There has been a slow but steady decline in the frequency of contrast fluoroscopic studies performed all over the world, including oesophagography. This trend is attributed to the increasing availability of endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI). Other diagnostic modalities that are continually supplanting oesophagography are manometry and oesophageal pH monitoring. As a result, contrast oesophageal imaging as a diagnostic modality is gradually being relegated to the background by both the radiologists and other physicians. The aim of this paper is to consider some of the reasons responsible for the general decline, especially as it relates to the third world, and to review, in general terms, the role of contrast oesophageal imaging studies in the diagnoses of gastro-intestinal diseases, and the reasons for continuous use of this modality in modern medical practice.