Dysphagia lusoria: utility of high-resolution impedance manometry to identify true disease.

Published on Jun 1, 2021in Neurogastroenterology and Motility2.946
· DOI :10.1111/NMO.14176
Jennifer Wellington1
Estimated H-index: 1
(UMB: University of Maryland, Baltimore),
Joseph Kim1
Estimated H-index: 1
(UMB: University of Maryland, Baltimore)
+ 1 AuthorsGuofeng Xie (Veterans Health Administration)
Dysphagia lusoria is a rare cause of dysphagia due to impingement of the esophagus by an aberrant right subclavian artery. Although most remain asymptomatic, this aberrant vessel can lead to progressive dysphagia in childhood or even later in life as a result of arteriosclerotic burden and attenuation of esophageal compliance that led to esophageal compression. We present a 56-year-old man with a 3-year history of progressively worsening dysphagia to solids and liquids and globus sensation. Videofluoroscopic swallowing study (modified barium esophagram) and barium esophagram showed delayed barium tablet transit in the upper esophagus and focal smooth narrowing of the upper esophagus caused by external compression, respectively. Computed tomography imaging demonstrated external compression of proximal esophagus from an aberrant right subclavian artery with high atherosclerotic burden. In addition, high-resolution impedance manometry (HRiM) revealed a striking high-pressure pulsatile vascular band in the proximal esophagus (108 mmHg) associated with poor bolus transit, demonstrating the utility of HRiM in strengthening the diagnoses of true dysphagia lusoria.
📖 Papers frequently viewed together
15 Citations
13 Citations
#1Rena Yadlapati (UCSD: University of California, San Diego)H-Index: 18
#2Peter J. Kahrilas (NU: Northwestern University)H-Index: 122
Last. John E. Pandolfino (NU: Northwestern University)H-Index: 79
view all 52 authors...
Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of es...
11 CitationsSource
#1Hon Chi Yip (CUHK: The Chinese University of Hong Kong)H-Index: 7
#2Philip Wai Yan Chiu (CUHK: The Chinese University of Hong Kong)H-Index: 38
Last. Prateek Sharma (KU: University of Kansas)H-Index: 80
view all 5 authors...
This is an official guidance statement of The International Society of the Diseases of the Esophagus (ISDE) to address all the operators involved in management of patients affected by upper gastrointestinal diseases during COVID-19 pandemic. This guidance is based on the best available evidence to date and will be updated as new evidence becomes available.
4 CitationsSource
#1Michael Coles (Georgia Regents University)H-Index: 2
#2Amol Sharma (Georgia Regents University)H-Index: 19
Dysphagia lusoria is rare embryologic defect of the aortic arch vasculature characterized by an aberrant retro-esophageal course of the right subclavian artery (RSA), comprising a vascular sling. This may manifest clinically with symptoms of dysphagia or reflux. Given the rarity of this pathology, there remains uncertainty regarding the most effective treatment algorithm. Vascular decompression procedure surgery is often used to rectify the aberrant vascular morphology. However, a low percentage...
2 CitationsSource
#1Uni Wong (UMB: University of Maryland, Baltimore)H-Index: 3
#2Erik Person (UMB: University of Maryland, Baltimore)H-Index: 1
Last. Guofeng Xie (UMB: University of Maryland, Baltimore)H-Index: 15
view all 6 authors...
Background/Aims: Swallows with viscous or solid boluses in different body positions alter esophageal manometry patterns. Limitations of previous studies include lack of standardized viscous substrates and the need for chewing prior to swallowing solid boluses. We hypothesize that high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions improves sensitivity for detecting esophageal motility abnormalities when compared with tr...
3 CitationsSource
#1Naueen A. Chaudhry (UF: University of Florida)H-Index: 4
#2Kamran Zahid (UF: University of Florida)H-Index: 1
Last. Qing Zhang (UF: University of Florida)H-Index: 1
view all 5 authors...
Transmitted cardiovascular pulsations on high resolution esophageal impedance manometry, and their significance in dysphagia
3 CitationsSource
#1G. C. do Carmo (USP: University of São Paulo)H-Index: 1
#2Jafar Jafari (QMUL: Queen Mary University of London)H-Index: 8
Last. R. B. de Oliveira (USP: University of São Paulo)H-Index: 6
view all 4 authors...
Background Normal values of the esophageal motor function parameters for high-resolution manometry (HRM-EPT) adopted by the Chicago classification were established using the proprietary system of Given Imaging. It is conceivable that normal values of a system do not apply to data from others. Most studies using HRM were based on supine swallows, whereas deglutition occurs mostly in the upright position. We wished to establish normal values for HRM-EPT parameters obtained with the Sandhill's HRM-...
36 CitationsSource
#1Xiujing Zhang (HUST: Huazhong University of Science and Technology)H-Index: 1
#2Xuelian Xiang (HUST: Huazhong University of Science and Technology)H-Index: 5
Last. Xiaohua Hou (HUST: Huazhong University of Science and Technology)H-Index: 18
view all 5 authors...
Background/Aims Most recent studies using high-resolution manometry were based on supine liquid swallows. This study was to evaluate the differences in esophageal motility for liquid and solid swallows in the upright and supine positions, and to determine the percentages of motility abnormalities in different states. Methods Twenty-four asymptomatic volunteers and 26 patients with gastroesophageal reflux disease underwent high-resolution manometry using a 36-channel manometry catheter. The peris...
24 CitationsSource
#1Alice Bennett (Flinders Medical Centre)H-Index: 3
#2Charles CockH-Index: 16
Last. Russell Kym MorcomH-Index: 1
view all 4 authors...
Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric ...
13 CitationsSource
#1A. D. Rogers (UCT: University of Cape Town)H-Index: 1
#2M. Nel (UCT: University of Cape Town)H-Index: 1
Last. N. G. Naidoo (UCT: University of Cape Town)H-Index: 1
view all 4 authors...
Dysphagia Lusoria is dysphagia secondary to an aberrant right subclavian artery that has a retroesophageal course. Adachi and Williams categorized aortic arch anomalies, showing that the right subclavian artery arising in this fashion (as the final branch of the descending aortic arch) is one of the more common. However, this very rarely coexists with a bicarotid trunk. We present such a case as it is manifested in a 36-year-old lady complaining of marked weight loss and dysphagia. The diagnosis...
14 CitationsSource
#1Monika A. Kwiatek (NU: Northwestern University)H-Index: 30
#2Faiz Mirza (NU: Northwestern University)H-Index: 2
Last. John E. PandolfinoH-Index: 79
view all 4 authors...
Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation
96 CitationsSource
Cited By0