Dysphagia in head and neck cancer patients with evidence of esophageal dysmotility on manometry

Abstract

Objectives

Dysphagia is a well-known complication of head and neck cancer (HNC) treatment that significantly impacts daily life for survivors. This study aims to characterize esophageal dysmotility identified on high resolution manometry (HRM) in HNC survivors with dysphagia.

Methods

A retrospective chart review of 30 patients who underwent HRM treated for dysphagia between August 1st 2020 to February 2nd, 2023, was conducted. Patients with dysphagia, at least one HRM, and treated in a HNC dysphagia clinic were included. HRM reports were analyzed using Chicago Classification Version 4.0 (CCV4). EGJ outflow obstruction (EGJOO) was validated using endoscopy or radiographic findings. Data was summarized using mean for continuous variables and frequencies for categorical variables.

Results

Of the 30 patients included in our study, 18 (60.0 %) showed evidence of CCV4 dysmotility. The most common subtypes were found to be ineffective motility (n = 6, 33.3 %), followed by EGJOO (n = 5, 27.8 %). Absent contractility and hypercontractile esophagus showed the same frequency (n = 3, 16.7 %), as did achalasia type 1 and type 2 (n = 1, 5.6 %).

Conclusion

Oropharyngeal and pharyngoesophageal dysphagia are well recognized causes of dysphagia, while esophageal dysmotility is an understudied cause of dysphagia in the HNC population. In this study of patients undergoing HRM for workup of their dysphagia after HNC, 60% had evidence of a CCV4 motility disorder, with the most common subtypes being ineffective motility and EGJOO. Therefore, HRM, the gold standard of diagnosis for esophageal dysmotility, should be considered in HNC patients who have symptoms suspicious for dysmotility.