Barrett's esophagus: diagnosis by double-contrast esophagography

A blinded, retrospective study was performed to determine the role of double-contrast esophagography in diagnosing Barrett's esophagus. The study group consisted of 200 patients who had double-contrast esophagrams and endoscopy because of severe reflux symptoms. The radiographs were reviewed by two gastrointestinal radiologists who had no knowledge of the endoscopic findings. Patients were classified as being at high risk for Barrett's esophagus if the radiographs revealed a high stricture or ulcer or a reticular mucosal pattern; at moderate risk if the radiographs revealed a distal peptic stricture and/or reflux esophagitis; and at low risk if none of the aforementioned findings were present. When these radiologic criteria were used, 10 patients (5%) were thought to be at high risk, 73 (37%) at moderate risk, and 117 (58%) at low risk for Barrett's esophagus. Endoscopic correlation revealed biopsy-proved Barrett's mucosa in nine (90%) of 10 patients at high risk, in 12 (16%) of 73 at moderate risk, and in only one (1%) of 117 at low risk for Barrett's esophagus. Thus, endoscopy is clearly indicated for patients in the high-risk group. Because of the lower prevalence of Barrett's esophagus in the moderate-risk group, clinical judgment should be used in deciding when to perform endoscopy in these patients. However, most patients were in the low-risk group, and the prevalence of Barrett's esophagus was so low in this group that endoscopy does not appear to be warranted. Thus, the major value of double-contrast esophagography is its ability to separate patients into high-, moderate-, and low-risk groups for Barrett's esophagus to determine the relative need for endoscopy and biopsy.     

Medication-induced esophagitis: diagnosis by double-contrast esophagography

Although medication-induced esophagitis is recognized more frequently nowadays, reports of associated radiographic findings are limited. Nine cases of esophagitis associated with various medications were evaluated by using double-contrast esophagography. The usual features were several discrete focal ulcerations localized to a short segment of the proximal half of the esophagus. In seven of the cases, the offending medication was an antibiotic. Symptoms resolved in about 4 days after medication was discontinued. Finding characteristic radiologic abnormalities in the appropriate clinical setting may obviate endoscopy.     

Short-segment Barrett's esophagus: findings on double-contrast esophagography in 20 patients

OBJECTIVE: The purpose of this study was to determine the findings of short-segment Barrett's esophagus on double-contrast esophagography. MATERIALS AND METHODS: A review of pathology and endoscopy data revealed 142 patients with short-segment Barrett's esophagus, which was defined as columnar epithelium in the distal esophagus extending 3 cm or less above the gastroesophageal junction at endoscopy with histopathologic confirmation of intestinal metaplasia. Twenty of these patients underwent double-contrast esophagography. These 20 patients comprised our study group. The original radiology reports and images were reviewed to determine the findings on double-contrast esophagography. Medical records were also reviewed to determine the clinical findings and treatment. RESULTS: Double-contrast esophagrams revealed hiatal hernias in 18 patients (90%), gastroesophageal reflux in 16 (80%), reflux esophagitis in seven (35%), peptic scarring or strictures in 11 (55%), and a reticular mucosal pattern in none. A total of 14 patients (70%) had morphologic findings of reflux disease with esophagitis alone (three patients), peptic scarring or strictures alone (seven patients), or both (four patients), but the remaining six (30%) had hiatal hernias or gastroesophageal reflux as the only radiographic finding. CONCLUSION: Double-contrast esophagography revealed morphologic findings of reflux disease with esophagitis, peptic scarring or strictures, or both in 70% of patients with short-segment Barrett's esophagus. Thus, the absence of esophagitis or peptic scarring or strictures on double-contrast esophagography does not exclude the possibility of short-segment Barrett's esophagus.     

Focal spiculation of the upper thoracic esophagus: normal variant at double-contrast esophagography.

A review of 100 routine biphasic upper gastrointestinal examinations revealed focal spiculation of the upper thoracic esophagus as a transient finding in 11 patients (11%) who otherwise had no clinical or radiographic signs of esophageal disease. All 11 patients had remarkably similar findings, with thin (1-2 mm wide), transverse folds or striations above the level of the aortic arch, producing a spiculated or serrated appearance in profile. This focal spiculation should be considered a normal variant in the esophagus on double-contrast radiographs. It is suspected that this phenomenon is related to weakening of peristalsis or localized contraction of the longitudinally oriented muscularis mucosae at the junction of the striated- and smooth-muscle portions of the esophagus. Whatever the explanation, radiologists should be familiar with this finding, so that it is not mistaken for a focal area of esophagitis.     

