Clinical and Radiologic Evaluation Reveals High Prevalence of Abnormalities in Young Adults with Dysphagia

Abstract

The purpose of this study was to retrospectively evaluate the radiologic findings in young adults with dysphagia undergoing barium swallow and to compare these with the final clinical diagnosis. Clinical history, barium swallow, endoscopy (21 patients), manometry (18 patients), 24 h pH monitoring (4 patients), and outcome of treatments were studied and compared in 43 patients aged 14-30 years (mean 24 years). There were 26 men and 17 women. Duration of symptoms varied between 2 weeks and 22 years and included globus (n = 22), obstruction (n = 31), water brash (n = 6), classic reflux symptoms (n = 10), atypical reflux symptoms (n = 9), slow eating (n = 6), and vomiting (n = 11). The final diagnosis was achalasia (n = 2), arteria lusoria (n = 1), esophagitis (n = 1), esophageal dysfunction (n = 11), esophageal stricture (n = 5), gastroesophageal reflux disease (n = 8), and pharyngeal dysfunction (n = 2). Thirteen patients were assessed to be normal. The result of the barium swallow was in agreement with the final diagnosis in all but 3 patients who were assessed as normal, and the final diagnosis was esophagitis (n = 1), dysmotility (n = 1), and reflux disease (n = 1). Anatomic and functional abnormalities are common in young adults with dysphagia. Barium swallow reveals the explanation of the symptoms in 70% of such patients. Radiology therefore should be the method of choice for the investigation of dysphagic young adults.

High‐resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry

“…However diagnoses based on conventional manometry are often interpretive, based as much on the clinical presentation as the pressure recordings. The association between conventional manometric findings and symptoms is often poor, 10 and the pathological basis of symptoms remains unclear in a significant minority of patients 9, 11 . This may be because dysphagia is more closely related to disturbed bolus transport than oesophageal motor activity per se .…”

“…The efficacy of bolus transport depends on physical properties of the swallowed material, 6 the biomechanics of the oesophagus itself, 6 body position, 7, 8 and the structural limitations imposed by neighbouring thoracic structures. The complexity of this process and our inability to collect data that fully addresses this complexity may explain why in a proportion of patients presenting with dysphagia and abnormal bolus transport, the diagnosis remains obscure despite investigation using conventional techniques 9–11 . The ability of manometry with 5–8 recording channels to predict the success or failure of bolus transport is limited by poor spatial resolution.…”

Oesophageal high-resolution manometry: moving from research into clinical practice

“…Other oesophageal motility disorders are poorly defined, often include “abnormalities” that can be found in symptom-free individuals as well,15 16 and are inconsistent over time 17. Moreover, the association between conventional manometric findings, symptom severity and course of disease is poor 18 – 20. Thus the clinical significance of oesophageal dysmotility is often uncertain and many diagnoses based on conventional manometry are subjective, based as much on the clinical presentation as the objective pressure recordings.…”

Fluoroscopic Evaluation of Oropharyngeal Dysphagia: Anatomic, Technical, and Common Etiologic Factors

“…The advantages and disadvantages of the different oropharyngeal assessment options are discussed in Table 1. In contrast to the signs of oropharyngeal swallowing impairment, patients with esophageal dysphagia frequently complain of the feeling of a lump in the throat, or a sensation of food sticking at the sternal notch (the so-called “Globus” sensation [17, 18]). This symptom is frequently associated with distal esophageal lesions, such as achalasia or gastroesophageal reflux, and requires a full Upper GI study for proper investigation [19].…”