Solid Bolus Swallowing in the Radiologic Evaluation of Dysphagia

Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is usually not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important.

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Does Dysphagia Indicate Recurrence of Benign Esophageal Strictures?

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.2.7 ◽

1995 ◽

Vol 2 (1) ◽

pp. 7-9

Author(s):

Olle Ekberg ◽

Anders Borgström ◽

Frans-Thomas Fork ◽

Eje Lövdahl

Keyword(s):

Esophageal Stricture ◽

Eating Habits ◽

Clinical History ◽

Barium Swallow ◽

Motor Disorder ◽

Esophageal Dysmotility ◽

Solid Bolus ◽

Retrosternal Pain ◽

Esophageal Strictures ◽

Dysphagic Patients

Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended.

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The Radiologic Evaluation of Chest Pain in the Athlete

Clinics in Sports Medicine ◽

10.1016/s0278-5919(20)30987-x ◽

1987 ◽

Vol 6 (4) ◽

pp. 845-870

Author(s):

Stuart Groskin

Keyword(s):

Chest Pain ◽

Radiologic Evaluation

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Esophageal Dysmotility and the Utility of Barium Swallow: An Opaque Diagnosis

Annals of Surgery and Perioperative Care ◽

10.26420/annsurgperiopercare.2017.1021 ◽

2017 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Anna Aronova

Keyword(s):

Barium Swallow ◽

Esophageal Dysmotility

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FA02.02: TWENTY-FIVE YEARS OF LAPAROSCOPIC TREATMENT FOR ESOPHAGEAL ACHALASIA: OUR EXPERIENCE ON 1000 LAPAROSCOPIC HELLER-DOR OPERATIONS

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa02.02 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 3-3

Author(s):

Mario Costantini ◽

Renato Salvador ◽

Giovanni Capovilla ◽

Andrea Costantini ◽

Anna Perazzolo ◽

...

Keyword(s):

Chest Pain ◽

Pain Score ◽

Conflicts Of Interest ◽

Ph Monitoring ◽

Univariate Analysis ◽

Esophageal Achalasia ◽

Barium Swallow ◽

Pneumatic Dilation ◽

Tertiary Referral Center ◽

Manometric Pattern

Abstract Background In the past decades, Laparoscopic Heller-Dor (LHD) progressively became the treatment of choice for esophageal achalasia. Aim of this study was to assess our 25-year experience with LHD at a single high-volume institution. Methods 1000 patients underwent LHD from 1992–2017 by 6 staff surgeons. Patients who had already been treated with surgical or endoscopic myotomy were ruled out. Symptoms were scored using a detailed questionnaire; barium swallow, endoscopy, manometry (conventional or High Resolution) were performed, before and after surgery, while 24-hour pH monitoring was performed 6 months after surgery. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Results LHD was performed on 1000 patients (M: F = 536:464); the median age was 46 (IQR 36–54), 183 (18.3%) had a history of endoscopic treatments (pneumatic dilation or botox injections, or both). The surgical procedure was completed laparoscopically in all but 7 patients (0.7%) and there was one perioperative death for heart attack. There were 25 perforations (2.5%): 22 were recognized and repaired during the operation, 3 were detected by postoperative contrast swallow. In 674 patients the manometric pattern was classified as follows: 310 (46%) pattern I, 315 (46.7%) pattern II and 49 (7.3%) pattern III. The outcome was positive in 902 patients (90.2%). In patients who had a previous treatment the failures were 25/183 (13.7%) while in the primary treatment group the failures were 73/817 (8.9%) (P = 0.055). All the 98 patients whose LHD failed underwent one or more pneumatic dilations, which ameliorated their symptoms in all but 11 patients (10 required reoperation). The overall success rate of combined LHD and dilations was 98.4%. At univariate analysis, manometric pattern (P = 0.001), absent sigmoid megaesophagus (P = 0.003) and chest pain score (P = 0.002) were the only factors predictive of the result. At multivariate analysis, these three factors were independently associated with good outcome. Postoperative 24-hour pH was abnormal in 50/590 patients (8.5%). Two patients developed an esophageal cancer during follow-up. Conclusion In a university tertiary referral center, LHD relieves achalasia symptoms durably. The preoperative manometric pattern, the absence of a sigmoid esophagus and the chest pain score represent the strongest predictors of outcome. Disclosure All authors have declared no conflicts of interest.

