Imaging

Esophageal Dysmotility

Preliminary Diagnosis: Esophageal Dysmotility

I. What imaging technique is first-line for this diagnosis?

Single contrast barium esophagram

II. Describe the advantages and disadvantages of this technique for diagnosing esophageal dysmotility.

Advantages

  • Single contrast esophagram can accurately depict characteristic appearance of an esophageal diverticulum.

  • Air distention (which can cause patient discomfort) is not necessary.

  • The examination is relatively inexpensive.

  • No significant complications typify this outpatient procedure.

  • Barium is a relatively inert compound, and minor aspiration events are typically uneventful.

  • This is usually the only imaging study required.

Disadvantages

  • Unable to adequately assess mucosal detail in the assessment of esophagitis

III. What are the contraindications for the first-line imaging technique?

  • Relative contraindication in pregnancy

  • Contraindicated in gastrointestinal perforation (water soluble contrast agents can be used)

IV. What alternative imaging techniques are available?

Tc-99 esophageal transit scintigraphy

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing esophageal dysmotility.

Advantages

  • Noninvasive

Disadvantages

  • Not routinely performed when conventional esophagography is available

  • Use of radioactive pharmaceuticals

VI. What are the contraindications for the alternative imaging techniques?

No absolute contraindications exist.

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