Comparison of methods for determining cricopharyngeal intrabolus pressure in normal patients as possible indicator for cricopharyngeal myotomy

OBJECTIVE., We sought to compare methods for determining intrabolus cricopharyngeal pressure as a possible indicator for cricopharyngeal myotomy. STUDY DESIGN: We determined multiple intrabolus pressures in the cricopharyngeal region of 20 normal volunteers, of whom 12 were 20 to 35 years old and 8 were older than 75 years. Data were collected using a commercially available manofluorography system and a 6-sensor unidirectional solid-state 2- x 4-mm catheter. Each subject underwent 5 5-mL and 5 10-ml. liquid barium swallows. Data were analyzed, and young subjects were compared with old subjects. RESULTS: The mean mid-bolus pressures in young subjects were 5.2 +/- 4.9 mm Hg and 7.2 +/- 6.5 mm Hg for the 5-ml. and 10-ml. swallows, respectively, and in older subjects, 10.8 +/- 8.8 mm Hg and 12.3 +/- 7.4 mm Hg. The mean gradient pressures across the 3-cm cricopharyngeal region in young subjects were 2.02 +/- 5.0 mm Hg, and - 0.91 +/- 4.8 mm Hg for the 5-ml. and 10-ml. swallows, respectively, and for older subjects, 4.38 +/- 3.1 mm Hg and 2.82 +/- 3.4 mm Hg. CONCLUSIONS: Cricopharyngeal intrabolus pressures were lower in young than in older subjects. The mid-bolus pressure and the gradient pressure across the cricopharyngeal region appeared to be the most consistent methods for evaluating intrabolus pressures. SIGNIFICANCE Intrabolus pressure anomalies in the cricopharyngeal region have been proposed as an indicator for selecting patients who would benefit from cricopharyngeal myotomy. The methods of determining intrabolus pressures vary, with resulting variations in recommendations.