Abnormal esophageal body function: Radiographic-manometric correlation

Stationary manometry is the gold standard for the evaluation of patients wi th suspected esophageal motility disorders. Comparison of videoesophagram i n the evaluation of esophageal motility disorders with stationary motility has not been objectively studied. Two hundred two patients with foregut sym ptoms underwent stationary motility and videoesophagram. Radiographic asses sment of esophageal motility was done by video recording of five 10-cc swal lows of barium. Abnormal esophageal body function was defined by stasis of barium in the middle third of the esophagus on at least four swallows or st asis on at least three swallows in the distal third. Stationary manometry w as performed using a five-channel water perfused system. Contraction amplit udes <25 mm Hg in any of the last two channels or the presence of simultane ous or interrupted waves in 10 per cent or more were considered to be abnor mal. Sixty-two patients had abnormal manometry. Thirty-four patients also d emonstrated abnormal videoesophagrams for an overall sensitivity of 55 per cent. The positive predictive value was 53 per cent; specificity was 79 per cent; and negative predictive value was 80 per cent. Sensitivity was great est in patients with achalasia (94%) and scleroderma (100%) and in patients presenting with dysphagia (89%). Sensitivity was poor for nonspecific esop hageal motility disorders. A videoesophagram is relatively insensitive in d etecting motility disorders. It seems most useful in the detection of patie nts with esophageal dysfunction, for which surgical treatment is beneficial , and in those patients presenting with dysphagia.