Correlation between Timed Barium Esophagogram and the Eckardt Stage in Achalasia

Objective : To evaluate the correlation of timed barium esophagogram (TBE) parameters and the Eckardt stage in patients with achalasia. Methods : This prospective study was done in 29 adult achalasia patients who underwent TBE and were assessed for clinical symptoms according to the Eckardt stage. The association between the Eckardt stage and TBE parameters including the height and the width of barium column, esophageal emptying between 1 and 5 minutes was calculated by comparing the area of barium column and esophageal emptying between 0 and 5 minutes, which was calculated from the relative changes in ingested volume to estimated volume of barium column on the 5-min image and this was calculated by using Kruskal-Wallis test. Comparison of mean emptied volume at 1 min. image and mean emptied volume between 1 and 5 minutes was done by using paired samples t-tests. Results: There was a significant difference in the amount of emptied volume at 1 min image (mean = 118.27, SD = 31.1) and emptied volume between 1 min and 5 min images (mean = 11.41, SD = 9.4); t(27) =15.375, p < 0.001.  The statistically significant difference in esophageal emptying between 1 and 5 minutes across the Eckardt stages was found (H=8.115, 3 d.f., p=0.044). The difference was statistically significant between the Eckardt stage 2 and 3 (p=0.039). There were no statistically significant differences in other TBE parameters across the Eckardt stages. Conclusion:  No statistically significant difference in TBE parameters across the Eckardt stages was found in the present study. However, TBE is a useful objective method to assess esophageal emptying in patients with achalasia. Interpretation of TBE should be standardized. Calculation of esophageal emptying should include the amount of barium emptied from the esophagus in the first minute.