Esophagus: Radiologic Evaluation of Esophageal Function

Radiologic assessment of the esophagus is an essential part of the diagnostic work-up of patients with deglutition disorders. The radiologic examination comprises two parts: single- and double contrast examinations to assess the morphology of the esophagus and the esophago-gastric junction, which may reveal signs of esophagitis, tumor, strictures, or rings. Radiologic evaluation of the esophagus would be incomplete without assessing esophageal function. Attempts to diagnose esophageal motor dysfunction, such as achalasia, were undertaken in the early days of single-contrast barium radiology (Hurst et al. 1930). The development of cinefluoroscopy and videofluoroscopy has significantly improved the ability to study the motor function of the pharynx and esophagus in detail. The pharyngeal and esophageal transport of liquid and solid boluses can be studied in real time and in slow motion. Although slow motion analysis is more crucial for the assessment of pharyngeal function, video recording of esophageal bolus transport is also essential for a thorough analysis of the esophagus. Subtle abnormalities of motor function may go undetected during real-time observation of swallowing.