A review of pharyngeal manometry normative data (Walters et al., 2023)

<b>Purpose:</b> The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values.<b>Method: </b>A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure.<b>Results:</b> Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters.<b>Conclusions:</b> Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics.<b>Supplemental Material S1. </b>Findings for all mean consensus metrics, as well as variations in catheter diameter, manufacturer, patient positioning, sampling frequency, and bolus types and volumes.Walters, R. K., Gudipudi R., Gordis, T., Davidson, K., Nguyen, S. A., &amp; O’Rourke, A. K. (2023). A systematic review of pharyngeal high-resolution manometry normative data. <i>American Journal of Speech-Language Pathology</i>, <i>33</i>(2), 1059–1068. https://doi.org/10.1044/2023_AJSLP-23-00221

<b>研究目的：</b>高分辨率咽测压（high-resolution pharyngeal manometry, HRPM）在咽部吞咽障碍（pharyngeal dysphagia）评估中的应用日益增多，但其临床应用的标准化进程却相对滞后。若缺乏基于正常参考值的标准化操作规范，临床医师难以将这项新兴技术转化为有临床价值的实用手段。本研究旨在梳理并对比已发表的常见HRPM指标的正常参考值，助力建立共识性参考标准。
<b>研究方法：</b>本研究对纳入健康成人群体、采用国际工作组共识定义的HRPM指标的前瞻性与回顾性研究开展系统综述。若数据可获取，则提取以下变量：咽部收缩积分（pharyngeal contractile integrals, PhCI）、腭咽部、中咽部、下咽部收缩积分，以及上食管括约肌（upper esophageal sphincter, UES）综合松弛压（integrated relaxation pressure, IRP）、松弛时间（relaxation time, RT）、最大导纳，还有下咽部食团内压。
<b>研究结果：</b>最终纳入30项研究。不同研究间所采用的操作技术与设备存在显著差异。相较于年长个体，年轻群体的PhCI与UES IRP水平更低。相较于仰卧位受试者，直立位个体的UES RT更长；而使用更大体积食团或更细导管的受试者，其UES RT也更长。
<b>研究结论：</b>由于现有文献中采用的操作方案、导管构型、生产厂商与分析软件差异巨大，难以通过合并数据形成HRPM正常参考值的共识。未来需开展遵循标准化HRPM操作方案的前瞻性研究，针对特定导管构型与生产厂商，纳入更大规模的健康人群队列，以建立HRPM指标的可靠参考值。
<b>补充材料S1：</b>所有共识平均指标的研究结果，以及导管直径、生产厂商、受试者体位、采样频率、食团类型与体积的相关差异。
Walters, R. K., Gudipudi R., Gordis, T., Davidson, K., Nguyen, S. A., & O’Rourke, A. K. (2023). 咽高分辨率测压正常数据的系统综述. 《美国言语语言病理学期刊》, 33(2), 1059–1068. https://doi.org/10.1044/2023_AJSLP-23-00221