Skip to main content
SpringerLink
Log in

Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease

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

A Correction to this article was published on 09 May 2020

This article has been updated

Abstract

Gastroesophageal reflux disease and esophageal dysmotility are common in patients with advanced lung disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.

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

Fig. 1

Similar content being viewed by others

Change history

  • 09 May 2020

    The original version of this article unfortunately contained a mistake. The shared first authorship information was missing in the published article. It has been given below. The first authorship is shared between Dr. Shai Posner and Kurren Mehta

References

  1. Johannson KA, Strambu I, Ravaglia C, Grutters JC, Valenzuela C, Mogulkoc N, Luppi F, Richeldi L, Wells AU, Vancheri C, Kreuter M. Antacid therapy in idiopathic pulmonary fibrosis: more questions than answers? Lancet Resp Med. 2017;5:591–8.

    Article  Google Scholar 

  2. D'Ovidio F, Mura M, Tsang M, Waddell TK, Hutcheon MA, Singer LG, Hadjiliadis D, Chaparro C, Gutierrez C, Pierre A, Darling G, Liu M, Keshavjee S. Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thoracic Cardiovas Surgery. 2005;129:1144–52.

    Article  Google Scholar 

  3. D'Ovidio F, Mura M, Ridsdale R, Takahashi H, Waddell TK, Hutcheon M, Hadjiliadis D, Singer LG, Pierre A, Chaparro C, Gutierrez C, Miller L, Darling G, Liu M, Post M, Keshavjee S. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transplantation : Official J Am Soci Transplant Am Soci Transplant Surgeons. 2006;6:1930–8.

    Article  CAS  Google Scholar 

  4. Fisichella PM, Davis CS, Lowery E, Ramirez L, Gamelli RL, Kovacs EJ. Aspiration, localized pulmonary inflammation, and predictors of early-onset bronchiolitis obliterans syndrome after lung transplantation. J Am College Surgeons. 2013;217:90–100.

    Article  Google Scholar 

  5. Tobin RW, Pope CE, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158:1804–8.

    Article  CAS  Google Scholar 

  6. Elserag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology. 1997;113:755–60.

    Article  CAS  Google Scholar 

  7. Raghu G, Freudenberger TD, Yang S, Curtis JR, Spada C, Hayes J, Sillery JK, Pope CE 2nd, Pellegrini CA. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. European Respiratory J. 2006;27:136–42.

    Article  CAS  Google Scholar 

  8. Seccombe J, Mirza F, Hachem R, Gyawali CP. Esophageal motor disease and reflux patterns in patients with advanced pulmonary disease undergoing lung transplant evaluation. Neurogastroenterology Motility. 2013;25:657–63.

    Article  CAS  Google Scholar 

  9. Basseri B, Conklin JL, Pimentel M, Tabrizi R, Phillips EH, Simsir SA, Chaux GE, Falk JA, Ghandehari S, Soukiasian HJ. Esophageal motor dysfunction and gastroesophageal reflux are prevalent in lung transplant candidates. Annals Thoracic Surgery. 2010;90:1630–6.

    Article  Google Scholar 

  10. D'Ovidio F, Singer LG, Hadjiliadis D, Pierre A, Waddell TK, de Perrot M, Hutcheon M, Miller L, Darling G, Keshavjee S. Prevalence of gastroesophageal reflux in end-stage lung disease candidates for lung transplant. Annals Thoracic Surgery. 2005;80:1254–60.

    Article  Google Scholar 

  11. Posner S, Zheng J, Wood RK, Shimpi RA, Hartwig MG, Chow SC, Leiman DA. Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates. Diseases of the esophagus Official J Int Soc Diseases Esophagus. 2018. https://doi.org/10.1093/dote/dox157.

    Article  Google Scholar 

  12. Sweet MP, Herbella FA, Leard L, Hoopes C, Golden J, Hays S, Patti MG. The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg. 2006;244:491–7.

    PubMed  PubMed Central  Google Scholar 

  13. Tangaroonsanti A, Vela MF, Crowell MD, DeVault KR. Houghton LA Esophageal dysmotility according to Chicago classification v.30 vs v.20: Implications for association with reflux, bolus clearance, and allograft failure post-lung transplantation. Neurogastroenterol Motility Official J Eu Gastrointestinal Motility Society. 2018;30:13296.

    Article  Google Scholar 

  14. Katzka DA. A gastroenterologist's perspective on the role of barium esophagography in gastroesophageal reflux disease. Abdominal radiology (New York). 2018;43:1319–22.

    Article  Google Scholar 

  15. Schima W, Eisenhuber E, Kulinna-Cosentini C (2011) Radiologic evaluation of esophageal function. Dysphagia: Springer, pp 339–357.

  16. Levine MS, Rubesin SE, Laufer IJR. Barium studies in modern radiology: do they have a role? Radiology. 2009;250:18–22.

    Article  Google Scholar 

  17. Mendez BM, Davis CS, Weber C, Joehl RJ, Fisichella PM. Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis. Am J Surg. 2012;204:e21–26.

    Article  Google Scholar 

  18. Seccombe J, Mirza F, Hachem R, Gyawali CJN, Esophageal motor disease and reflux patterns in patients with advanced pulmonary disease undergoing lung transplant evaluation. Neurogastroenterol Motil. 2013;25:657–e508.

