Novel Electrical Impedance Methodology to Understand Functional Dysphagia

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Summary/Abstract Dysphagia or difficulty swallowing affects 15-20% of the general population in the USA. The reason for dysphagia remains unclear in large number of patients even after extensive testing using multiple modalities such as endoscopy, barium swallow and esophageal manometry. The current method of measuring esophageal peristalsis, i.e., high resolution manometry (HRM) measures only the contraction phase of peristalsis; Chicago classification of esophageal motility disorders is based on the abnormalities in the contraction phase of peristalsis. Measuring esophageal inhibition during peristalsis has been a challenge. From a functional point of view, the purpose of the inhibition phase is the relaxation of circular and longitudinal muscle so that bolus can flow through the relaxed segment with minimal resistance. The last funding period allowed us to develop methodologies to measure the luminal CSA/esophageal distension (marker of inhibition) from the intraluminal impedance measurements; advantage of which is that one can measure luminal CSA/distension at closely spaced intervals along the entire length of the esophagus, relatively easily. Using above methodology, we found abnormalities in the distension phase of esophageal peristalsis in number of patient groups with dysphagia who have normal contraction phase of peristalsis. These patients are currently labelled as functional dysphagia and there are no proper strategies to diagnose and treat this large group of patients. The goals of our future studies are to determine, 1) the mechanism of poor distension of the esophagus in patients with functional dysphagia, 2) whether pharmacologic agents that influence the contraction phase of peristalsis have an effect on the distension phase of peristalsis in normal subjects and patients with functional dysphagia, 3) whether poor distensibility and longitudinal muscle dysfunction seen in patients with eosinophilic esophagitis is reversible following treatment with a newly approved biologic agent for its treatment, 4) whether Nissen fundoplication surgery leads to poor distensibility of the esophagus, and if one can predict which patient may develop dysphagia following surgery. Overall, we believe that continued studies in the above direction will lead to better diagnostic and treatment strategies for dysphagia symptom.