Functional abnormalities of the esophagus include gastroesophageal reflux and motility disorders. The most important structural lesion is carcinoma of the esophagus or gastroesophageal junction. In one study, biphasic esophagography was found to have 96% sensitivity in diagnosing cancer of the esophagus or esophagogastric junction [20] comparable to the reported sensitivity of endoscopy for diagnosing these lesions. In two other large patient series, endoscopy failed to reveal any cases of esophageal carcinoma that had been missed on the barium studies [21,22]. The findings in these series suggest that endoscopy is not routinely warranted to rule out missed tumors in patients who have normal findings on radiologic examinations. Although double-contrast views best detect mucosal lesions (eg, tumors, esophagitis), prone single-contrast views of patients who continuously drink a low-density barium suspension best detect lower esophageal rings or strictures. Lower esophageal rings are two to three times more likely to be diagnosed on prone single-contrast views than on upright double-contrast views because of inadequate distention of the distal esophagus when the patient is upright [11,23]. In one study, the biphasic esophagram was found to depict about 95% of all lower esophageal rings, whereas endoscopy detected only 76% of these rings [23]. Similarly, biphasic esophagrams have been found to have a sensitivity of about 95% for the detection of peptic strictures, sometimes revealing strictures that are missed with endoscopy [24,25]. The biphasic esophagram is also a useful test in patients with esophageal motility disorders causing dysphagia. Videofluoroscopy of discrete swallows of a low-density barium suspension in the prone right antero-oblique position permits detailed assessment of esophageal motility.
Dysphagia. Functional abnormalities of the esophagus include gastroesophageal reflux and motility disorders. The most important structural lesion is carcinoma of the esophagus or gastroesophageal junction. In one study, biphasic esophagography was found to have 96% sensitivity in diagnosing cancer of the esophagus or esophagogastric junction [20] comparable to the reported sensitivity of endoscopy for diagnosing these lesions. In two other large patient series, endoscopy failed to reveal any cases of esophageal carcinoma that had been missed on the barium studies [21,22]. The findings in these series suggest that endoscopy is not routinely warranted to rule out missed tumors in patients who have normal findings on radiologic examinations. Although double-contrast views best detect mucosal lesions (eg, tumors, esophagitis), prone single-contrast views of patients who continuously drink a low-density barium suspension best detect lower esophageal rings or strictures. Lower esophageal rings are two to three times more likely to be diagnosed on prone single-contrast views than on upright double-contrast views because of inadequate distention of the distal esophagus when the patient is upright [11,23]. In one study, the biphasic esophagram was found to depict about 95% of all lower esophageal rings, whereas endoscopy detected only 76% of these rings [23]. Similarly, biphasic esophagrams have been found to have a sensitivity of about 95% for the detection of peptic strictures, sometimes revealing strictures that are missed with endoscopy [24,25]. The biphasic esophagram is also a useful test in patients with esophageal motility disorders causing dysphagia. Videofluoroscopy of discrete swallows of a low-density barium suspension in the prone right antero-oblique position permits detailed assessment of esophageal motility.