The esophageal breesophagus is used for contrast-enhanced imaging of the esophagus (food pipe) and esophagogastric junction (junction of the esophagus with the stomach). It is a radiographic imaging modality that allows diagnostic detection of a variety of diseases. Another important element is the assessment of the swallowing act, which is also documented. The method competes with endoscopic examination of the esophagus or stomach during gastroscopy (gastroscopy).
Indications (areas of application)
- Achalasia – dysfunction of the lower esophageal sphincter (esophageal muscles) with the inability to relax; it is a neurodegenerative disease in which nerve cells of the myenteric plexus die. In the final stage of the disease, the contractility of the esophageal muscles is irreversibly damaged, with the result that food particles are no longer transported into the stomach and lead to pulmonary dysfunction by passing into the trachea (windpipe). Typical symptoms of achalasia are: Dysphagia (dysphagia), regurgitation (regurgitation of food), chest pain (chest pain) and weight loss; as a secondary achalasia, it is usually the result of a neoplasia (malignant neoplasm), such as a cardiac carcinoma (gastric inlet cancer).
- Dysphagia (difficulty swallowing).
- Inflammatory processes – for example, in infections or in the context of reflux esophagitis (English : reflux oesophagitis, Gastroesophageal Reflux Disease, GERD), refers to an inflammatory disease of the esophagus (esophagitis), which is caused by the abnormally (unphysiologically) long reflux (reflux) of gastric acid).
- Foreign body
- Hernias – e.g., hiatal hernia (diaphragmatic hernia), sliding back of a portion of the stomach into the thoracic (chest) area
- Control after surgical procedures on the esophagus.
- Esophageal diverticula – bulges in the wall of the esophagus.
- Esophageal stenosis (narrowing of the esophagus).
- Esophagotracheal fistula – non-physiological connection between the trachea and esophagus, resulting from an inflammatory process, for example.
- Esophageal varices – varicose veins of the esophagus caused by a detour of blood in severe liver disease (e.g., cirrhosis) that can lead to life-threatening bleeding.
- Esophageal spasm – cramping of the smooth muscle in the esophageal wall.
- Tumors of the esophagus
- Displacement of the esophagus – e.g., in left ventricular hypertrophy: the pathological enlargement of the left ventricle (e.g., in hypertension – high blood pressure) narrows the esophagus due to its anatomical location.
The procedure
The patient should be fasting on the day of the examination, this is especially true if a gastrointestinal passage is also to be performed. The patient stands during the examination. The contrast medium (usually barium sulfate) is swallowed in the form of a paste or lozenge by the patient after careful instruction in such a way that the act of swallowing can already be documented with the aid of fluoroscopy. If a stenosis (narrowing) is suspected, a thin contrast medium is chosen. Further images are taken in different planes and follow the contrast medium on its way into the stomach. Normally, the images show a contrast medium passage without obstructions, a smooth organ wall with regular longitudinal fold relief, smooth passage through the esophageal sphincter (esophageal sphincter) into the stomach, and normal findings of the surrounding structures such as the thorax (chest) and neck. Documentation is in the form of single images or a digital film sequence. The double contrast technique of esophageal swallowing requires additional measures: Before swallowing the contrast medium, the patient is given an effervescent tablet to swallow with water. This effervescent tablet triggers gas evolution (carbonic acid – negative contrast medium). The contrast medium is then swallowed. Possibly, a drug to inhibit the peristalsis of the esophagus or stomach can be administered (e.g., Buscopan).
