Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus

Taher I. Omari; Julia C.F. Maclean; Charles Cock; Timothy M. McCulloch; Nogah Nativ-Zeltzer; Ashli K. O'Rourke; Michal M. Szczesniak; Peter I. Wu; Jacqueline Allen; Yoichiro Aoyagi; Howell Henrian G. Bayona; Silvia Carrión; Michelle R. Ciucci; Kate Davidson; Shumon I. Dhar; Shaheen Hamdy; Rebecca Howell; Corrine Jones; Molly A. Knigge; An Moonen; Gregory N. Postma; Jo Puntil-Sheltman; Anais Rameau; Julie Regan; Mistyka Schar; Nathalie Rommel

doi:10.1111/nmo.70042

Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus

Taher I. Omari, Julia C.F. Maclean, Charles Cock, Timothy M. McCulloch, Nogah Nativ-Zeltzer, Ashli K. O'Rourke, Michal M. Szczesniak, Peter I. Wu, Jacqueline Allen, Yoichiro Aoyagi, Howell Henrian G. Bayona, Silvia Carrión, Michelle R. Ciucci, Kate Davidson, Shumon I. Dhar, Shaheen Hamdy, Rebecca Howell, Corrine Jones, Molly A. Knigge, An MoonenGregory N. Postma, Jo Puntil-Sheltman, Anais Rameau, Julie Regan, Mistyka Schar, Nathalie Rommel

College of Medicine and Public Health

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Abstract

Introduction: The Leuven Consensus provides a classification scheme for the diagnosis of pharyngeal and upper esophageal sphincter (UES) motor disorders using metrics derived from pharyngeal high-resolution manometry-impedance (P-HRM-I).

Methods: Twenty-six experts with broad multidisciplinary backgrounds contributed their knowledge and experience to this initiative via a formal deliberative Delphi process. Guidance on a swallow assessment protocol as well as diagnostic criteria for UES dysfunction and pharyngeal contractile dysfunction is provided.

Results: For UES dysfunction, the stepwise evaluation of UES and intrabolus pressure metrics under increasing bolus volume and/or viscosity conditions is used to confirm failure of manometric relaxation and opening of the UES region. For pharyngeal contractile dysfunction, the evaluation of contractile metrics is used to define pharyngeal hypocontractility or hypercontractility.

Conclusion: These recommendations complement routine instrumental investigations and provide a standardized process, criteria, and nomenclature for P-HRM-I assessment of patients reporting symptoms of oropharyngeal dysphagia.

Original language	English
Article number	e70042
Number of pages	15
Journal	Neurogastroenterology and Motility
DOIs	https://doi.org/10.1111/nmo.70042
Publication status	E-pub ahead of print - 9 Apr 2025

Keywords

consensus guideline
deglutition
deglutition disorders
diagnosis
dysphagia
high-resolution manometry
intraluminal impedance
protocol

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10.1111/nmo.70042Licence: CC BY-NC

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Omari, T. I., Maclean, J. C. F., Cock, C., McCulloch, T. M., Nativ-Zeltzer, N., O'Rourke, A. K., Szczesniak, M. M., Wu, P. I., Allen, J., Aoyagi, Y., Bayona, H. H. G., Carrión, S., Ciucci, M. R., Davidson, K., Dhar, S. I., Hamdy, S., Howell, R., Jones, C., Knigge, M. A., ... Rommel, N. (2025). Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus. Neurogastroenterology and Motility, Article e70042. Advance online publication. https://doi.org/10.1111/nmo.70042

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title = "Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus",

abstract = "Introduction: The Leuven Consensus provides a classification scheme for the diagnosis of pharyngeal and upper esophageal sphincter (UES) motor disorders using metrics derived from pharyngeal high-resolution manometry-impedance (P-HRM-I). Methods: Twenty-six experts with broad multidisciplinary backgrounds contributed their knowledge and experience to this initiative via a formal deliberative Delphi process. Guidance on a swallow assessment protocol as well as diagnostic criteria for UES dysfunction and pharyngeal contractile dysfunction is provided. Results: For UES dysfunction, the stepwise evaluation of UES and intrabolus pressure metrics under increasing bolus volume and/or viscosity conditions is used to confirm failure of manometric relaxation and opening of the UES region. For pharyngeal contractile dysfunction, the evaluation of contractile metrics is used to define pharyngeal hypocontractility or hypercontractility. Conclusion: These recommendations complement routine instrumental investigations and provide a standardized process, criteria, and nomenclature for P-HRM-I assessment of patients reporting symptoms of oropharyngeal dysphagia.",

keywords = "consensus guideline, deglutition, deglutition disorders, diagnosis, dysphagia, high-resolution manometry, intraluminal impedance, protocol",

author = "Omari, {Taher I.} and Maclean, {Julia C.F.} and Charles Cock and McCulloch, {Timothy M.} and Nogah Nativ-Zeltzer and O'Rourke, {Ashli K.} and Szczesniak, {Michal M.} and Wu, {Peter I.} and Jacqueline Allen and Yoichiro Aoyagi and Bayona, {Howell Henrian G.} and Silvia Carri{\'o}n and Ciucci, {Michelle R.} and Kate Davidson and Dhar, {Shumon I.} and Shaheen Hamdy and Rebecca Howell and Corrine Jones and Knigge, {Molly A.} and An Moonen and Postma, {Gregory N.} and Jo Puntil-Sheltman and Anais Rameau and Julie Regan and Mistyka Schar and Nathalie Rommel",

year = "2025",

month = apr,

day = "9",

doi = "10.1111/nmo.70042",

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journal = "Neurogastroenterology and Motility",