Esophageal disruption: evaluation with iohexol esophagography

Twenty-six patients with possible esophageal disruption who were also at risk for aspiration or direct communication of the esophagus with the tracheobronchial tree were examined with iohexol esophagography. Fifteen patients had normal studies confirmed by findings at a barium examination performed immediately after. In 11 patients abnormalities were diagnosed on the basis of iohexol esophagograms; the abnormalities included extraluminal extravasation of contrast material (n = 7), aspiration (n = 1), esophageal stricture with intramural diverticulosis (n = 1), edema of the gastroesophageal junction (n = 1), and epiphrenic diverticulum (n = 1). Eight of these patients were immediately reexamined with barium esophagography, which yielded no additional information. Low-osmolality, water-soluble contrast agents are a safe alternative for patients in whom barium esophagography poses a risk of mediastinitis and esophagography with diatrizoate meglumine and diatrizoate sodium (Gastrografin) poses a risk of pulmonary edema.     

食管造影在诊断食管异物中的作用探讨

食管异物为耳鼻喉科常见急症之一,如不及时治疗可因食管穿孔、纵隔脓肿等并发症引起严重后果。早期诊断可及早予以适当治疗,提高治愈率。食管造影检查创伤小,准确率高,方便快捷,是诊断本症的重要方法之一。现结合我院过去2年中门诊病例探讨食管造影检查在食管异物诊断中的作用。1资料与方法2004年1月~2005年12月主诉为吞咽困难、疼痛、憋气等症状,并有明确异物史、接受食管造影检查有阳性发现的门诊患者共65例。病程1~35 h,其中男35例,女30例。小于5岁2例,均为圆形钱币类异物;大于60岁2例,均为假牙类异物;16~55岁61例,均为动物性异物,以鱼骨…     

Motility disorders of the esophagus: diagnosis with barium-rice administration

Purpose: To evaluate the role of barium-rice administration for a standardized diagnosis of dysphagia and esophageal motility disorders. Materials and methods: Sixty healthy volunteers and 218 patients with various esophageal disorders (achalasia, scleroderma and other connective tissue diseases, neurologic diseases, esophagitis and others) were examined both by a conventional barium study and by a barium-rice study. The barium-rice meal consisted of barium sulfate and boiled rice, mixed half and half. The time required for esophageal clearance of one sip was measured. Results: Normal esophageal transit time in healthy controls was between 5 and 15 s for both methods. In patients, the conventional barium study revealed a prolonged transit time in only 16.5% (36 of the 218 cases). The barium-rice study was abnormal in 51.8% (113 of 218 cases), independent of the underlying disease. The barium-rice study was pathological in 77 of those 182 patients (42.3%) who had normal barium transit time. In 24 patients the radiologic results were confirmed by endoscopy and manometric measurements. Conclusions: Esophageal motility abnormalities are detected by a barium-rice study with a high sensitivity. With this simple and low-cost method, quantitative and reproducible results can be obtained. Barium-rice administration is a suitable tool for screening and follow-up of patients with dysphagia and esophageal motility disorders.     

A comparative assessment of tube esophagography with double-contrast esophagography in the detection of reflux esophagitis

We undertook a prospective study comparing the sensitivities of double-contrast and tube esophagography in 34 patients with gastroesophageal reflux and compared our findings with those at endoscopy. Neither test detected changes accurately in mild inflammation; however, they both became more sensitive as the severity of esophagitis increased. The sensitivity of both tests increased from 0% in grade 2 to 86% in grade 4 esophagitis. The tube esophagogram demonstrated inflammatory changes better than the double-contrast esophagogram in only 18% of the 34 patients, all with grade 3 or 4 esophagitis, despite the elimination of the barium pool in the distal esophagus and improved distension of the esophagogastric junction. Endoscopy is still the most reliable means of diagnosing and grading esophagitis.     

Herpes esophagitis: sensitivity of double-contrast esophagography

During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.     

Double contrast cervical esophagography: use of a specially designed cup to aid double-contrast cervical esophagography

We designed a cup to aid double-contrast cervical esophagography using photo fluorography and an image intensifier. The cup allows an adequate amount of air to be delivered with the contrast media so that the cervical esophageal lumen expands to give an ideal double contrast image. The clear image is obtained, having to calculate exact timing. The timing sequence we used during the serial radiography was 4 seconds at 2 radiographs per second while the patient continually swallowed the contrast medium and air.     

