Abstract
Background: Esophageal motility studies are performed in patients who have dysphagia that is not explained by stenosis. Diagnosis can be challenging and requires expertise in the interpretation of tests and symptoms.
Aims: Our aim is to investigate the diagnostic value of videofluoroscopic swallowing study (VFSS) in combination with esophageal manometry. Study Design: This study has a prospective study design. Methods: 73 patients with dysphagia underwent videofluoroscopy in a standing position. Each subject swallowed barium boluses and findings were correlated with manometry findings. Results: The study cohort was categorized into five groups according to their disease as achalasia (31.1%), presbyesophagus (4.1%), scleroderma (5.5%), neurogenic dysphagia (6.8%), and other diseases (54.4%), which included gastroesophageal reflux, diffuse esophageal spasm, cricopharyngeal achalasia, and diseases with nonspecific VFSS patterns. When evaluating VFSS, the perfect agreement was observed between two observers in the final diagnosis. (kappa: 0.91, p<0,001). Conclusion: Although it does not replace manometry, VFSS is important as an additional useful imaging method in EMDs.Keywords: Videofluoroscopic swallowing study, bolus transport, esophagus, manometry, esophageal motility, chest pain.
Graphical Abstract
[1]
Kaindlstorfer A, Pointner R. An appraisal of current dysphagia diagnosis and treatment strategies. Expert Rev Gastroenterol Hepatol 2016; 10(8): 929-42.
[http://dx.doi.org/10.1586/17474124.2016.1158098] [PMID: 26906944]
[http://dx.doi.org/10.1586/17474124.2016.1158098] [PMID: 26906944]
[2]
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27(2): 160-74.
[http://dx.doi.org/10.1111/nmo.12477] [PMID: 25469569]
[http://dx.doi.org/10.1111/nmo.12477] [PMID: 25469569]
[3]
Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJPM. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 2012; 24(Suppl. 1): 57-65.
[http://dx.doi.org/10.1111/j.1365-2982.2011.01834.x] [PMID: 22248109]
[http://dx.doi.org/10.1111/j.1365-2982.2011.01834.x] [PMID: 22248109]
[4]
Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol 2008; 42(5): 627-35.
[http://dx.doi.org/10.1097/MCG.0b013e31815ea291] [PMID: 18364587]
[http://dx.doi.org/10.1097/MCG.0b013e31815ea291] [PMID: 18364587]
[5]
Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg 1999; 9(4): 390-5.
[http://dx.doi.org/10.1381/096089299765552990] [PMID: 10484299]
[http://dx.doi.org/10.1381/096089299765552990] [PMID: 10484299]
[6]
Swanström LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 2011; 213(6): 751-6.
[http://dx.doi.org/10.1016/j.jamcollsurg.2011.09.001] [PMID: 21996484]
[http://dx.doi.org/10.1016/j.jamcollsurg.2011.09.001] [PMID: 21996484]
[7]
Suter M, Dorta G, Giusti V, Calmes JM. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 2004; 14(7): 959-66.
[http://dx.doi.org/10.1381/0960892041719581] [PMID: 15329186]
[http://dx.doi.org/10.1381/0960892041719581] [PMID: 15329186]
[8]
Hewson EG, Ott DJ, Dalton CB, Chen YM, Wu WC, Richter JE. Manometry and radiology. Complementary studies in the assessment of esophageal motility disorders. Gastroenterology 1990; 98(3): 626-32.
[http://dx.doi.org/10.1016/0016-5085(90)90281-5] [PMID: 2298367]
[http://dx.doi.org/10.1016/0016-5085(90)90281-5] [PMID: 2298367]
[9]
Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg 1995; 130(6): 609-15.
[http://dx.doi.org/10.1001/archsurg.1995.01430060047009] [PMID: 7763169]
[http://dx.doi.org/10.1001/archsurg.1995.01430060047009] [PMID: 7763169]
[10]
Vantrappen G, Janssens J, Hellemans J, Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 1979; 76(3): 450-7.
[PMID: 428703]
[PMID: 428703]
[11]
Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg 2007; 17(7): 894-900.
[http://dx.doi.org/10.1007/s11695-007-9166-3] [PMID: 17894148]
[http://dx.doi.org/10.1007/s11695-007-9166-3] [PMID: 17894148]
[12]
Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with Dysphagia. Am J Gastroenterol 2011; 106(2): 349-56.
[http://dx.doi.org/10.1038/ajg.2010.384] [PMID: 20924368]
[http://dx.doi.org/10.1038/ajg.2010.384] [PMID: 20924368]
[13]
Ott DJ, Chen YM, Hewson EG, et al. Esophageal motility: assessment with synchronous video tape fluoroscopy and manometry. Radiology 1989; 173(2): 419-22.
[http://dx.doi.org/10.1148/radiology.173.2.2798872] [PMID: 2798872]
[http://dx.doi.org/10.1148/radiology.173.2.2798872] [PMID: 2798872]
[14]
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159-74.
[http://dx.doi.org/10.2307/2529310] [PMID: 843571]
[http://dx.doi.org/10.2307/2529310] [PMID: 843571]
[15]
Carlson DA, Omari T, Lin Z, et al. High-resolution impedance manometry parameters enhance the esophageal motility evaluation in non-obstructive dysphagia patients without a major Chicago Classification motility disorder. Neurogastroenterol Motil 2017; 29(3) e12941
[http://dx.doi.org/10.1111/nmo.12941] [PMID: 27647522]
[http://dx.doi.org/10.1111/nmo.12941] [PMID: 27647522]
[16]
Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 1997; 42(9): 1859-65.
[http://dx.doi.org/10.1023/A:1018802908358] [PMID: 9331148]
[http://dx.doi.org/10.1023/A:1018802908358] [PMID: 9331148]
[17]
Gerek M, Çiyiltepe M. Videofluoroscopic Evaluation in Swallowing Disorders KBB ve BBC Dergisi 2004; 12(2): 89-100.
[18]
Kendall A, Ellerston J, Heller A, et al. Objective measures of swallowing function applied to the dysphagia population: a one year experience. Dysphagia 2016; 31(4): 538-46.
[19]
Massey BT, Dodds WJ, Hogan WJ, Brasseur JG, Helm JF. Abnormal esophageal motility. An analysis of concurrent radiographic and manometric findings. Gastroenterology 1991; 101(2): 344-54.
[http://dx.doi.org/10.1016/0016-5085(91)90010-I] [PMID: 2065909]
[http://dx.doi.org/10.1016/0016-5085(91)90010-I] [PMID: 2065909]
[20]
Scharitzer M, Lenglinger J, Schima W, Weber M, Ringhofer C, Pokieser P. Comparison of videofluoroscopy and impedance planimetry for the evaluation of oesophageal stenosis: a retrospective study. Eur Radiol 2017; 27(4): 1760-7.
[http://dx.doi.org/10.1007/s00330-016-4516-y] [PMID: 27553930]
[http://dx.doi.org/10.1007/s00330-016-4516-y] [PMID: 27553930]
[21]
Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJPM. Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia. Neurogastroenterol Motil 2012; 24(8): e364-72.
[http://dx.doi.org/10.1111/j.1365-2982.2012.01949.x] [PMID: 22672410]
[http://dx.doi.org/10.1111/j.1365-2982.2012.01949.x] [PMID: 22672410]