Digital radiography in the evaluation of oesophageal motility disorders

AIMS: To develop a simple technique for examination of the oesophagus by digital radiography and to assess its role in the evaluation of motility disorders of the oesophagus. MATERIALS AND METHODS: Forty-nine patients and 44 control subjects underwent manometry and digital examination of the oesophagus, The digital study consisted of two parts: firstly examination of the pharynx and cervical oesophagus using 15 mi of fluid barium in anterio-posterior (AP) and lateral views, with image acquisition of four frames/s for 2 s, Secondly, examination of the thoracic oesophagus and oesophagogastric junction using 25 mi of barium in two prone oblique and one supine AP series, with image acquisition of one frame/s for 20 s, Oesophageal transit time (OTT) was measured in each case. Abnormal or non-peristaltic contractions were described regarding their morphology, time of visualization and length. The presence or absence of hiatal hernia, reflux or any associated organic lesions was noted. RESULTS: Digital radiography diagnosed 14 cases of achalasia and 28 cases of non-specific oesophageal motility disorder (NOMD), Normal OTT was 11.95 +/- 1.304 s. The OTT was prolonged (16s or more) in all patients except five; four of these were cases of NOMD, Abnormal contractions were classified into circular and longitudinal types. The circular non-obliterating type was commoner. Achalasia was diagnosed in all cases, as failure of relaxation of the inferior oesophageal sphincter was always present and easily depicted by digital radiography, Abnormal contractions in the body of the oesophagus were elicited in 57% of cases of achalasia, The sensitivity of digital radiography in detecting oesophageal motility disorders was 85.7% based on the presence of abnormal contractions and 91.6% by eliciting a prolonged OTT, CONCLUSIONS: Examination of the oesophagus by digital radiography is simple, non-invasive, reproducible, rapid and without discomfort to patients. It allows the diagnosis of motility disorders of the oesophagus by detecting abnormal contractions and/or prolonged OTT and showed any associated organic lesions. (C) 2000 The Royal College of Radiologists.