[Effect of balloon dilatation on upper esophageal sphincter in brainstem stroke patients with dysphagia: an...

To explore the effects of balloon dilation intervention on function of upper esophageal sphincter ( UES) in brainstem stroke patients with dysphagia before and after treatment by high resolution solid-state manometry.

Thirty brainstem stroke patients with pharyngeal dysphagia were recruited. The dilatation treatment group ( n = 15) completed a 3-week regimen of modified balloon dilatation and traditional swallowing including E-stim, Mendelsohn Maneuver and supraglottic swallowing. And the control group ( n = 15) only completed 3 weeks of traditional swallowing therapy. Before, and after dilatation, the nadir of UES and its duration were measured during swallowing of thin liquid, thick liquid and pasty material in 3-ml volumes. The results of both groups were compared for identical parameters.

In the experimental group, post-treatment UES residual pressure (for water, P = 0. 008; for thick liquid,P = 0. 004 ; for paste, P = 0. 001 ) and relaxation duration ( for water, P = 0. 006 ; for thick liquid, P =0. 002; for paste, P < 0. 001 ) both significantly improved for all three materials. UES resting pressure approximated normal (Pre-treatment 30 ± 3 mm Hg; post-treatment 59 ± 6 mm Hg, P < 0. 001 ) . In the control group, there was no improvement in post-treatment UES residual pressure and relaxation duration for all three materials ( P > 0. 05). In the experimental group, feeding tube was removed in 12 /15 versus 2/15 patients in the control group. The experimental group had 3. 5 points improvement (P =0. 001) while the control group improved by a mere 0. 63 point ( P = 0. 026) in FOIS scores.

Failed UES is a major cause of dysphagia in brainstem stroke patients. Dysphagia therapy with dilatation improves relaxation of UES. Moreover, it is helpful for restoring UES resting pressure. Traditional swallowing therapy has no positive effect on UES.