    Article  CAS  Google Scholar 

  19. Bello B, Zoccali M, Gullo R, Allaix ME, Herbella FA, Gasparaitis A, Patti MG. Gastroesophageal reflux disease and antireflux surgery-what is the proper preoperative work-up? J Gastrointestinal Surg: Official J Soc Surgery Alimentary Tract. 2013;17:14–20.

    Article  Google Scholar 

  20. Serna-Gallegos D, Basseri B, Bairamian V, Pimentel M, Soukiasian HJ. Gastroesophageal reflux reported on esophagram does not correlate with pH monitoring and high-resolution esophageal manometry. The American surgeon. 2014;80:1026–9.

    Article  Google Scholar 

  21. Halland M, Ravi K, Barlow J, Arora A. Correlation between the radiological observation of isolated tertiary waves on an esophagram and findings on high-resolution esophageal manometry. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 2016;29:22–6.

    Article  CAS  Google Scholar 

  22. O'Rourke AK, Lazar A, Murphy B, Castell DO, Martin-Harris B. Utility of Esophagram versus High-Resolution Manometry in the Detection of Esophageal Dysmotility. Otolaryngology-head Neck Surgery official J Am Academy Otolaryngology-Head and Neck Surgery. 2016;154:888–91.

    Article  Google Scholar 

  23. Posner S, Finn RT, Shimpi RA, Wood RK, Fisher D, Hartwig MG, Klapper J, Reynolds J, Niedzwiecki D, Parish A, Leiman DA. Esophageal contractility increases and gastroesophageal reflux does not worsen after lung transplantation. Dis Esophagus : official journal of the International Society for Diseases of the Esophagus. 2019;32(10):1–8.

    Article  Google Scholar 

  24. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterology Motility. 2015;27:160–74.

    Article  CAS  Google Scholar 

  25. Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5:527–33.

    Article  Google Scholar 

  26. Blonski W, Kumar A, Feldman J, Richter JE. Timed Barium swallow: diagnostic role and predictive value in untreated achalasia, esophagogastric junction outflow obstruction, and non-achalasia dysphagia. Am J Gastroenterol. 2018;113:196–203.

    Article  Google Scholar 

  27. Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJ. Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia. Neurogastroenterol Motility. 2012;24:e364–372.

    Article  CAS  Google Scholar 

  28. Ott DJ, Richter JE, Chen YM, Wu WC, Gelfand DW, Castell DO. Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol. 1987;149:307–11.

    Article  CAS  Google Scholar 

  29. El-Takli I, O'Brien P, Paterson WG. Clinical diagnosis of achalasia: how reliable is the barium x-ray? Can J Gastroenterol. 2006;20:335–7.

    Article  CAS  Google Scholar 

  30. Lacy BE, Weiser K, Chertoff J, Fass R, Pandolfino JE, Richter JE, Rothstein RI, Spangler C, Vaezi MF. The diagnosis of gastroesophageal reflux disease. Am J Medicine. 2010;123:583–92.

    Article  Google Scholar 

  31. Pan JJ, Levine MS, Redfern RO, Rubesin SE, Laufer I, Katzka DA. Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring. Eur J Radiol. 2003;47:149–53.

    Article  Google Scholar 

  32. Hartwig MG, Anderson DJ, Onaitis MW, Reddy S, Snyder LD, Lin SS, Davis RD. Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Annals Thoracic Surgery. 2011;92:462–8.

    Article  Google Scholar 

  33. Sweet MP, Patti MG, Hoopes C, Hays SR, Golden JA. Gastro-oesophageal reflux and aspiration in patients with advanced lung disease. Thorax. 2009;64:167–73.

    Article  CAS  Google Scholar 

  34. Raghu G, Pellegrini CA, Yow E, Flaherty KR, Meyer K, Noth I, Scholand MB, Cello J, Ho LA, Pipavath S, Lee JS, Lin J, Maloney J, Martinez FJ, Morrow E, Patti MG, Rogers S, Wolters PJ, Yates R, Anstrom KJ, Collard HR. Laparoscopic anti-reflux surgery for the treatment of idiopathic pulmonary fibrosis (WRAP-IPF): a multicentre, randomised, controlled phase 2 trial. Lancet Respiratory Medicine. 2018;6:707–14.

    Article  Google Scholar 

  35. Weitzendorfer M, Kohler G, Antoniou SA, Pallwein-Prettner L, Manzenreiter L, Schredl P, Emmanuel K, Koch OO. Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy? European Surgery. 2017;49:210–7.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Richard K. Wood (RKW) and Rahul A. Shimpi (RAS) for their esophageal function test interpretations.

Funding

No grant support was used to fund this research.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27705, USA

    Shai Posner, Deborah A. Fisher & David A. Leiman

  2. Duke University School of Medicine, Duke University, Durham, NC, USA

    Kurren Mehta

  3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Alice Parish & Donna Niedzwiecki

  4. Department of Radiology, Duke University, Durham, NC, USA

    Rajan T. Gupta

  5. Duke Clinical Research Institute, Durham, NC, USA

    Deborah A. Fisher & David A. Leiman

Authors
  1. Shai Posner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kurren Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alice Parish
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donna Niedzwiecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rajan T. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deborah A. Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David A. Leiman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Leiman.

Ethics declarations

Conflict of interest

The authors have no relevant conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Posner, S., Mehta, K., Parish, A. et al. Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease. Dysphagia 35, 864–870 (2020). https://doi.org/10.1007/s00455-020-10113-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-020-10113-2

Keywords

Search

Navigation