Fig 15 - uploaded by Marc S Levine
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-Diffuse esophageal spasm (DES). A, Spot film of esophagus in patient with DES shows disrupted peristalsis with obliterative focal contraction in lower esophagus. B, Spot film of another patient with DES shows typical "corkscrew" or "curling" appearance.
Source publication
This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an...
Citations
... Studies were performed using standard and modified barium swallow and esophagography protocols with single-contrast examinations incorporating a full column of thin-barium suspension, i.e., 40 -80% w/v, to provide optimal luminal distension and enable motility assessment. [8][9][10] Barium studies were examined by two radiologists experienced in performing and interpreting barium esophagograms. Radiographic diagnosis of proximal esophageal web, defined as a very short segment of acute narrowing in the barium column at cervical levels, was made by consensus of the two radiologists. ...
... Hasta hace poco, los TME primarios que no cumplían con criterios establecidos para otros diagnósticos, se agrupaban como TME no específicos o NEMD (Nonspecific Esophageal Motility Disorder). Los hallazgos radiológicos en NEMD también son inespecíficos e incluyen alteraciones de la peristalsis primaria y contracciones terciarias (10,11) . ...
El esófago en cascanueces, también conocido como esófago en sacacorchos, describe la apariencia anormalmente segmentada del esófago en los casos de espasmo esofágico, visualizada en el estudio con doble contraste. Normalmente el peristaltismo primario se extiende a través del esófago como una onda coordinada de contracción y relajación. En el espasmo esofágico múltiples segmentos se contraen simultáneamente y hay una alteración de la relajación normal. Los síntomas incluyen dolor en el pecho, disfagia o ambos.
... Bones, muscles, and breasts are also visible, enabling the diagnosis of numerous conditions, such as fractures, spinal diseases, and breast nodules. Groups of authors have indirectly reported that barium swallow studies enable the early diagnosis of various conditions, such as gastric and esophageal diseases, (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) cardiovascular abnormalities, (20)(21)(22)(23) and even respiratory by the assumption that the lack of response to the treatment would mean that the chronic cough was motivated by another cause. In addition, we were unable to determine the sensitivity of the method. ...
... Our literature review found no studies evaluating the use of barium swallow studies in patients with chronic cough. Therefore, the parameters used in the present study were selected on the basis of those used in previous studies, (4,9,14,16,24,25) taking into consideration the major anatomic relationships between the esophagus and other thoracic structures. ...
To assess the routine use of barium swallow study in patients with chronic cough.
Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons.
The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration.
Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.
... These may cause esophagitis and potentially producing a cluster of symptoms similar to RE (7). Endoscopies, mucosal biopsies and/or barium-air contrast radiograms significantly increase the specificity of the differential diagnosis (23,24). It has been reported that the specificity of endoscopy in detecting mucosal damage associated to GERD reaches 90 -95% (25). ...
Gastrointestinal complications are common in patients who undergo kidney transplantation and may affect posttransplant outcomes. We examined the incidence and predictors of gastroesophageal reflux disease (GERD) and dyspepsia and their associations with graft survival and mortality after transplant.
We examined United States Renal Data System data and Medicare billing claims to identify diagnoses of dyspepsia and GERD among Medicare beneficiaries transplanted in 1995-2002 (n=42,257). Among GERD cases, we identified patients with reflux esophagitis (RE). We determined independent predictors of upper gastrointestinal complications and modeled these conditions as time-dependent outcomes predictors with Cox regression.
The 3-year cumulative incidences of GERD, RE, and dyspepsia were 20%, 5%, and 6%, respectively. Overall, 23% of transplant recipients received a diagnosis of at least one of these complications by 3 years after transplant. Female gender and a pretransplant upper gastrointestinal disease diagnosis predicted posttransplant gastrointestinal complications. Older age, obesity, Caucasian, and African-American race were associated to increased risk of developing GERD. Patients diagnosed with any of the examined upper gastrointestinal complications experienced an increased risk of graft-failure (hazard ratio 1.58; 95% confidence interval 1.48-1.69) and death (hazard ratio 1.61; 95% confidence interval 1.46-1.77).
