Skip to main content
SpringerLink
Log in

Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

The modified  barium swallow (MBS) study is a videofluoroscopic evaluation of oropharyngeal swallow function. Esophageal imaging is not routinely performed during an MBS, and few guidelines for implementation or interpretation exist. Aims of the current investigation were to (1) delineate the percentage of normal, oropharyngeal, esophageal, and mixed swallowing dysfunction, (2) develop operational definitions for rating our standardization cursory view of esophageal bolus flow, and (3) determine inter-rater reliability between speech pathology (SLP) and physician raters for categorizing esophageal abnormalities. A two-phase retrospective review of 358 patient charts and MBS studies was conducted. Esophageal bolus flow was operationally defined as (1) normal, (2) anatomic abnormality, (3) dysmotility and (4) combined. Descriptive statistics, a Chi square with alpha set at 0.05, and Kappa analysis were performed. Esophageal dysfunction was identified in 80 (26%) patients and included: anatomic abnormality (69%), dysmotility (17%), and combined abnormality (14%). Phase one reliability testing yielded fair agreement between SLP and MD raters k = 0.5. Following revision of definitions and consensus training, phase two reliability testing resulted in excellent agreement between the same raters k = 0.9. Multiphase or primary esophageal dysphagia was found in 26% of our sample using a standardized protocol rating esophageal bolus flow from the upper esophageal sphincter through the lower esophageal sphincter during the MBS. Improved agreement between SLP and MD raters after definition revision and training suggests these operational definitions are concise, objective and reliable. An expanded MBS study may lead to early identification of esophageal disorders, encourage multidisciplinary patient care, and improve patient health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Logemann JA. Manual for the videofluorographic study of swallowing. 1993: Pro-Ed.

  2. Jones B, et al. Pharyngeal findings in 21 patients with achalasia of the esophagus. Dysphagia. 1987;2:87–92.

    Article  CAS  PubMed  Google Scholar 

  3. Borgström PS, Olsson R, Sundkvist G, Ekberg O. Pharyngeal and oesophageal function in patients with diabetes mellitus and swallowing complaints. Br J Radiol. 1987;61(729):817–21.

    Article  Google Scholar 

  4. Montesi A, et al. Oropharyngeal and esophageal function in scleroderma. Dysphagia. 1991;6:219–23.

    Article  CAS  PubMed  Google Scholar 

  5. Mendell DA, Logemann JA. A retrospective analysis of the pharyngeal swallow in patients with a clinical diagnosis of GERD compared with normal controls: a pilot study. Dysphagia. 2002;17(3):220–6.

    Article  PubMed  Google Scholar 

  6. Sivit CJ, et al. Pharyngeal swallow in gastroesophageal reflux disease. Dysphagia. 1988;2:151–5.

    Article  CAS  PubMed  Google Scholar 

  7. Henderson RD, Woolf C, Marryatt G. Pharyngoesophageal dysphagia and gastroesophageal reflux. Laryngoscope. 1976;86(10):1531–9.

    Article  CAS  PubMed  Google Scholar 

  8. Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12:11–8.

    Article  CAS  PubMed  Google Scholar 

  9. Castell JA, et al. Manometric abnormalities of the oesophagus in patients with Parkinson’s disease. Neurogastroenterol Motil. 2001;13:361–4.

    Article  CAS  PubMed  Google Scholar 

  10. Roeder BE, Murry JA, Dierkhising RA. Patient localization of esophageal dysphagia. Dig Dis Sci. 2004;49(4):697–701.

    Article  PubMed  Google Scholar 

  11. Edwards D. Discriminitive information in the diagnosis of dysphagia. JR Coll Phys Lond. 1975;9:257–63.

    CAS  Google Scholar 

  12. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion: is the patient accurate? Dig Dis Sci. 1995;40(10):2192–6.

    Article  CAS  PubMed  Google Scholar 

  13. Smith DF, Ott DJ, Gelfand DW, Chen MY. Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus. Am J Roentgenol. 1998;171:1361–5.

    Article  CAS  Google Scholar 

  14. Farwell DG, et al. Esophageal pathology in patients after treatment for head and neck cancer. Otolaryngol Head Neck Surg. 2010;143(3):375–8.

    Article  PubMed  Google Scholar 

  15. Triadafilopoulos G, et al. Oropharyngeal and esophageal interrelationships in patients with nonobstructive dysphagia. Dig Dis Sci. 1992;37(4):551–7.

    Article  CAS  PubMed  Google Scholar 

  16. Gullung JL, Hill EG, Castell DO, Bonnie Martin-Harris B. Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry. Ann Otol Rhinol Laryngol. 2012;121(11):738–45.

    Article  PubMed  Google Scholar 

  17. Lever TE, et al. The effect of an effortful swallow on the normal adult esophagus. Dysphagia. 2007;22(4):312–25.

    Article  PubMed  Google Scholar 

  18. Malagelada J, et al. World gastroenterology organisation global guidelines: dysphagia—global guidelines and cascades update September 2014. J Clin Gastroenterol. 2015;49(5):370–8.

    Article  PubMed  Google Scholar 

  19. Martin-Harris B, et al. MBS measurement tool for swallow impairment-MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gullung JL, et al. Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry. Ann Otol Rhinol Laryngol. 2012;121(11):738–45.

    Article  PubMed  Google Scholar 

  21. Miles A, et al. Esophageal swallowing timing measures in healthy adults during videofluoroscopy. Ann Otol Rhinol Laryngol. 2016;125(9):764–9.

    Article  PubMed  Google Scholar 

  22. American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders [Knowledge and Skills]. Available from http://www.asha.org/policy.%5D.

  23. Allen JE, et al. Comparison of esophageal screen findings on videofluoroscopy with full esophagram results. Head Neck. 2012;34(2):264–9.

    Article  PubMed  Google Scholar 

  24. Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the videofluoroscopic study of Swallowing. Head Neck Surg. 2015;152(3):488–93.

    Article  Google Scholar 

  25. American College of Radiology. ACR practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults. 2013. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/uppergiadults.pdf. Accessed June 2015.

  26. Miles A. Inter-rater reliability for speech-language therapists’ judgement of oesophageal abnormality during oesophageal visualization. Int J Lang Commun Disord. 2016;52(4):1–6.

    Google Scholar 

  27. Levine MS, Rubesin SE, Laufer IL. Barium studies in modern radiology: do they have a role. Radiology. 2009;250(1):18–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Swallowing Disorders, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA

    Stephanie Watts, Joy Gaziano, John Jacobs & Joel Richter

Authors
  1. Stephanie Watts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joy Gaziano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author Contributions

SW Study concept and design; acquisition of data; drafting of the manuscript; statistical analysis, JG Data analysis, manuscript preparation, JJ Data analysis, JR Study concept and design, study supervision; critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Stephanie Watts.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watts, S., Gaziano, J., Jacobs, J. et al. Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol. Dysphagia 34, 34–42 (2019). https://doi.org/10.1007/s00455-018-09966-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-018-09966-5

Keywords

Search

Navigation