Esophagography in Patients With Esophageal Achalasia Diagnosed With High-resolution Esophageal Manometry

Abstract

Background/AimsHigh-resolution esophageal manometry (HREM) is considered to be the gold standard for the diagnosis of achalasia. However, the Japan Esophageal Society recommends that esophagography is also accurate in either diagnosing or excluding the disorder. Accordingly, we compared the efficacy of esophagography and HREM in diagnosing achalasia patients with upper gastrointestinal symptoms.MethodsHREM was performed in 126 patients with dysphagia. The final diagnosis of achalasia was done using HREM. Demographic data, symptoms, quality of life (QOL) were also obtained. We assessed the patients who were not able to be diagnosed by esophagography and compared the diagnostic values for esophagography with HREM-based achalasia diagnosis as the gold standard.ResultsA total of 48 cases of patients with achalasia, including 21 men and 27 women (mean age, 48.4 ± 19.6 years), were included in the study. Two patients were excluded. Of the remaining 46 patients, 36 (78.3%) patients were diagnosed as having achalasia by esophagography. The diagnostic sensitivity, specificity, and accuracy of esophagography were 78.3%, 88.0%, and 83.0%, respectively. Patients with type III achalasia had significantly lower physical QOL score than those with type I or II achalasia. Although the mental QOL score in patients with type III achalasia tended to decrease compared with that in patients with type I and II achalasia, the difference was not statistically significant.ConclusionsDiagnosing esophageal achalasia by using esophagography alone has limited yield. Therefore, HREM should be used in patients with dysphagia and in whom achalasia cannot be diagnosed using EGD or esophagography.

Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

“…Additionally, the gastric tube is placed in the chest and may be in a state of passive expansion[ 7 ]. In the present case, we found that the patient had gastric tube mild dilatation before surgery (Figure 1C )[ 8 ]. These factors lead to delayed gastric emptying and an increase in the incidence of gastroesophageal reflux[ 7 , 9 , 10 ].…”

European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations

“…However, as the positive predictive accuracy was 96%, the authors concluded that the barium oesophagram is a useful tool in achalasia diagnosis 11 . Similar sensitivity and specificity rates were obtained in another study comparing barium swallow studies with HRM; the diagnostic sensitivity, specificity and accuracy of the barium oesophagram were 78.3%, 88.0% and 83.0%, respectively 14 . Consequently, it may be concluded that diagnosing achalasia by using barium oesophagram alone has a limited yield.…”

“…11 Similar sensitivity and specificity rates were obtained in another study comparing barium swallow studies with HRM; the diagnostic sensitivity, specificity and accuracy of the barium oesophagram were 78.3%, 88.0% and 83.0%, respectively. 14 Consequently, it may be concluded that diagnosing achalasia by using barium oesophagram alone has a limited yield. The technique of timed barium oesophagram (TBO) is similar to the usual barium swallow study but uses set time intervals (one, two and five minutes) after ingestion of a fixed barium suspension to measure the height and width of the barium column in order to assess oesophageal emptying more objectively (Figure 1).…”

Onigiri esophagography as a screening test for esophageal motility disorders

“…Another study which only recruited patients with achalasia reported that the sensitivity of barium esophagography in the diagnosis of achalasia was 78.3%, which was still not enough. 6 We have thought of the possible usefulness of a solid meal, specifically the Onigiri. Recently, a number of studies have been carried out to examine the usefulness of HRM using solid meals rather than a liquid medium, and the Onigiri has been shown to be one of the best candidate solid mediums.…”

“…It was reported that the conventionally-performed barium esophagography is useful for detecting EMDs by evaluating the extent of esophageal obstruction in relation to fluids. 5 , 6 However, all the EMDs other than the most severe EMD, namely achalasia does not usually cause stagnation of liquid barium. The sensitivity and specificity of esophagography using liquid barium in screening for EMDs were not sufficient.…”