Airway Closure Delay: The Predominant Pathophysiology in Reflux-Associated Dysphagia

Area of Science:

• Otolaryngology
• Gastroenterology
• Swallowing Physiology

Background:

• Gastroesophageal reflux disease (GERD) is frequently observed in patients with oropharyngeal dysphagia.
• The specific impact of reflux on the physiological mechanisms of oropharyngeal swallowing remains unclear.

Purpose of the Study:

• To investigate the pathophysiology of dysphagia in patients with reflux as their sole associated condition.
• To utilize objective measures from modified barium swallow studies to characterize swallowing abnormalities.

Main Methods:

• Retrospective chart review of patients diagnosed with reflux without other known swallowing-influencing conditions.
• Analysis of modified barium swallow study data, including pharyngeal transit time (TPT), hyoid elevation (Hmax), upper esophageal sphincter opening (UESmax), pharyngeal area (PAmax), airway closure timing, and penetration/aspiration (Pen/Asp) scores.

Main Results:

• Among 122 patients, 57% exhibited at least one abnormal swallowing measure.
• Delayed airway closure relative to bolus arrival at the upper esophageal sphincter (UES) was the most frequent abnormality (47.5%).
• Prolonged TPT, diminished Hmax, poor UESmax, and enlarged PAmax occurred in 2.5%, 8%, 4%, and 11.5% of patients, respectively.

Conclusions:

• Delayed airway closure is the primary swallowing abnormality in reflux-associated dysphagia.
• Standard penetration/aspiration scores may not adequately identify this specific swallowing dysfunction.