title: Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry.
abstract: OBJECTIVE
  Deglutition is a highly integrated process of neural signaling and coordinated muscular contraction that begins with bolus preparation in the oral cavity and ends with closure of the lower esophageal sphincter after bolus passage. The goal of this study was to examine the relationship between measures of oropharyngeal and esophageal swallow function.
  
  
  METHODS
  A retrospective review was performed of patients who underwent modified barium swallow study (MBSS) and multichannel intraluminal impedance-esophageal manometry (MII-EM) over 7 years at an academic institution. The MBSS was scored with the Modified Barium Swallow Impairment Profile (MBSImP). Associations between impairments as measured by the MBSImP and MII-EM were assessed with a 2-sided Fisher's exact test.
  
  
  RESULTS
  One hundred sixty-four patients met the inclusion criteria for the study. Comparison of MBSImP component and oral and pharyngeal total regional scores to MII-EM scores revealed a significant association between abnormal esophageal clearance on MBSS (MBSImP component 17) and abnormal findings on MII-EM (p < 0.001). Delay in initiation of pharyngeal swallow (MBSImP component 6) was significantly associated with abnormal esophageal clearance on MBSS (p = 0.023).
  
  
  CONCLUSIONS
  Abnormal esophageal clearance on MBSS (MBSImP component 17) indicates a need for further esophageal testing. A functional interrelationship between abnormalities of oropharyngeal and esophageal swallowing does exist, illuminating the importance of thorough pharyngoesophageal examination for dysphagia symptoms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Gullung
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.forename: Donald O
authors.initials: DO
authors.lastname: Castell
authors.forename: Bonnie
authors.initials: B
authors.lastname: Martin-Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D017097:Electric Impedance; D004568:Electrodiagnosis; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009960:Oropharynx / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult