TITLE
Sensation of stasis is poorly correlated to impaired esophageal bolus transport.
A. Bogte1, A.J. Bredenoord2, J. Oors2, P.D. Siersema1 and A.J.P.M. Smout2
1
Gastrointestinal Research Unit, Department of Gastroenterology and Hepatology, University
Medical Center, Utrecht, the Netherlands. 2Department of Gastroenterology, Academic
Medical Center, Amsterdam, the Netherlands.
ABSTRACT
Background: It is unclear what causes the sensation of dysphagia in patients with nonobstructive dysphagia. Furthermore, it is unknown how many of these patients have impaired
bolus clearance and/or abnormal esophageal motility as assessed with fluorography and
high-resolution manometry (HRM).
Methods: Twenty healthy volunteers and 20 patients with dysphagia underwent HRM and
concurrent videofluoroscopy. Each subject swallowed 5 liquid barium and 5 solid barium
boluses, and esophageal contraction parameters and bolus transport were evaluated. After
each swallow, subjects reported if they perceived incomplete bolus passage. A stasis score
was used to quantify the degree of stasis on videofluoroscopy.
Results: Stasis of liquid barium boluses occurred in patients in 3.5 [2-5] of 5 swallows, while
in the controls 2 [0-4] of 5 swallows were incompletely cleared (p=0.07). Both in patients and
controls most of the swallowed solid boluses were incompletely cleared (patients 4.5 [3-5] of
5 vs controls 4 [4-5] of 5, p=0.9).
During liquid bolus swallows, dysphagia was much more frequently reported by patients (1
[0-3] of 5) than by controls (median 0 [0-0]), p=0.003). Likewise, dysphagia during solid bolus
swallows was more frequently reported by patients than by controls (3 [2-4] of 5 swallows vs.
0.5 [0-2], p=0.001).
Using the stasis score's cut-off value of ≥3 as the definition of unsuccessful bolus transit, the
sensitivity of dysphagia for incomplete liquid bolus swallow was 42.2% in patients and 4.9%
in controls (p=0.002), whereas the specificity of dysphagia was 77.8% in patients and
96.6% in controls (p=0.002). For solid bolus swallows, the sensitivity for stasis was 67.5% in
patients and 23.5% in controls (p=0.002), whereas the specificity was 65.0% in patients and
89.5% in controls (p=0.002). The sensitivity of dysphagia was higher for solid bolus stasis
than for liquid bolus stasis, both in patients and controls (both p=0.028), whereas the
specificity of dysphagia was higher for liquid bolus stasis than for solid bolus stasis, in both
groups (both p=0.028).
Significant associations between stasis score of solids and esophageal manometry
parameters were found for transition zone length, contraction amplitude, IRP, DCI and IBP,
whereas no correlation was found between the stasis score for liquids and manometric
parameters.
Conclusions: Both in patients and controls, the symptom dysphagia does not correlate well
with stasis of liquids or solids, or with HRM parameters. These findings indicate that
esophageal hypersensitivity rather than incomplete bolus clearance is the most important
pathophysiological mechanism in patients with non-obstructive dysphagia.
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