A high-density barium suspension (e.g., that used for a double-contrast upper GI series) is ideal for this purpose. This indicates only 38 subjects (22.0%) of this cohort had normal testing across all modalities.Because studies have implicated GERD in the etiology of certain motility disorders,The four most common modalities (24‐hour dual‐probe pH testing, esophageal high‐resolution manometry, EGD, and contrast videofluoroscopy) were employed in patients with the primary symptom of globus sensation. Fluoroscopic imaging and compression of all small bowel loops is a critical component of the examination because focal lesions are easily obscured by overlapping loops of small bowel unless compression is applied to separate these loops and ensure an adequate examination. Compression spot image of the right lower quadrant shows a Meckel’s diverticulum (M) as the cause of the patient’s bleeding. The visibility of skeletal shadows through the barium column indicates that small filling defects are more likely to be seen, which is particularly important for the detection of colonic polyps.
The ManoScan recording was analyzed using the ManoView ESO analysis software and results placed in the EHR.Antisecretory medications were withdrawn at minimum 3 calendar days prior to esophageal acid testing. Descriptive statistics and pairwise comparisons were performed as well as sensitivity and specificity calculations.One hundred seventy‐two patients met inclusion criteria.
Esophageal peristalsis is inhibited by rapid swallowing of barium, allowing the esophagus to distend fully. GER can result in abnormal esophageal motility characterized by weakened primary esophageal peristalsis. In contrast, single-contrast barium studies are most appropriate in older or debilitated patients who are unable to cooperate for a double-contrast examination.
Many reported no abnormalities of the pharyngeal phase,Upper esophageal sphincter function in patients with globus sensation has been studied with with mixed results. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus. Esophageal manometry identified an esophageal motility disorder (most commonly ineffective esophageal motility) in 62.8% of subjects, similar to other studies.Modified barium swallow was normal in 93% of swallows, supporting previous findings that it is not useful for patients with globus.Upper esophageal sphincter abnormalities have frequently been implicated in the etiology of globus sensation.Isolated lower esophageal sphincter dysfunction has not commonly been associated with globus symptoms; in general, this cohort supports that perspective.
Commonly diagnosed as globus sensation or globus syndrome, a study of stressors and life events around the time of symptom onset support a psychological etiology.Contrary to classification, many patients with globus sensation have organic disease. After the patient ingests several swallows of barium, the stomach is compressed with a compression paddle or the cone on the fluoroscope to demonstrate the rugal folds, assess the pliability of the gastric wall, and detect focal areas of rigidity secondary to tumor or scarring. Similarly, on small bowel follow-throughs, overlapping small bowel loops in the pelvis may compromise the fluoroscopist’s ability to detect abnormalities in the distal ileum.
Since the 1980s, advances in cross-sectional imaging and endoscopy have led to a gradual but steady decline in the number of barium studies performed in the United States. On barium enemas, a tortuous sigmoid colon may have overlapping loops, even with appropriate compression. For example, an esophagogram requires a moderately dense barium suspension that provides full-column and mucosal relief imaging; a high-density barium suspension or paste may also be needed for optimal mucosal coating. χOne‐hundred seventy‐two subjects with complete data were included in this analysis (Table Ineffective esophageal motility was the most frequently identified abnormality on high‐resolution manometry (Table Results of the modified barium swallow and esophagram are shown in Table There were 21 subjects with abnormal DeMeester score on pH testing and esophageal manometry testing showing either ineffective esophageal motility or jackhammer esophagus. Full-column (barium-filled views) and mucosal relief views constitute the single-contrast phase of the examination. Motion recordings should be obtained while the patient takes multiple discrete swallows of barium, because rapid swallowing causes reflex inhibition of esophageal peristalsis. The data were downloaded to a computer for graphic display as well as manual and automatic analyses. Although barium studies no longer reign supreme in the diagnosis of gastrointestinal (GI) disease, single- and double-contrast examinations continue to have a role in modern radiology practice. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated for each of the testing methods as compared to esophageal manometry.
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