Role of barium esophagography in evaluating dysphagia

8th June 2018OffByRiseNews

Zarzour, MD, Rupan Role of barium esophagography in evaluating dysphagia, MD, and Cheri L. B ring, measuring less than 13 mm in caliber with a length of 1-3mm.

Notice the gradual tapering of the distal esophagus, characteristic of a typical peptic stricture. Barium swallow examination: Summary of technique The BSE begins with fluoroscopic survey of the mediastinum and abdomen for the presence of an air-fluid column in the esophagus and the presence or absence of a gastric bubble, as symptoms of GERD can overlap those of an undiagnosed motility disorder, such as achalasiaor scleroderma. The patient takes a single swallow of low-density barium to ensure no delay in emptying or the presence of an obstructing mass. 3 forming the acute angle of His. The LES is the distal 3- to 4-cm segment of the esophagus that remains contracted at rest by intrinsic tone of the muscle itself and by extrinsic cholinergic innervation.

Free Classes for Wisconsin Middle School Students

The GE junction is radiographically identified where the gastric folds terminate. 4 There should be less than 2 cm between the GE junction and hiatus. 4 It is important to recognize the dynamic nature of the GEJ. It moves with changes in patient position, swallowing, and inspiration.

Barium swallow examination: Double-contrast portion The double-contrast portion of the examination is performed with the patient in the upright LPO position. A packet of EZ Gas II dissolved in 10 mL of water is given to the patient to drink quickly, followed by 2 ounces of high-density barium. High-quality air-contrast views of the esophagus provide the detail needed for diagnosing mucosal pathology, such as erosive esophagitis. Esophagitis is defined as defects in esophageal mucosa caused by damage to the epithelial cells by the caustic effects of pepsin. 4 Radiographic findings of esophagitis are seen in the distal one-third to one-half of the esophagus and can range depending on the level of severity. Erosions due to GER, typically in the distal esophagus, may be solitary or multiple. When a solitary erosion is identified, the most common location is the posterior wall of the distal esophagus.

The transition from Barrett’s esophagus to adenocarcinoma progresses from low-grade to high-grade dysplasia, requiring endoscopic surveillance for these patients. In a recent review of 11,028 patients with Barrett’s esophagus in a follow-up period of 17 years, the incidence of adenocarcinoma was 2. 9 cases per 1000 person-years with an absolute annual risk of 0. Barium swallow examination: Motility portion GER can result in abnormal esophageal motility characterized by weakened primary esophageal peristalsis. 17 Unlike nonspecific dysmotility, GERD dysmotility does not typically demonstrate tertiary contractions.

In the normal swallow, the primary peristaltic wave should rapidly and consistently progress distally to the GEJ and completely clear the esophagus. Secondary peristalsis is intermittent and follows the primary contraction, and propels any remaining bolus from the esophagus. It is spontaneously initiated by luminal distention and is a normal clearing wave. Tertiary contractions are nonperistaltic contractions and always considered abnormal. The presence and type of motility disorder is crucial information since patients with GERD may have overlapping symptoms with those patients with achalasia, scleroderma, or diffuse esophageal spasm. 4 This type of motility disorder will generally improve following anti-reflux surgery. Barium swallow examination: Single-contrast portion The single-contrast portion of the BSE is also performed with the patient in the prone right anterior oblique position.

Leave a Reply Cancel reply

The patient is instructed to continuously swallow low-density barium in order to maximally distend the esophagus while spot radiographs are obtained. Evaluation for hiatal hernia and shortened esophagus Identifying the GEJ is important to accurately diagnose a hiatal hernia. Valsalva or inspiration while lying prone can reveal an occult hernia. There are four types of hiatal hernias. GEJ migrates superiorly through the hiatus.

The identification of a shortened esophagus is critical. In addition to lack of reducibility, evidence of a short esophagus includes a hiatal hernia 5 cm or greater, ulcerative esophagitis, presence of a stricture or a type III hernia. 4,27 Identifying a shortened esophagus is of upmost importance as it can lead to adverse surgical outcomes if not properly diagnosed. Provocative maneuvers to elicit gastroesophageal reflux The BSE can identify the presence and extent of reflux. During the exam, care should be taken to recognize spontaneous reflux. Reflux can be provoked by having the patient assume various positions.