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Omari, TI, Maclean, JCF, Cock, C, McCulloch, TM, Nativ-Zeltzer, N, O'Rourke, AK, Szczesniak, MM, Wu, PI, Allen, J, Aoyagi, Y, Bayona, HHG, Carrión, S, Ciucci, MR, Davidson, K, Dhar, SI, Hamdy, S, Howell, R, Jones, C, Knigge, MA, Moonen, A, Postma, GN, Puntil-Sheltman, J, Rameau, A, Regan, J, Schar, M & Rommel, N 2025, 'Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus', Neurogastroenterology and Motility. https://doi.org/10.1111/nmo.70042

TY - JOUR

T1 - Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance

T2 - The Leuven Consensus

AU - Omari, Taher I.

AU - Maclean, Julia C.F.

AU - Cock, Charles

AU - McCulloch, Timothy M.

AU - Nativ-Zeltzer, Nogah

AU - O'Rourke, Ashli K.

AU - Szczesniak, Michal M.

AU - Wu, Peter I.

AU - Allen, Jacqueline

AU - Aoyagi, Yoichiro

AU - Bayona, Howell Henrian G.

AU - Carrión, Silvia

AU - Ciucci, Michelle R.

AU - Davidson, Kate

AU - Dhar, Shumon I.

AU - Hamdy, Shaheen

AU - Howell, Rebecca

AU - Jones, Corrine

AU - Knigge, Molly A.

AU - Moonen, An

AU - Postma, Gregory N.

AU - Puntil-Sheltman, Jo

AU - Rameau, Anais

AU - Regan, Julie

AU - Schar, Mistyka

AU - Rommel, Nathalie

PY - 2025/4/9

Y1 - 2025/4/9

N2 - Introduction: The Leuven Consensus provides a classification scheme for the diagnosis of pharyngeal and upper esophageal sphincter (UES) motor disorders using metrics derived from pharyngeal high-resolution manometry-impedance (P-HRM-I). Methods: Twenty-six experts with broad multidisciplinary backgrounds contributed their knowledge and experience to this initiative via a formal deliberative Delphi process. Guidance on a swallow assessment protocol as well as diagnostic criteria for UES dysfunction and pharyngeal contractile dysfunction is provided. Results: For UES dysfunction, the stepwise evaluation of UES and intrabolus pressure metrics under increasing bolus volume and/or viscosity conditions is used to confirm failure of manometric relaxation and opening of the UES region. For pharyngeal contractile dysfunction, the evaluation of contractile metrics is used to define pharyngeal hypocontractility or hypercontractility. Conclusion: These recommendations complement routine instrumental investigations and provide a standardized process, criteria, and nomenclature for P-HRM-I assessment of patients reporting symptoms of oropharyngeal dysphagia.

AB - Introduction: The Leuven Consensus provides a classification scheme for the diagnosis of pharyngeal and upper esophageal sphincter (UES) motor disorders using metrics derived from pharyngeal high-resolution manometry-impedance (P-HRM-I). Methods: Twenty-six experts with broad multidisciplinary backgrounds contributed their knowledge and experience to this initiative via a formal deliberative Delphi process. Guidance on a swallow assessment protocol as well as diagnostic criteria for UES dysfunction and pharyngeal contractile dysfunction is provided. Results: For UES dysfunction, the stepwise evaluation of UES and intrabolus pressure metrics under increasing bolus volume and/or viscosity conditions is used to confirm failure of manometric relaxation and opening of the UES region. For pharyngeal contractile dysfunction, the evaluation of contractile metrics is used to define pharyngeal hypocontractility or hypercontractility. Conclusion: These recommendations complement routine instrumental investigations and provide a standardized process, criteria, and nomenclature for P-HRM-I assessment of patients reporting symptoms of oropharyngeal dysphagia.

KW - consensus guideline

KW - deglutition

KW - deglutition disorders

KW - diagnosis

KW - dysphagia

KW - high-resolution manometry

KW - intraluminal impedance

KW - protocol

UR - http://www.scopus.com/inward/record.url?scp=105002216522&partnerID=8YFLogxK

U2 - 10.1111/nmo.70042

DO - 10.1111/nmo.70042

M3 - Article

AN - SCOPUS:105002216522

SN - 1350-1925

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

M1 - e70042

ER -

Defining Pharyngeal and Upper Esophageal Sphincter Disorders on High-Resolution Manometry-Impedance: The Leuven Consensus

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Keywords

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