Normal solid bolus swallowing erect position

Abstract

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.

Abnormal solid bolus swallowing in the erect position

“…Swallowing examinations were considered abnormal if the bolus did not continue in a caudal direction within 5 s following a delay at any level in the pharyngoesophagus (Curtis et al 1986). This 5 s period allowed the peristaltic wave to overtake and pass beyond the arrested solid bolus in all instances.…”

“…The 38 individuals who swallowed all solid boluses without delay (the tablet only, the sphere only, or both the tablet and sphere) were excluded from this evaluation and are reported elsewhere (Curtis et al 1986). Hence, 176 of the 214 (82.3%) symptomatic or fluoroscopically abnormal individuals demonstrated an abnormal solid bolus swallow defined as one or more delays lasting 5 or more s (Table 1).…”

“…All initial fluoroscopic examinations were performed in a manner described previously (Curtis et al 1986). All solid bolus swallows were videorecorded in the left posterior oblique projection to document the arrest, the level of the arrest, and subsequent manipulations required to free the solid bolus for further caudal progression.…”

Solid Bolus Swallowing in the Radiologic Evaluation of Dysphagia

“…Spot filming has the narrowing. Asymptomatic patients had Schatzki's rings (2), strictures due to esophagitis (29), and postoperative narrowings (2), while 3 patients had a normal liquid swallow and thus the tablet only revealed the narrowing (Fig. 4).…”

How I do it: Examination of the patient with dysphagia

“…For example, the patient with solid-food dysphagia who has a normal study with liquid or even pasty barium sulfate has not been examined thoroughly. The patient should be given a solid bolus -such as a barium-impregnated marshmallow, bagel or bread sphere [15], or a tablet (1.3-mm-diameter Wolf tablet) -that may be held up at a subtle stricture or that may induce spasm not seen with a liquid bolus. Naturally, use of a solid bolus would be contraindicated if liquid boluses had penetrated into the larynx or had been aspirated into the trachea.…”