Subclinical esophageal peristaltic dysfunction during the early phase following a stroke

Evaluation of swallowing following stroke has previously concentrated on th e oropharyngeal phase. We have studied whether there is esophageal dysmotil ity during the early phase following stroke in patients with no clinical ev idence of oropharyngeal dysfunction. Twenty-five patients with a clinical d iagnosis of stroke, and CT scan confirmation, without swallowing abnormalit ies at bedside evaluation were studied. Each subject had two esophageal man ometric studies, one between days 3-5 after the stroke and the second durin g the third week after the stroke. Mean percentage (+/-SE) of completed per istaltic events increased from 57.8 +/- 5.9 (days 3-5) to 77.3 +/- 3.9 (wee k 3) (P = 0.005). Mean propagation of peristalsis (SE) between 10 and 5 cm above the lower esophageal sphincter increased from 2.9 +/- 0.2 cm/sec (day s 3-5) to 3.7 +/- 0.3 cm/sec (week 3) (P = 0.003). We have demonstrated sub clinical peristaltic dysfunction in the smooth muscle segment of the esopha gus in stroke patients with relatively preserved oropharyngeal function.