Esophageal Motility Disorders: How Does the Barium Swallow Correlate With Manometry?

Abstract

Achalasia is defined as dysfunction of the esophageal wall myenteric plexus, which causes symptoms of dysphagia. While manometry is typically regarded as the gold standard for diagnosing and confirming achalasia, other imaging modalities such as barium swallow and upper endoscopy are often obtained initially. The barium swallow study can be a supportive or confirmatory test, whereas the upper endoscopy is typically used to rule out pseudo-achalasia. Additionally, barium swallow is an imaging modality of choice in resource-limited settings. A standardized approach for categorizing motility disorders is the Chicago Classification. This is a newer classification of achalasia based on high-resolution manometry. However, the role of barium contrast studies does not seem to have been evaluated in the context of the Chicago Classification of the three achalasia subtypes, suggesting an underappreciated role of fluoroscopy in the diagnostic evaluation of achalasia subtypes.