High Resolution Manometry: A Novel Pattern Recognition Method for Dysphagia

描述（由申请人提供）：吞咽是一项重要的生命功能，吞咽失败会导致危及生命的并发症。吞咽相关的行为涉及复杂的、适应性的肌肉收缩的调节，从而在整个口腔、喉咽和食道产生压力和瓣膜事件。然而，我们对产生和调节这些压力的机制的理解仍然不完整。有效的吞咽是压力梯度的结果，压力梯度使药物完全转移到食道的可能性最大化。高分辨率测压仪（HRM）可以直接测量沿咽部长度的这些压力模式，并提供可量化的、全面的数据集，直接表征每次吞咽事件。人力资源管理的使用尚处于起步阶段，由于其独特的能力，有可能成为咽吞咽疾病诊断和管理中非常有价值的工具。当与视频透视（VF）评估相结合时，HRM/VF可以提供详细的、多维的评估，这将定义产生压力的结构和运动，重新定义正常和功能障碍吞咽的模型，提高诊断的准确性，并直接测量治疗效果。然而，缺乏对压力模式的全面分析目前阻碍了在基于证据的实践中使用人力资源管理。本研究计划的总体目标是通过优化HRM分析并将结果与VF获得的结果相结合，开发新的临床诊断咽吞咽障碍的能力。这项新技术将用于确定这些联合技术在多大程度上可以优化不同吞咽障碍人群的吞咽困难诊断。在这项工作的最后阶段，我们将测试这种新工具的临床接受度。这项工作是非常重要的，因为HRM结合VF分析适当和优化将增加干预吞咽困难患者的临床护理。

DESCRIPTION (provided by applicant): Swallowing is a critical life function and its failure leads to life threatening complications. Swallow-related behaviors involve the modulation of complex, adaptive muscular contractions to produce pressures and valving events throughout the oral cavity, laryngo-pharynx and esophagus. However, our understanding of the mechanisms that generate and modulate these pressures remains incomplete. Efficient swallow is the result of a pressure gradient that maximizes the probability of complete bolus transfer into the esophagus. High Resolution Manometry (HRM) can directly measure these pressure patterns along the length of the pharynx and provides a quantifiable, comprehensive data set directly characterizing each swallow event. The use of HRM is in its infancy and due to its unique capabilities, has the potential to become an exceptionally valuable tool in the diagnosis and management of pharyngeal swallowing disorders. When coupled with videofluoroscopic (VF) evaluations, HRM/VF could provide the detailed, multi-dimensional assessment that will define the structures and movements which generate pressure, redefine the models of normal and dysfunctional swallow, increase accuracy of diagnosis, and directly measure therapeutic effect. However, the lack of a comprehensive analysis of the pressure patterns currently precludes the use of HRM in evidence- based practice. The overarching goal of this research proposal is to develop new clinical capabilities for the diagnosis of impaired pharyngeal swallowing by optimizing HRM analysis and combining results with those obtained by VF. This new technology will then be used to determine the extent to which these combined technologies can optimize diagnosis of dysphagia in populations with variable swallowing impairment. In the final phase of this work, we will test clinical acceptance of this new tool. This work is highly significant because HRM combined with VF when analyzed appropriate and optimized will augment interventions in the clinical care of patients with dysphagia.