Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia

The use of esophageal manometry seems to be increasing, but the utility of pharyngeal and upper esophageal sphincter (UES) manometry is not widely rec ognized. This article is intended to clarify this subject. Initially, we re view the anatomy and physiology of this area. Most studies indicate that th e manometry of the UES and pharynx provides useful information primarily in patients that have symptoms of oropharyngeal dysfunction. Oropharyngeal dy sphagia has high morbidity, mortality, and cost. It occurs in one third of all stroke patients and is common in the chronic care setting; up to 60% of nursing home occupants have feeding difficulties, of whom a substantial po rtion have dysphagia. For patients with oropharyngeal dysphagia, as for tho se with esophageal dysphagia, barium swallow study and manometry are compli mentary. Their combined use permits us to enhance the understanding of the pathophysiologic process that causes the patient's symptoms. Abnormalities have been noted in a variety of diseases, such as Parkinson's disease, ocul opharyngeal muscular dystrophy, achalasia, and scleroderma. Thus, it ils po ssible to determine the primary pathology that is causing the patient's dys phagia by analyzing the manometry results. Pharyngeal and UES manometry als o has a value in evaluating patients who are candidates for myotomy or dila tation, as it can help identify patients with a prospective good outcome.