Achalasia x ray: Difference between revisions
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{{Achalasia}} | {{Achalasia}} | ||
{{CMG}} | {{CMG}} {{AE}} {{TS}} | ||
==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. | |||
==X ray== | |||
Esophagram is less sensitive than [[manometry]] in diagnosing early stages of achalasia. | |||
===Role of Contrast Studies in Diagnosis=== | |||
* 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. | |||
===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> | |||
* [[X-ray]] with a [[barium swallow]], or esophagography. The patient swallows a barium solution, which fails to pass smoothly through the [[lower esophageal sphincter]]. An air-fluid margin is seen over the barium column due to the lack of peristalsis. Narrowing is observed at the level of the gastroesophageal junction ("bird's beak" or "rat tail" appearance of the lower esophagus). Esophageal dilation is present in varying degrees as the esophagus is gradually stretched by retained food. A five-minute timed barium swallow is useful to measure the effectiveness of treatment. | * [[X-ray]] with a [[barium swallow]], or esophagography. The patient swallows a barium solution, which fails to pass smoothly through the [[lower esophageal sphincter]]. An air-fluid margin is seen over the barium column due to the lack of peristalsis. Narrowing is observed at the level of the gastroesophageal junction ("bird's beak" or "rat tail" appearance of the lower esophagus). Esophageal dilation is present in varying degrees as the esophagus is gradually stretched by retained food. A five-minute timed barium swallow is useful to measure the effectiveness of treatment. | ||
Revision as of 07:55, 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.
X ray
Esophagram is less sensitive than manometry in diagnosing early stages of achalasia.
Role of Contrast Studies in Diagnosis
- 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.
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.[1]
- X-ray with a barium swallow, or esophagography. The patient swallows a barium solution, which fails to pass smoothly through the lower esophageal sphincter. An air-fluid margin is seen over the barium column due to the lack of peristalsis. Narrowing is observed at the level of the gastroesophageal junction ("bird's beak" or "rat tail" appearance of the lower esophagus). Esophageal dilation is present in varying degrees as the esophagus is gradually stretched by retained food. A five-minute timed barium swallow is useful to measure the effectiveness of treatment.
- 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
- ↑ 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.