Instruct the patient to lie in the supine or LPO position to allow barium to pool in the gastric fundus. As the patient rolls toward the right lateral position, assess for reflux. There is controversy concerning provocative maneuvers, specifically the water siphon test. While these maneuvers increase the sensitivity for GER, they result in lower specificity. The degree of esophageal injury depends on the frequency of reflux, the degree of reflux, and the efficacy of esophageal clearance of the refluxate.

Foot Locker – shoes stores in

If reflux does occur, its superior extent and the time required for clearance is reported. The major purpose of the barium study is not to establish the presence or absence of GER, but rather to detect the sequelae of reflux and to identify patients at risk for Barrett’s esophagus. Conclusion GERD remains one of the most common diseases encountered by physicians, and radiologists can play an important role in diagnosing its complications The well-performed double-contrast BSE provides a relatively quick and inexpensive means of diagnosis. GERD pathogenesis, pathophysiology, and clinical manifestations. Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia.

Canon CL, Morgan DE, Einstein DM, et al. Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. Lin S, Brasseur JG, Pouderoux P, Kahrilas PJ. The phrenic ampulla: distal esophagus or potential hiatal hernia? Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia.

Shortening of the esophagus in response to swallowing. Ott DJ, Gelfand DW, Wu WC, Castell DO. The inflammatory esophagogastric polyp and fold. Hu C, Levine MS, Laufer I.

Easy Language

Solitary ulcers in reflux esophagitis: radiographic findings. In: Gore R, Levine M, eds. Levine MS, Kressel HY, Caroline DF, et al. Barrett’s esophagus: reticular pattern of the mucosa. Yamamoto AJ, Levine MS, Katzka DA, et al. Short-segment Barrett’s esophagus: findings on double-contrast esophagography in 20 patients. Hvid-Jensen F, Pedersen L, Drewes AM, et al.

Tips Corner: Creating Opportunities for Spontaneous and Functional Communication

Incidence of adenocarcinoma among patients with Barrett’s esophagus. Gupta S, Levine MS, Rubesin SE, et al. Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus. Diener U, Patti MG, Molena D, et al. Esophageal dysmotility and gastroesophageal reflux disease. Campbell C, Levine MS, Rubesin SE, et al.

BEST Baby Hacks Every New Mom Needs

Association between esophageal dysmotility and gastroesophaeal reflux on barium studies. Ott DJ, Chen YM, Hewson EG, et al. Esophageal motility: assessment with synchronous video tape fluoroscopy and manometry. Patti MG, Robinson T, Galvani C, et al. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. Effects of manometrically discovered nonspecific motility disorders of the esophagus on the outcomes of antireflux surgery. Luedtke P, Levine MS, Rubesin SE, et al.

Radiologic diagnosis of benign esophageal strictures: a pattern approach. Ott DJ, Chen YM, Wu WC, Gelfand DW. Endoscopic sensitivity in the detection of esophageal strictures. Fixed transverse folds in the esophagus: a sign of reflux esophagitis. Levine MS, Moolten DN, Herlinger H, Laufer I.

Queens Center |

Gordon AR, Levine MS, Redfern RO, et al. Cervical esophageal webs: association with gastroesophageal reflux. Baker ME, Einstein DM, Herts BR, et al. Gastroesophageal reflux disease: integrating the barium esophagram before and after antireflux surgery.

Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. Gastroesophageal reflux: what is the role of barium studies? Measurement of gastroesophagela reflux in the evaluation of hiatus hernia and chest pain in fliers. Evaluation of gastroesophageal reflux and its complications. Zarzour is a Assistant Professor in the Department of Radiology, Dr. Sanyal is an Associate Professor and the Witten-Stanley Endowed Chair of Radiology, and Dr.

Zarzour, MD, Rupan Sanyal, MD, and Cheri L. B ring, measuring less than 13 mm in caliber with a length of 1-3mm. Notice the gradual tapering of the distal esophagus, characteristic of a typical peptic stricture. Barium swallow examination: Summary of technique The BSE begins with fluoroscopic survey of the mediastinum and abdomen for the presence of an air-fluid column in the esophagus and the presence or absence of a gastric bubble, as symptoms of GERD can overlap those of an undiagnosed motility disorder, such as achalasiaor scleroderma. The patient takes a single swallow of low-density barium to ensure no delay in emptying or the presence of an obstructing mass. 3 forming the acute angle of His. The LES is the distal 3- to 4-cm segment of the esophagus that remains contracted at rest by intrinsic tone of the muscle itself and by extrinsic cholinergic innervation.

