Barium swallow

Patients are generally treated in the supine position. If conventional simulationis used, a barium swallow should be done at the time of simulation to outline the target volume. Optimal immobilization such as an alpha cradle to improve daily set up reproducibility... 

An 80-year-old woman had severe difficulty in swallowing and flaccid paralysis of her cervical muscles starting 4 days after the periocular injection of botulinum toxin 120 MU for blepharospasm (12). She also developed bilateral facial nerve paralysis and slurred speech and could not fully close her eyes. Barium swallow and fluoroscopy showed signs of aspiration. The serum concentration of antiacetylcholine receptor antibodies was 6.9 units (reference range 0-0.7 units). Mestinone and prednisone improved her symptoms. She had been treated with botulinum toxin on 18 occasions over the previous 13 years without any untoward effects. 

Radiography using barium sulfate is called a barium swallow or a barium enema. Barium suliate is mixed with water into a slurry (mtxmre) that looks and tastes like ground-up chalk. The patient swallows the dense mixture. A doctor or nurse then holds a fluoroscope over the patient s abdomen. The fluoroscope emits X rays that show up on a television screen. 

Additional diagnostic steps that can be taken include sigmoidoscopy or colonoscopy examination of the stool for occult blood and ova and parasites complete blood cell count erythrocyte sedimentation rate and serum electrolytes. In some cases, radiographic imaging studies, such as computed tomography scans or barium swallows or enemas, may also be necessary if the findings of the above assessment are not typical for IBS. ... 

The best test is upper Gl endoscopy (more useful than barium swallow) helps exclude other causes of esophagitis (e.g., viral, aphthous ulcers). Diagnosis is confirmed by the histologic presence of Candida in biopsy lesions taken during endoscopy. 

Abdominal ultrasound Barium enema Barium swallow Carcinoembiyonic antigen Clostridial toxin assay Colonoscopy... 

Barium enema Barium swallow Bone densitometry Bone x-ray... 

The video esophagram, or modified barium swallow, is the standard technique to evaluate dysphagia. This examination is more sensitive than clinical evaluation of aspiration (DeMatteo et al. 2005), and is also more sensitive than the conventional upper GI series for the detection of aspiration (Vazquez and Buonomo 1999). A scout radiograph of the chest should be obtained to assess for evidence of aspiration. For the examination, the child must be securely... 

Fig. 2.13. Congenital esophageal stenosis. Barium swallow reveals a discrete annular narrowing in the distal esophagus. Tracheobronchial rests were found at pathology...

Fig. 2.28. Esophageal stricture. Barium swallow shows a long stricture involving almost the entire length of the esophagus years after ingesting an unknown corrosive agent...

Fig. 2.31. Epidermolysis bullosa. Barium swallow reveals a proximal annular stricture and a long segment of diffuse irregularity of the esophagus...

A barium swallow readily describes the tumour as to location, size, and morphology but as mentioned above both CT and endoscopic ultrasound are needed for staging purposes. Three main morphologic types are identified (1) the most common polypoid-exophytic form, (2) the depressed-ulcerative form, and (3) the least common, that of a stricture from diffuse infiltration. 

Endoscopy cannot assess motility adequately. An oesophagus may appear dilated and amotile, but formal assessment is not possible as the primary wave progression cannot be followed, and the presence of the endoscope may interfere with function. Endoscopists are of course fully aware of this limitation and would not attempt a definitive motility diagnosis. However, some motility disorders will present with symptoms similar to those caused by structural lesions, and a motility cause maybe overlooked. Patients with dysphagia maybe investigated for years before a diagnosis of achalasia (Fig. 4.10) is entertained, which could have been achieved by simple barium swallow. 

Somers S, Stevenson GW, Thompson G (1986) Comparison of endoscopy and barium swallow with marshmallow in dysphagia. J Can Assoc Radiol 37 73-75 Thommesen P (1988) The shape of the duodenal loop. Radiological, physiological and clinical aspects in patients with X-Ray negative dyspepsia. Dan Med Bull 35 537-549... 

Fig. 6.1.16a,b. Barium swallow in this twenty-six-year-old male reveals an appearance reminiscent of achalasia. The true nature of the problem can be discerned from the irregular impression on the gastric fundus caused by a carcinoma (a). Follow-up CT demonstrates evidence of generalised abdominal involvement with widespread ascites. Note the tumour mass at the cardia together with obliteration of the left crus and anterior margin of the aorta... 

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