High-resolution manometry with impedance for the assessment of age related swallowing impairment (dysphagia)

Author: Charles Cock

Cock, Charles, 2023 High-resolution manometry with impedance for the assessment of age related swallowing impairment (dysphagia), Flinders University, College of Medicine and Public Health

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Impaired swallowing (dysphagia) is common in ageing. The personal consequences for survival,

health outcomes and quality of life are potentially devastating. The role of dysphagia in overall

functional decline remains to be fully elucidated, with potentially a feed forward loop of dysphagia

leading to sarcopenia, and in turn, further muscle weakness leading to increasing swallowing


This research program analysed high-resolution manometry with impedance (HRM-I) recordings

from pharyngeal and oesophageal regions using novel pressure-flow analysis methods. The studies

were focused on assessing how swallowing function changes in people and patients who are over

80 years of age, an age group for whom data of this kind are lacking.

The over 80s were compared to younger people and patients and, additionally, repeat

measurements were collected over time to determine individual longitudinal changes.

Global pharyngeal function deteriorated with age. This deterioration was contributed to by upper

oesophageal sphincter (UOS) dysfunction, evidenced by reduced UOS relaxation and opening. UOS

dysfunction appeared to cause a downstream resistance to bolus flow that required a compensatory

increase upstream pharyngeal propulsive force. In the over 80s, these forces were reduced,

suggesting decompensation.

The apparently age-related changes on pharyngeal function were also linked to oesophageal

dysmotility leading to failure of oesophageal bolus clearance in the over 80s and further exacerbated

in patients reporting oesophageal symptoms.

This research program adds a significant evidence base for understanding of age-related swallowing


Keywords: Deglutition, Dysphagia, Manometry, Age, Older

Subject: Medical Science thesis

Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Taher Omari