Achalasia x ray: Difference between revisions
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==Overview== | ==Overview== | ||
Achalasia is caused by insufficient [[lower esophageal sphincter]] (LES) relaxation causing mechanical obstruction at gastro-esophageal junction. It leads to absent [[peristalsis]] and stasis of food and liquid in esophagus. | Achalasia is caused by insufficient [[lower esophageal sphincter]] (LES) relaxation causing mechanical obstruction at gastro-esophageal junction. It leads to absent [[peristalsis]] and stasis of food and liquid in esophagus. | ||
==X ray | ==Esophagography== | ||
Esophagram is less sensitive than [[manometry]] in diagnosing early stages of achalasia. | * [[X-ray]] with a [[barium swallow]], or esophagography. The patient swallows a barium solution, which fails to pass smoothly through the [[lower esophageal sphincter]]. | ||
===Role of Contrast Studies in Diagnosis=== | * Esophagram is less sensitive than [[manometry]] in diagnosing early stages of achalasia. | ||
===Radiologic Findings Suggestive of Achalasia<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume= | issue= | pages= | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }} </ref>=== | |||
* "Bird's beak image" or "rat tail" appearance due to narrowing of esophagus at gastroesophageal junction. | |||
* Dilated esophageal body | |||
* Air fluid level due to absent peristalsis | |||
* Absence of an intragastric air bubble | |||
* In advanced achalasia - sigmoid appearance | |||
===Role of Contrast Studies in Diagnosis<ref name="pmid23877351">{{cite journal| author=Vaezi MF, Pandolfino JE, Vela MF| title=ACG clinical guideline: diagnosis and management of achalasia. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 8 | pages= 1238-49; quiz 1250 | pmid=23877351 | doi=10.1038/ajg.2013.196 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23877351 }} </ref>=== | |||
* To support [[manometry]] in diagnosing achalasia | * To support [[manometry]] in diagnosing achalasia | ||
* In cases of equivocal findings on manometry, esophagram could be an useful tool to make the final diagnosis. | * In cases of equivocal findings on manometry, esophagram could be an useful tool to make the final diagnosis. | ||
* To look for achalasia changes in later stages (such as tortuosity, [[megaesophagus]] and angulation). | * To look for achalasia changes in later stages (such as tortuosity, [[megaesophagus]] and angulation). | ||
* To assess esophageal emptying after treatment. Timed barium esophagram (TBE) is used to identify patients who are more likely to relapse despite initial improvement in their symptoms after treatment. | * To assess esophageal emptying after treatment. Timed barium esophagram (TBE) is used to identify patients who are more likely to relapse despite initial improvement in their symptoms after treatment. | ||
* To rule out structural abnormality | |||
* To look for presence of epiphrenic diverticula | |||
* To look for any esophageal thickening | |||
===Timed Barium Esophagram=== | ===Timed Barium Esophagram=== | ||
Height of barium coloumn is measured in esophagus at 1 and 5 min after patient ingests a large bolus of barium in upright position. Data has suggested that TBE results can predict therapeutic success and requirement for further interventions. Vaezi et al found strong association between TBE results and symptomatic relief after pneumatic dilation.<ref name="pmid10406238">{{cite journal| author=Vaezi MF, Baker ME, Richter JE| title=Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 7 | pages= 1802-7 | pmid=10406238 | doi=10.1111/j.1572-0241.1999.01209.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10406238 }} </ref> | Height of barium coloumn is measured in esophagus at 1 and 5 min after patient ingests a large bolus of barium in upright position. Data has suggested that TBE results can predict therapeutic success and requirement for further interventions. Vaezi et al found strong association between TBE results and symptomatic relief after pneumatic dilation.<ref name="pmid10406238">{{cite journal| author=Vaezi MF, Baker ME, Richter JE| title=Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 7 | pages= 1802-7 | pmid=10406238 | doi=10.1111/j.1572-0241.1999.01209.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10406238 }} </ref> | ||
* Fluoroscopy can be used to demonstrate the lack of peristaltic waves in the smooth-muscle portion of the esophagus. It may also reveal ‘vigorous’ achalasia, which is characterized by random spastic contractions in the esophagus. | * Fluoroscopy can be used to demonstrate the lack of peristaltic waves in the smooth-muscle portion of the esophagus. It may also reveal ‘vigorous’ achalasia, which is characterized by random spastic contractions in the esophagus. | ||
Revision as of 08:19, 5 January 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Overview
Achalasia is caused by insufficient lower esophageal sphincter (LES) relaxation causing mechanical obstruction at gastro-esophageal junction. It leads to absent peristalsis and stasis of food and liquid in esophagus.
Esophagography
- X-ray with a barium swallow, or esophagography. The patient swallows a barium solution, which fails to pass smoothly through the lower esophageal sphincter.
- Esophagram is less sensitive than manometry in diagnosing early stages of achalasia.
Radiologic Findings Suggestive of Achalasia[1]
- "Bird's beak image" or "rat tail" appearance due to narrowing of esophagus at gastroesophageal junction.
- Dilated esophageal body
- Air fluid level due to absent peristalsis
- Absence of an intragastric air bubble
- In advanced achalasia - sigmoid appearance
Role of Contrast Studies in Diagnosis[2]
- To support manometry in diagnosing achalasia
- In cases of equivocal findings on manometry, esophagram could be an useful tool to make the final diagnosis.
- To look for achalasia changes in later stages (such as tortuosity, megaesophagus and angulation).
- To assess esophageal emptying after treatment. Timed barium esophagram (TBE) is used to identify patients who are more likely to relapse despite initial improvement in their symptoms after treatment.
- To rule out structural abnormality
- To look for presence of epiphrenic diverticula
- To look for any esophageal thickening
Timed Barium Esophagram
Height of barium coloumn is measured in esophagus at 1 and 5 min after patient ingests a large bolus of barium in upright position. Data has suggested that TBE results can predict therapeutic success and requirement for further interventions. Vaezi et al found strong association between TBE results and symptomatic relief after pneumatic dilation.[3]
- Fluoroscopy can be used to demonstrate the lack of peristaltic waves in the smooth-muscle portion of the esophagus. It may also reveal ‘vigorous’ achalasia, which is characterized by random spastic contractions in the esophagus.
Classic appearance of achalasia on radiographs
References
- ↑ Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ Vaezi MF, Pandolfino JE, Vela MF (2013). "ACG clinical guideline: diagnosis and management of achalasia". Am J Gastroenterol. 108 (8): 1238–49, quiz 1250. doi:10.1038/ajg.2013.196. PMID 23877351.
- ↑ Vaezi MF, Baker ME, Richter JE (1999). "Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram". Am J Gastroenterol. 94 (7): 1802–7. doi:10.1111/j.1572-0241.1999.01209.x. PMID 10406238.