The GE junction is radiographically identified where the gastric folds terminate. 4 There should be less than 2 cm between the GE junction and hiatus. 4 It is important to recognize the dynamic nature of the GEJ. It moves with changes in patient position, swallowing, and inspiration.

Barium swallow examination: Double-contrast portion The double-contrast portion of the examination is performed with the patient in the upright LPO position. A packet of EZ Gas II dissolved in 10 mL of water is given to the patient to drink quickly, followed by 2 ounces of high-density barium. High-quality air-contrast views of the esophagus provide the detail needed for diagnosing mucosal pathology, such as erosive esophagitis. Esophagitis is defined as defects in esophageal mucosa caused by damage to the epithelial cells by the caustic effects of pepsin.

We make learning fun with program activities

4 Radiographic findings of esophagitis are seen in the distal one-third to one-half of the esophagus and can range depending on the level of severity. Erosions due to GER, typically in the distal esophagus, may be solitary or multiple. When a solitary erosion is identified, the most common location is the posterior wall of the distal esophagus. The transition from Barrett’s esophagus to adenocarcinoma progresses from low-grade to high-grade dysplasia, requiring endoscopic surveillance for these patients. In a recent review of 11,028 patients with Barrett’s esophagus in a follow-up period of 17 years, the incidence of adenocarcinoma was 2. 9 cases per 1000 person-years with an absolute annual risk of 0. Barium swallow examination: Motility portion GER can result in abnormal esophageal motility characterized by weakened primary esophageal peristalsis.

17 Unlike nonspecific dysmotility, GERD dysmotility does not typically demonstrate tertiary contractions. In the normal swallow, the primary peristaltic wave should rapidly and consistently progress distally to the GEJ and completely clear the esophagus. Secondary peristalsis is intermittent and follows the primary contraction, and propels any remaining bolus from the esophagus. It is spontaneously initiated by luminal distention and is a normal clearing wave. Tertiary contractions are nonperistaltic contractions and always considered abnormal. The presence and type of motility disorder is crucial information since patients with GERD may have overlapping symptoms with those patients with achalasia, scleroderma, or diffuse esophageal spasm.

4 This type of motility disorder will generally improve following anti-reflux surgery. Barium swallow examination: Single-contrast portion The single-contrast portion of the BSE is also performed with the patient in the prone right anterior oblique position. The patient is instructed to continuously swallow low-density barium in order to maximally distend the esophagus while spot radiographs are obtained. Evaluation for hiatal hernia and shortened esophagus Identifying the GEJ is important to accurately diagnose a hiatal hernia. Valsalva or inspiration while lying prone can reveal an occult hernia.

There are four types of hiatal hernias. GEJ migrates superiorly through the hiatus. The identification of a shortened esophagus is critical. In addition to lack of reducibility, evidence of a short esophagus includes a hiatal hernia 5 cm or greater, ulcerative esophagitis, presence of a stricture or a type III hernia. 4,27 Identifying a shortened esophagus is of upmost importance as it can lead to adverse surgical outcomes if not properly diagnosed.

There’s No Minimum Age for Teaching Spanish

Provocative maneuvers to elicit gastroesophageal reflux The BSE can identify the presence and extent of reflux. During the exam, care should be taken to recognize spontaneous reflux. Reflux can be provoked by having the patient assume various positions. Instruct the patient to lie in the supine or LPO position to allow barium to pool in the gastric fundus. As the patient rolls toward the right lateral position, assess for reflux. There is controversy concerning provocative maneuvers, specifically the water siphon test.

While these maneuvers increase the sensitivity for GER, they result in lower specificity. The degree of esophageal injury depends on the frequency of reflux, the degree of reflux, and the efficacy of esophageal clearance of the refluxate. If reflux does occur, its superior extent and the time required for clearance is reported. The major purpose of the barium study is not to establish the presence or absence of GER, but rather to detect the sequelae of reflux and to identify patients at risk for Barrett’s esophagus.

Conclusion GERD remains one of the most common diseases encountered by physicians, and radiologists can play an important role in diagnosing its complications The well-performed double-contrast BSE provides a relatively quick and inexpensive means of diagnosis. GERD pathogenesis, pathophysiology, and clinical manifestations. Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. Canon CL, Morgan DE, Einstein DM, et al. Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know.