Upper gastrointestinal complications are relatively common after kidney transplantation and are associated with a significantly increased risk of graft loss and death. Further research is needed to elucidate mechanisms underlying the observed adverse prognoses conferred by diagnosis of upper gastrointestinal complications after kidney transplant.
... Esophagograms may appear normal or, alternatively, have non-specific abnormalities such as stricture, ulceration, polyps, or fistula formation. 44 HSV esophagitis is usually associated with multiple, stellate ulcerations in mid-esophagus (less than 1.5 cm in diameter), whereas CMV esophageal ulcers are characteristically quite large and may be single or multiple. 19 Ulcers within plaques should suggest herpetic infection or concomitant herpes and Candida esophagitis. ...
Esophageal disease is a common complication and cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Opportunistic infections are the leading cause of esophageal complaints and may be a predictor of poor long-term prognosis, presumably as a reflection of severe underlying HIV immunodeficiency. The esophagus may be the site of the first acquired immunodeficiency syndrome (AIDS)-defining opportunistic illness in a large number of patients. Barium esophagography and upper gastrointestinal endoscopy are diagnostic modalities, commonly used to evaluate esophageal complaints in patients with AIDS. Treatment for most etiologies of esophagitis generally has a high degree of success, with a resultant improvement in quality of life. In addition to optimizing antiretroviral therapy, a thorough diagnostic assessment of every HIV-infected patient with esophageal complaints is warranted, followed by timely and appropriate treatment.
... Numerosi autori già negli anni '80-'90 [1,7,9,11,12,14,19] hanno proposto il confronto tra l'indagine manometrica e lo studio radiologico dinamico, riportando risultati di sensibilità e specificità buoni. L'indagine radiologica, peraltro, non ha avuto negli anni diffusione proporzionale ai dati riportati nella letteratura [11,12,13,14,15,16,17], probabilmente per problemi organizzativi legati alla necessità di avere un ambulatorio adeguato per lo studio della motilità esofagea a cui fare riferimento negli studi funzionali e al ridotto interesse da parte del radiologo verso una metodica tradizionale nell'epoca delle macchine pesanti. ...
To repropose the importance of videofluoroscopy in the study of esophageal motor disorders, comparing the radiologic and manometric results; the manometric results are considered the reference parameters.
From 1996 to 1999, 76 patients (42 males and 34 females), were studied first using manometry and then videofluoroscopy. The patients had symptoms like dysphagia, thoracic pain or both. The manometric study was performed with a perfusional system equipped with 6 tips (4 radial for the study of the esophageal sphincters and 2 placed longitudinally for the study of the esophageal peristalsis). With the patient in a supine position we analysed 5-10 deglutitions with 5 ml water bolus at 20-25 degrees C, administered using a graduated syringe. The radiologic study was performed with a remote-control digital television system, connected to a video recorder. Three 7.5 ml bolues of high density barium suspension (250% weight/volume) were injected orally in the upright position and other three were injected in the prone position following the passage from the oral cavity to the stomach.
The comparison of the manometric and videofluoroscopic results suggests that the total sensitivity of the radiological study in the detection of esophageal motor disorders was 92%. In particular dynamic radiologic investigation diagnosed the normal esophageal functionality in 100% of the cases, nonspecific esophageal motility disorders in 89.6%, diffuse esophageal spasm in 100% of the cases, the presence of achalasia in 90%, whereas "nutcraker esophagus" only in 50%. Videofluoroscopy therefore showed high sensitivity in four groups of the five considered. It has some limitations in the diagnosis of initial achalasia, and is not sufficiently sensitive in the diagnosis of "nutcracker esophagus".
Videofluoroscopy is a simple method which presents high sensitivity and specificity in the detection of motility disorders of the esophagus and could therefore be proposed as the first diagnostic method in patients with specific symptoms.