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O89 TWENTY-FIVE YEARS OF LAPAROSCOPIC TREATMENT FOR ESOPHAGEAL ACHALASIA: OUR EXPERIENCE ON 1001 LAPAROSCOPIC HELLER-DOR OPERATIONS

Diseases of the Esophagus ◽

10.1093/dote/doz092.89 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Salvador ◽

G Capovilla ◽

L Provenzano ◽

L Moletta ◽

E Pierobon ◽

...

Keyword(s):

Chest Pain ◽

Pain Score ◽

Ph Monitoring ◽

Univariate Analysis ◽

Primary Treatment ◽

Barium Swallow ◽

Past Century ◽

Long Term Outcome ◽

The Past ◽

Manometric Pattern

Abstract Background In the last decade of the past century, primary Laparoscopic Heller-Dor (LHD) for Achalasia progressively became the procedure of choice in the new millennium. The aim of this study was to assess the long-term outcome of LHD to treat Achalasia at a single high-volume institution during the past 25 years. Methods 1000 patients underwent LHD from 1992-2017 by 6 staff surgeons alternatively. Patients who had already been treated with surgical or endoscopic myotomy were ruled out. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry were performed, before and after surgery while, 24-hour pH monitoring were performed 6 months after surgery. Results LHD was the primary treatment for 1000 patients (M:F=536:464); the median age was 46 (IQR 36-54), 183 (18.3%) had a history of endoscopic treatments (pneumatic dilation or botox injections, or both). The surgical procedure was completed laparoscopically in all but 7 patients (0.7%) and there was one perioperative death for heart attack. There were 25 perforations (2.5%): 22 were recognized and repaired during the operation, 3 were detected by postoperative contrast swallow. The outcome was positive in 902 patients (90.2%). In patients who had a previous treatment the failures were 25/183 (13.7%) while in the primary treatment group the failures were 73/817 (8.9%) (p=0.055). All the 98 patients whose LHD failed subsequently underwent one or more endoscopic pneumatic dilations, which ameliorated their recurrent symptoms in all but 11 patients (10 of whom required reoperation). The overall success rate of the combination of LHD and endoscopic dilations (where necessary) was 98.4%. At univariate analysis, manometric pattern (p=0.001), sigmoid megaesophagus (p=0.003) and a chest pain score (p=0.002) were the only factors predictive of a positive final results. At multivariate analysis, these three factors were independently associated to good outcome. Postoperative 24-hour pH-monitoring was abnormal in 50/590 patients (8.5%) Two patients developed an esophageal cancer during the follow-up time. Conclusions In a university tertiary referral center LHD can durably relieve achalasia symptoms. Preoperative manometric pattern, a presence of a sigmoid esophagus and the chest pain score represent the strongest predictor of outcome.

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A rare but treatable cause of recurrent chest pain - Ictal chest pain

BMC Neurology ◽

10.1186/s12883-019-1575-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ching Soong Khoo ◽

Dongah Lee ◽

Kang Min Park ◽

Byung In Lee ◽

Sung Eun Kim

Keyword(s):

Chest Pain ◽

Cardiac Work ◽

Case Presentation ◽

Neurology Clinic ◽

Work Up

Abstract Background Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date. Case presentation We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug. Conclusions This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.

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991 Esophageal Dysmotility and the Utility of Barium Swallow: An Opaque Diagnosis

Gastroenterology ◽

10.1016/s0016-5085(15)33855-5 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1131-S-1132 ◽

Cited By ~ 2

Author(s):

Brendan M. Finnerty ◽

Anna Aronova ◽

Cheguevara Afaneh ◽

Kamal S. Turkmany ◽

Thomas Ciecierega ◽

...

Keyword(s):

Barium Swallow ◽

Esophageal Dysmotility

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Commentary: A Case of the Double Rarities

10.22541/au.162229559.96436714/v1 ◽

2021 ◽

Author(s):

michelle mulder ◽

Olivia D'Angelo

Keyword(s):

Differential Diagnosis ◽

Chest Pain ◽

Aortic Valve ◽

Valve Replacement ◽

Surgical Resection ◽

Bicuspid Aortic Valve ◽

Cardiac Tumor ◽

Cystic Teratoma ◽

Middle Aged ◽

Work Up

The authors report an exceptionally rare patient with findings of a bicuspid aortic valve in conjunction with a mature cystic teratoma in a middle-aged male presenting for symptomatic chest pain. Surgical resection and valve replacement were performed, confirming the rare cardiac tumor. While certainly interesting, this case highlights the importance of maintaining a broad differential diagnosis and the appropriate work-up, treatment and considerations for such rare pathology.

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