Radiographic techniques and efficacy in evaluating esophageal dysphagia

Abstract

The radiographic examination of the esophagus to determine structural and/or functional causes of dysphagia is best performed with multiple techniques. These include full-column studies to produce distended films with or without the use of a solid bolus, mucosal relief films to identify mucosal defects such as esophagitis or the presence of varices, double-contrast films, and motion recording (fluoroscopy). The efficacy of each technique depends on the quality of the study and the specific disorder to be detected. Esophageal lesions producing dysphagia are classified into extrinsic structural lesions, intrinsic structural lesions, and esophageal motility disorders. Radiographic studies are the preferred screening techniques for patients with dysphagia. Although not as sensitive for the evaluation of mucosal lesions, radiographic studies are superior to endoscopy for the detection of abnormal motility, esophageal rings, and strictures.

Esophageal Clearance Patterns in Normal Older Adults as Documented with Videofluoroscopic Esophagram

“…The test is considered abnormal when any of these findings are observed. For evaluating esophageal function, an esophagram is considered superior to endoscopy due to the dynamic aspects of the esophagram being able to view the progression of a bolus through the esophagus [6]. …”

Usefulness of Barium Studies for Differentiating Benign and Malignant Strictures of the Esophagus

“…3). Other studies have shown that the use of single-contrast technique improves radiographic diagnosis of peptic strictures and lower esophageal rings [25,26]. Biphasic barium studies may even permit detection of strictures that are missed on endoscopy.…”

Cricopharyngeal function and dysfunction

“…Hence, the patient presenting with symptoms localized to or referred to the cervical esophagus should be carefully questioned regarding symptoms that may indicate esophageal dysfunction. These patients also require careful endoscopic and/or radiological evaluation of the esophagus [15,16]. For example, in a radiological study by Jones and Donner of 40 patients with "unexplained pharyngeal dysphagia," unsuspected esophageal disease was diagnosed in 14 and combined pharyngeal and esophageal disorders in 11 [17].…”