[Dysphagia] Radiology and the esophagus

[eripley at yahoo.com (Irene Campbell-Taylor)]

For those of you who inform me that there is difficuly getting radiologists to sweep down the esophagus, the following guidelines may be helpful:
  Dysphagia.
  BIBLIOGRAPHIC SOURCE(S)
  Levine MS, Bree RL, Foley WD, Glick SN, Heiken JP, Huprich JE, Robbin ML, Ros PR, Shuman WP, Greene FL, Laine LA, Expert Panel on Gastrointestinal Imaging. Dysphagia. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 6 p. [33 references]
  GUIDELINE STATUS
  This is the current release of the guideline.
  It updates a previous published version: ACR Appropriateness Criteria? for imaging recommendations for patients with dysphagia. Reston (VA): American College of Radiology; 2001. 6 p.
  Excerpt:
  ?The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.
  Many patients with dysphagia can subjectively localize a sensation of blockage or discomfort to the throat or substernal region. Patients with pharyngeal dysphagia typically complain of food sticking in the throat or of a globus sensation with a lump in the throat. Other symptoms of oropharyngeal dysfunction include coughing or choking during swallowing due to laryngeal penetration or aspiration, a nasal-quality voice or nasal regurgitation due to soft palate insufficiency, and food dribbling from the mouth or difficulty chewing due to an abnormal oral phase of swallowing. When oropharyngeal dysphagia has an attributable cause (e.g., recent stroke), a modified barium swallow may be the appropriate test to assess the patient?s swallowing status and initiate treatment by a speech therapist. In patients with unexplained oropharyngeal dysphagia, however, a more detailed barium study may be needed to determine the cause. It also is important to recognize that abnormalities of
 the mid or distal esophagus or even the gastric cardia may cause referred dysphagia to the upper chest or pharynx, whereas abnormalities of the pharynx rarely cause referred dysphagia to the lower chest. The esophagus and cardia should therefore be evaluated in patients with pharyngeal symptoms, particularly if no abnormalities are found in the pharynx to explain these symptoms. Thus, a combined radiologic examination of the pharynx, esophagus, and gastric cardia is appropriate for patients with unexplained pharyngeal dysphagia.?
   
  


Dr I Campbell-Taylor
Clinical Neuroscientist
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