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Gastrointestinal Imaging

E2381. Barium Study for Dynamic Assessment of Esophageal Motility Disorders as a Cause of Dysphagia

Liu X1,  Guimaraes L2,  Liu L2,  Jaffer N.2 1. University of Toronto, Toronto, Canada; 2. University Health Network, Toronto, Canada

Address correspondence to X. Liu (xiaoyang.liu@hotmail.ca)

Background Information: Coordinated muscular motion is essential for passage of food and fluid down the esophagus. Esophageal motility disorders have disrupted esophageal motion and often present with dysphagia. Primary esophageal motility disorders include achalasia, diffuse esophageal spasm (DES), scleroderma, reflux esophagitis, and presbyesophagus. In addition to the being noninvasive and low cost, the dynamic nature of a barium study makes it an ideal imaging modality to assess esophageal motion, and is often employed initially for the diagnosis of esophageal motility disorders, before definitive manometry confirmation.

Educational Goals/Teaching Points: The purpose of this exhibit is to educate the audience with the techniques and findings of a dynamic barium study in esophageal motility disorders. We will emphasize the important intermediary role of a dynamic barium study for the assessment of dysphagia, manifested as a motility abnormality on the cine esophagram. We hope to familiarize the audience with the application of a barium study in the diagnosis, classification, prognosis, and follow-up of esophageal motility disorders. We also aim to deepen the understanding of each motility disease entity by providing essential clinical, pathophysiology, and treatment information. Such understanding, combined with proper barium study techniques, allows for enhanced diagnostic accuracy and facilitates management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We will cover clinical information, pathophysiology, and a wide spectrum of barium study techniques and findings for esophageal motility disorders including achalasia, scleroderma, DEC, reflux esophagitis, and presbyesophagus. We will explain the details of patient position, contrast administration, dynamic cine, as well as specific techniques such as timed barium esophagography for assessment of esophageal emptying and marshmallow study. We will also provide a selection of video clips and static images from dynamic barium studies to demonstrate the defining features. Key findings to differentiate disease entities with overlapping pathophysiology, for example, DES versus vigorous achalasia, will be specifically addressed. Special emphasis will also be put on correlation of imaging results with clinical management, follow-up, and prognosis.

Conclusion: A dynamic barium study is an important intermediary imaging modality for the assessment of dysphagia and the diagnosis of underlying esophageal motility disorders. It is crucial to develop a comprehensive understanding of the technique, as well as the clinical and radiologic manifestations correlating to the pathophysiology of each motility disorder.