Single-Contrast Esophagram A single-contrast esophagram or barium swallow includes full-column distension, mucosal relief views, and fluoroscopic observation of esophageal motility. Single-contrast studies are well suited for elderly, debilitated, obese, and postoperative patients as well as patients who are unable to fully cooperate with the biphasic examination. A single-contrast esophagram may be performed with barium or water-soluble contrast. Discussion of Procedures by Variant Variant 1: Oropharyngeal dysphagia with an attributable cause. Initial imaging. An accurate medical and surgical history from the patient or medical record is helpful to determine the appropriate test to optimally assess the patient. Typical functional and neurologic causes of oropharyngeal dysphagia include recent stroke, worsening dementia, myasthenia gravis, or amyotrophic lateral sclerosis. Many patients with oropharyngeal dysphagia can subjectively localize a sensation of blockage or discomfort in the throat. Patients with oropharyngeal dysphagia typically complain of food sticking in the throat or of a globus sensation with a lump in the throat. Other symptoms of oropharyngeal dysfunction include coughing or choking during swallowing (due to laryngeal penetration or aspiration), a nasal-quality voice or nasal regurgitation (due to soft palate insufficiency), food dribbling from the mouth, and difficulty initiating swallow or chewing (due to an abnormal oral phase of swallowing). It is also important to recognize that abnormalities of the mid or distal esophagus or even the gastric cardia may cause referred dysphagia to the upper chest or pharynx, whereas abnormalities of the pharynx rarely cause referred dysphagia to the lower chest [6]. Therefore, the esophagus and cardia should be evaluated in patients with pharyngeal symptoms, particularly if no abnormalities are found in the pharynx to explain these symptoms [12].
Dysphagia. Single-Contrast Esophagram A single-contrast esophagram or barium swallow includes full-column distension, mucosal relief views, and fluoroscopic observation of esophageal motility. Single-contrast studies are well suited for elderly, debilitated, obese, and postoperative patients as well as patients who are unable to fully cooperate with the biphasic examination. A single-contrast esophagram may be performed with barium or water-soluble contrast. Discussion of Procedures by Variant Variant 1: Oropharyngeal dysphagia with an attributable cause. Initial imaging. An accurate medical and surgical history from the patient or medical record is helpful to determine the appropriate test to optimally assess the patient. Typical functional and neurologic causes of oropharyngeal dysphagia include recent stroke, worsening dementia, myasthenia gravis, or amyotrophic lateral sclerosis. Many patients with oropharyngeal dysphagia can subjectively localize a sensation of blockage or discomfort in the throat. Patients with oropharyngeal dysphagia typically complain of food sticking in the throat or of a globus sensation with a lump in the throat. Other symptoms of oropharyngeal dysfunction include coughing or choking during swallowing (due to laryngeal penetration or aspiration), a nasal-quality voice or nasal regurgitation (due to soft palate insufficiency), food dribbling from the mouth, and difficulty initiating swallow or chewing (due to an abnormal oral phase of swallowing). It is also important to recognize that abnormalities of the mid or distal esophagus or even the gastric cardia may cause referred dysphagia to the upper chest or pharynx, whereas abnormalities of the pharynx rarely cause referred dysphagia to the lower chest [6]. Therefore, the esophagus and cardia should be evaluated in patients with pharyngeal symptoms, particularly if no abnormalities are found in the pharynx to explain these symptoms [12].