Abstract. Individuals with structural and functional abnormalities of the esophagus are frequently symptomatic when swallowing solids and have been reported to demonstrate delay during nuclide examinations. This study was performed in symptomatic individuals to determine how often a solid bolus (13 mm barium tablet or 10 mm bagel bread sphere) passed through the esophagus without delay and whether erect solid bolus swallowing occurred without significant bolus hesitation during fluoroscopic evaluation.All individuals referred for an upper gastrointestinal examination or barium swallow who complained of dysphagia, heartburn, or chest pain were evaluated with a solid bolus. Individuals demonstrating gastroesophageal reflux, a hiatal hernia, a Schatzki B ring, or any esophageal motility disturbance were given a solid bolus.Twenty-six (27%) of 98 symptomatic individuals given a barium tablet had no delay in its passage. Thirteen (8%) of 150 symptomatic individuals given a bagel sphere had an erect solid bolus swallow with no delay in its passage. Only one individual of 26 given both solids (4%) showed no delay in transit of either bolus.Solid bolus swallows without delay were noted to occur in two ways: (i) The entire solid bolus passed in less than 3 s without delay of any kind, and (2) some temporary delay (less than 5 s) occurred at regions of anatomic esophageal narrowing (circopharyngeus, thoracic inlet, transverse aorta, left mainstem bronchus, or diaphragm). These temporarily delayed swallows were assisted by coincidentally swallowed fluid or the following peristaltic wave. No additional swallows were required to complete passage into the stomach. Bolus passage was accomplished predominantly by oral thrust, gravitational pull, esophageal relaxation, and possibly because of intraluminal esophageal pressure differentials. Therefore, solid bolus erect swallowing can occur without significant delay of bolus passage into the stomach in a symptomatic population.

Abstract. The routine use of solid boluses in the radiologic evaluation of the pharyngoesophagus has not been described in the literature. Because esophageal perforations have been reported as a result of delayed passage of caustic medications, this study was performed to determine the prevalence of solid bolus delay in a routine symptomatic radiologic population. Solid bolus erect swallowing was performed using either a 13 mm barium tablet or a 10 mm bagel bread sphere; occasionally, both were used.All individuals referred for an upper gastrointestinal (GI) examination or barium swallow who complained of dysphagia, heartburn, or chest pain were evaluated with a solid bolus. Any individual demonstrating gastroesophageal reflux, hiatal hernia, Schatzki's B ring, or esophageal motility disturbance was given a solid bolus as well.Individuals swallowing a sphere showed four times more frequent proximal pharyngoesophageal delay than tablet swallowers. The tablet arrested initially more frequently at both the aorta and lower esophageal sphincter than did the sphere. However, there was twice the total incidence of arrest of all swallowed spheres compared to tablets at the aorta. Approximately the same total number of spheres arrested at the lower esophageal sphincter as tablets.Any delay that allows a solid bolus to be overtaken in the erect position by the peristaltic contraction wave can be considered abnormal. The delays usually occur at anatomic narrowings. A sphere is more sensitive than a tablet in evaluating solid bolus pharyngoesophageal dysfunction in the erect position.