Carcinoma of esophagus: radiologic diagnosis and staging

Esophageal carcinoma is an uncommon malignancy accounting for approximately 7% of gastrointestinal tract cancers and 1% of all cancers. Esophageal cancer still remains one of the most lethal of all cancers. Since a multimodality approach is presently used to treat esophageal cancer, early radiologic diagnosis and accurate tumor staging are essential to direct therapy toward cure or palliation. This article presents a review of radiologic diagnosis and staging of esophageal cancer.     

"Nutcracker" esophagus: diagnosis with radionuclide esophageal scintigraphy versus manometry

"Nutcracker" esophagus is a syndrome consisting of chest pain and/or dysphagia with elevation of the mean distal esophageal contractile pressure amplitude (MDA) (greater than 120 mm Hg). Its existence as a disorder of esophageal function and the proper manometric diagnostic criteria have been debated. A correlative study of radionuclide esophageal scintigraphy (RES) and manometry was performed in 31 patients with this manometric diagnosis. RES results were abnormal in 13 of 16 (81%) patients with an MDA above 150 mm Hg, and in only three of 15 (20%) patients with an MDA below this level. There was a significant difference in RES parameters (mean transit time and percentage emptying) between these two groups. Repeat manometric and RES studies showed considerable variability, but only RES showed a significant correlation between baseline and repeat studies. RES confirms a functional disorder in a subgroup of patients with the manometric diagnosis of nutcracker esophagus and supports a change in the manometric criteria for diagnosis of this disorder to an MDA above 150 mm Hg.     

Diseases of the chest in AIDS: CT diagnosis

The advantages of computed tomography for the evaluation of various chest lesions commonly encountered in patients with AIDS are discussed. The significance of limited and extensive lymphadenopathy is considered and examples are presented. Also specifically illustrated are cases of opportunistic pneumocystis, cytomegalovirus, and nocardia pneumonitides and of candida esophagitis; septic emboli; empyema; premature bulla formation ranging from apical bullae to diffuse parenchymal destruction; Kaposi's sarcoma, and lymphoma. Examples of the value of CT in resolving obscure clinical chest problems in AIDS patients are also illustrated.     

Diseases of the spinal canal in children: diagnosis with noncontrast CT scans

The spinal cord and its coverings were assessed in 131 CT studies performed without intrathecal contrast material in 108 patients ages newborn to 20 years old. The spinal cord, including the conus medullaris, and the theca can be readily identified in most patients, except in the upper thoracic region. Correlation with other radiologic studies and surgery showed few false-positive and false-negative results. Of particular importance, in no patient was unnecessary surgery performed nor was necessary surgery not performed as a result of the method. The technique was a useful screening test, often sufficient alone, for the assessment of congenital disease (proved lesions included 20 tethered spinal cords, 11 congenital mass lesions, five split cords, and 11 hydromyelic cysts or syrinxes). There were nine confirmed intraspinal neoplasms. The technique was good for identifying epidural lesions; however, we recommend myelography and/or CT myelography for suspected intradural tumors because of the greater anatomic definition required. Noncontrast CT requires careful attention to technique, and may be successful only with the use of late-model, high-resolution CT units. Noncontrast CT is a rapid, cost-effective method of assessing suspected disease in the pediatric spinal canal, at least while access to MR is still limited.     

Double-contrast esophagography in the diagnosis of esophagitis due to Candida. A study on HIV-seropositive patients]

This study was aimed at assessing the sensitivity of double-contrast esophagography in diagnosing Candida esophagitis. This condition accounts for 85% of all esophageal infections in the subjects suffering from AIDS. Thirty-nine HIV+ patients were evaluated: 19 of them had endoscopic diagnosis of Candida esophagitis. Our study confirmed the high sensitivity of esophagography (90%), as reported in the literature. Radiographic findings were edematous esophageal folds in the early stage and, subsequently, plaques and diffuse ulcerations. These patterns are suggestive of anatomical lesions: in the early stage, mucosal edema and erythema are observed, and later on pseudomembranes and ulcerations. None of our patients exhibited stenosis. All the subjects with Candida esophagitis had less than 250/mm3 of CD4 lymphocytes. In conclusion, double-contrast esophagography must be included in the periodic examinations performed on patients with AIDS, so as to allow an early diagnosis.