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

Abstract

Objective: Reflux disease is common in patients with oropharyngeal dysphagia, but the impact of reflux on oropharyngeal swallowing physiology is not known. This study uses objective measures of swallowing function from modified barium swallow studies to describe the pathophysiology of dysphagia in a group of patients whose only associated condition is reflux.

Study design: Retrospective chart review.

Setting: Tertiary care voice and swallowing clinic.

Subjects and methods: The Swallowing Database at the University of Utah was queried for patients with a diagnosis of reflux without additional conditions known to affect swallowing function. Pharyngeal transit time (TPT), distance of hyoid elevation (H_max), maximum opening size of the upper esophageal sphincter (UES_max), area of pharynx at maximum constriction (PA_max), airway closure timing relative to the arrival of the bolus at the UES, and penetration/aspiration (Pen/Asp) score were assessed.

Results: Of the 122 patients who met inclusion criteria for the study, 42% had normal pharyngeal swallowing function, 57% had at least 1 abnormal swallowing measure, and 47.5% demonstrated a delay in airway closure relative to arrival of the bolus at the UES on at least 1 swallow. The incidence of prolonged TPT, diminished H_max, poor UES_max, and enlarged PA_max were 2.5%, 8%, 4%, and 11.5%, respectively. Sixty percent with a delay in airway closure had a normal Pen/Asp score.

Conclusion: A delay in airway closure relative to the arrival of the bolus at the UES is the most common abnormality of swallowing function found in patients with reflux-associated dysphagia but may not be identified using the Pen/Asp score.

Keywords: dysphagia; reflux; swallowing.