Abnormal solid bolus swallowing in the erect position

Abstract

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.

Evaluation of the esophagus with a marshmallow bolus: Clarifying the cause of dysphagia

“…Others have also made this observation [3,4]. However, the use of solid boluses in assessing esophageal function has not been studied extensively and warrants further investigation [7].…”

Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders?

“…Bolus transit time in seconds (time of swallowing from the pharyngoesophageal sphincter to the gastroesophageal junction) greater than 10 s, and reduced peristalsis or lack of peristalsis as a marker of motility disorders [8,16,17]; 2. Visible gastroesophageal reflux (spontaneous or provoked by a Valsalva maneuver) and an obtuse His angle as a marker of GERD [17]. The severity of reflux was classified into two grades: grade 1= reflux provoked by a Valsalva maneuver, grade 2= spontaneous reflux.…”