Oral Intake Difficulty and Aspiration Pneumonia Assessment Using High‐Resolution Manometry

Objective The sequential generation of swallowing pressure (SP) from the nasopharynx to the proximal esophagus is important for the bolus to pass from the oral cavity to the esophagus. The purpose of this study was to investigate the correlation of the SP sequence mode on high‐resolution manometry (HRM) with oral intake difficulty and aspiration pneumonia. Methods Consecutive patients with dysphagia who were admitted to our dysphagia clinic between November 2016 and November 2020 were enrolled in this cross‐sectional study. We classified the HRM pressure topography data according to the SP sequence mode into type A, normal; B, partially decreased; C, totally decreased; and D, sequence disappeared, and according to the upper esophageal sphincter (UES) during pharyngeal swallowing into type 1, flattening and 2, non‐flattening. Clinical dysphagia severity was determined based on oral intake difficulty and aspiration pneumonia. Results In total, 202 patients with dysphagia (mean [standard deviation] age, 68.3 [14.5] years; 140 [69.8%] male) were enrolled. Type C (odds ratio [OR], 10.48; 95% confidence interval [CI], 2.89–51.45), type D (OR, 19.90; 95% CI, 4.18–122.35), and type 2 (OR, 6.36; 95% CI, 2.88–14.57) were significantly related to oral intake difficulty. Type C (OR, 3.23; 95% CI, 1.08–11.12) and type 2 (OR, 4.18; 95% CI, 1.95–9.15) were significantly associated with aspiration pneumonia. Conclusion The failure of sequential generation of SP was associated with higher risk of oral intake difficulty and aspiration pneumonia. These assessments are useful in understanding the pathophysiology and severity of dysphagia and in selecting safety nutritional management methods. Level of Evidence 4 Laryngoscope, 134:2127–2135, 2024 In this study, we revealed that the SP sequence mode was correlated with oral intake difficulty and aspiration pneumonia. Our findings are useful in understanding pathophysiology and severity of dysphagia. Furthermore, they may also facilitate timely and appropriate nutritional management and selection of rehabilitation techniques for patients with dysphagia.