Omari TI, Dejaeger E, Van Beckevoort D, et al. A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol. 2011;106:1796–802.

    Article  PubMed  Google Scholar 

  22. Lee TH, Lee JS, Park JW, et al. High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms. Dis Esophagus. 2014;27:220–9. This study provides proof of concept regarding the application of pharyngeal HRIM to the detection of pharyngeal residue. It also demonstrates this modality’s additive benefit in relation to VFSS by more specifically defining the mechanistic abnormality leading to this residue.

    Article  CAS  PubMed  Google Scholar 

  23. Kwiatek MA, Mirza F, Kahrilas PJ, et al. Hyperdynamic upper esophageal sphincter pressure: a manometric observation in patients reporting globus sensation. Am J Gastroenterol. 2009;104:289–98.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Peng L, Patel A, Kushnir V, et al. Assessment of upper esophageal sphincter function on high-resolution manometry: identification of predictors of globus symptoms. J Clin Gastroenterol. 2015;49:95–100.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Babaei A, Venu M, Naini SR, et al. Impaired upper esophageal sphincter reflexes in patients with supra-esophageal reflux disease. Gastroenterology. 2015;149(6):1381–91. This study demonstrates the utility of HRIM in characterizing UES abnormalities potentially correlated with supraesophageal reflux. Impaired UES reflexes triggered by liquid infusate were noted to be more common among patients with reported SERD.

    Article  PubMed  Google Scholar 

  26. Silva LC, Herbella FA, Neves LR, et al. Anatomophysiology of the pharyngo-upper esophageal area in light of high-resolution manometry. J Gastrointest Surg. 2013;17:2033–8.

    Article  PubMed  Google Scholar 

  27. Jungheim M, Schubert C, Miller S, et al. Normative data of pharyngeal and upper esophageal sphincter high resolution manometry. Laryngorhinootologie. 2015;94(9):601–8.

    Article  CAS  PubMed  Google Scholar 

  28. Ghosh SK, Pandolfino JE, Zhang Q, et al. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol. 2006;291:G525–31.

    Article  CAS  PubMed  Google Scholar 

  29. Szczesniak MM, Maclean J, Zhang T, et al. Inter-rater reliability and validity of automated impedance manometry analysis and fluoroscopy in dysphagic patients after head and neck cancer radiotherapy. Neurogastroenterol Motil. 2015;27(8):1183–9.

    Article  CAS  PubMed  Google Scholar 

  30. Mielens JD, Hoffman MR, Ciucci MR, et al. Automated analysis of pharyngeal pressure data obtained with high-resolution manometry. Dysphagia. 2011;26:3–12.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Vijay Kumar KV, Shankar V, Santosham R. Assessment of swallowing and its disorders—a dynamic MRI study. Eur J Radiol. 2013;82:215–9.

    Article  CAS  PubMed  Google Scholar 

  32. Fujii N, Inamoto Y, Saitoh E, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part I: single- and multiphase volume scanning for three-dimensional morphological and kinematic analysis. Dysphagia. 2011;26:99–107.

    Article  PubMed  Google Scholar 

  33. Inamoto Y, Fujii N, Saitoh E, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26:209–17.

    Article  PubMed  Google Scholar 

  34. Kreeft AM, Rasch CR, Muller SH, et al. Cine MRI of swallowing in patients with advanced oral or oropharyngeal carcinoma: a feasibility study. Eur Arch Otorhinolaryngol. 2012;269:1703–11.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Hartl DM, Kolb F, Bretagne E, et al. Cine magnetic resonance imaging with single-shot fast spin echo for evaluation of dysphagia and aspiration. Dysphagia. 2006;21:156–62.

    Article  PubMed  Google Scholar 

  36. Panebianco V, Ruoppolo G, Pelle G, et al. Morpho-functional patterns of physiologic oropharyngeal swallowing evaluated with dynamic fast MRI. Eur Arch Otorhinolaryngol. 2010;267:1461–6.

    Article  CAS  PubMed  Google Scholar 

  37. Inamoto Y, Saitoh E, Okada S, et al. Anatomy of the larynx and pharynx: effects of age, gender and height revealed by multidetector computed tomography. J Oral Rehabil. 2015;42(9):670–7.

    Article  CAS  PubMed  Google Scholar 

  38. Amin MR, Achlatis S, Lazarus CL, et al. Dynamic magnetic resonance imaging of the pharynx during deglutition. Ann Otol Rhinol Laryngol. 2013;122:145–50.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Lafer M, Achlatis S, Lazarus C, et al. Temporal measurements of deglutition in dynamic magnetic resonance imaging versus videofluoroscopy. Ann Otol Rhinol Laryngol. 2013;122:748–53. This study among healthy volunteers compared measurements of swallowing by dynamic MRI with those by videofluoroscopy, demonstrating reliability and consistency between the two modalities. Temporal resolution of swallowing by dynamic MRI was high enough to distinguish between the respective pharyngeal transit times of liquid and pudding.

    Article  PubMed  Google Scholar 

  40. Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114:2226–44.

    Article  PubMed  Google Scholar 

  41. Ertekin C, Aydogdu I. Electromyography of human cricopharyngeal muscle of the upper esophageal sphincter. Muscle Nerve. 2002;26:729–39.

    Article  PubMed  Google Scholar 

  42. Shemirani NL, Halum SL, Merati AL, et al. Cricopharyngeal electromyography: patterns of injury based on etiology. Otolaryngol Head Neck Surg. 2007;137:792–7.

    Article  PubMed  Google Scholar 

  43. Alfonsi E, Merlo IM, Ponzio M, et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010;81:54–60.

    Article  CAS  PubMed  Google Scholar 

  44. Alfonsi E, Versino M, Merlo IM, et al. Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes. Neurology. 2007;68:583–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nitin K. Ahuja

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Walter W. Chan

  3. Harvard Medical School, Boston, MA, USA

    Walter W. Chan

Authors
  1. Nitin K. Ahuja
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walter W. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walter W. Chan.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Esophagus

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahuja, N.K., Chan, W.W. Assessing Upper Esophageal Sphincter Function in Clinical Practice: a Primer. Curr Gastroenterol Rep 18, 7 (2016). https://doi.org/10.1007/s11894-015-0480-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-015-0480-y

Keywords

Search

Navigation