title: Sensation of stasis is poorly correlated with impaired esophageal bolus transport.
abstract: BACKGROUND
  It is common belief that symptoms of patients with non-obstructive dysphagia are the result of impaired bolus clearance in the esophagus, usually caused by esophageal motility disorders. We therefore investigated the relationship between transit of swallowed boluses and the symptom dysphagia.
  
  
  METHODS
  Twenty healthy volunteers and 20 patients with dysphagia underwent videofluoroscopy. Success of bolus transport was graded on a 7-point scale. Each subject swallowed five liquid and five solid barium boluses.
  
  
  RESULTS
  For liquids, patients reported dysphagia during 1 [0-3] of the five swallows, while controls reported no dysphagia (median 0 [0-0]; p = 0.003). For solids, patients reported dysphagia during 3 [2-4] of five swallows, while controls reported dysphagia in 0.5 [0-2] of five swallows (p = 0.001). When correlating dysphagia to ineffective clearance (score ≥ 3), in 3 [2-4] of five liquids, the subjects perception of clearance was related to the clearance result on fluoroscopy in patients and also 3 [1-5] were correctly perceived in controls (p = 0.6). For solids, in 4 [3-5] of five swallows, the subjects perception of clearance was related to the clearance result on fluoroscopy in patients, but only 2 [1-3] of five swallows were correctly perceived by controls, the difference being statistically significant.
  
  
  CONCLUSIONS
  Patients very frequently report dysphagia when bolus clearance is successful. Therefore, the major underlying problem in patients with non-obstructive dysphagia is disordered perception and increased sensitivity to physiological bolus stasis. Treatment should therefore be directed at reducing increased sensitivity rather than at improving motility.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Bogte
authors.forename: A J
authors.initials: AJ
authors.lastname: Bredenoord
authors.forename: J
authors.initials: J
authors.lastname: Oors
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.forename: A J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D000328:Adult; D000368:Aged; D003679:Deglutition; D015154:Esophageal Motility Disorders / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012677:Sensation
keywords: dysphagia; esophagus; peristalsis; swallow; videofluoroscopy