In various studies, videofluoroscopy has been found to have an overall sensitivity of 80% to 89% and specificity of 79% to 91% for diagnosing esophageal motility disorders (eg, achalasia, diffuse esophageal spasm) compared with esophageal manometry [17,26]. Occasionally, barium studies may even reveal dysmotility not seen at manometry (eg, some patients with the beak-like distal esophageal narrowing of achalasia are found to have complete relaxation of the lower esophageal sphincter on manometry) [27]. Even for those patients with a significant esophageal motility disorder detected on a barium study, manometry may be performed to further elucidate the nature of this motility disorder. Endoscopy performed to evaluate the esophagus for structural abnormalities in patients with dysphagia is a highly accurate test for esophageal cancer when multiple endoscopic biopsy specimens and brushings are obtained. It is also more sensitive than double-contrast esophagography for detecting mild reflux esophagitis or other subtle forms of esophagitis. However, endoscopy is a much more invasive test than the barium study. It is also less sensitive than the barium study for detecting lower esophageal rings or strictures [11,23-25] and does not permit evaluation of esophageal motility disorders. For these reasons, a biphasic esophagram is often recommended as the initial diagnostic test for patients with dysphagia [3,5,28]. Dysphagia Fluoroscopy Single-Contrast Esophagram Although the biphasic esophagram provides superior mucosal detail, allowing for earlier detection of subtle lesions, patient cooperation and mobility are required. For debilitated, immobile patients or patients who are limited in their ability to cooperate, a single-contrast esophagram may be necessary. Fluoroscopy Barium Swallow Modified In patients with retrosternal dysphagia, the entire esophagus and the gastric cardia should be assessed. Therefore, the modified barium swallow may not be appropriate.
Dysphagia. In various studies, videofluoroscopy has been found to have an overall sensitivity of 80% to 89% and specificity of 79% to 91% for diagnosing esophageal motility disorders (eg, achalasia, diffuse esophageal spasm) compared with esophageal manometry [17,26]. Occasionally, barium studies may even reveal dysmotility not seen at manometry (eg, some patients with the beak-like distal esophageal narrowing of achalasia are found to have complete relaxation of the lower esophageal sphincter on manometry) [27]. Even for those patients with a significant esophageal motility disorder detected on a barium study, manometry may be performed to further elucidate the nature of this motility disorder. Endoscopy performed to evaluate the esophagus for structural abnormalities in patients with dysphagia is a highly accurate test for esophageal cancer when multiple endoscopic biopsy specimens and brushings are obtained. It is also more sensitive than double-contrast esophagography for detecting mild reflux esophagitis or other subtle forms of esophagitis. However, endoscopy is a much more invasive test than the barium study. It is also less sensitive than the barium study for detecting lower esophageal rings or strictures [11,23-25] and does not permit evaluation of esophageal motility disorders. For these reasons, a biphasic esophagram is often recommended as the initial diagnostic test for patients with dysphagia [3,5,28]. Dysphagia Fluoroscopy Single-Contrast Esophagram Although the biphasic esophagram provides superior mucosal detail, allowing for earlier detection of subtle lesions, patient cooperation and mobility are required. For debilitated, immobile patients or patients who are limited in their ability to cooperate, a single-contrast esophagram may be necessary. Fluoroscopy Barium Swallow Modified In patients with retrosternal dysphagia, the entire esophagus and the gastric cardia should be assessed. Therefore, the modified barium swallow may not be appropriate.