Barium Swallow Research Articles

OGC P35 A clinical audit looking at how efficient the current pathways are for detecting upper oesophageal cancer

Abstract Background Dysphagia is a red flag symptom of possible oesophageal cancer. Patients are referred to gastroenterology, Upper GI Surgery or Otolaryngology. The referral pathway is determined by whether the symptoms are thought to be oropharyngeal or oesophageal in nature. Often, correlation between patient’s perception of the level of dysphagia and the anatomical location of the underlying cause is unreliable. This can result in a number of patients receiving either a delayed complete examination of the oesophagus or not receiving one at all. Our aim was to identify potential delays in the diagnostic pathway of patients with suspected upper oesophageal malignancy. Methods A retrospective analysis of 348 patients with a confirmed histological diagnosis of oesophageal cancer between January 2021 – March 2023 was performed. Only patients with cervical oesophageal cancer up to 20cm were included. The time between GP referral and commencement of treatment was compared against NHS England standards. The initial investigation ordered for those patients after being referred to the specialist was reviewed in order to identify any diagnostic delays. According to NICE guidelines, all patients with dysphagia should be referred for oesophago-gastro-duodenoscopy (OGD) urgently. Barium swallow should not be the first line investigation for suspected oesophageal cancer. Results 14 cervical oesophageal cancer cases were identified. 5 cases discussed at UGI Multidisciplinary meeting with incidental diagnosis were excluded. All remaining 9 cases were discussed at both Head and Neck and UGI MDMs. 6/9 patients were first referred to ENT with dysphagia. The remaining 3/9 were referred to either Gastroenterology or UGI. 4/9 patients had OGD whereas 5/9 had barium swallow and 7/9 rigid oesophagoscopy organized by ENT. Interestingly, 4/5 barium swallow tests were the first line investigation. Median interval from GP referral till start of treatment was 108 days which is almost double compared to the standards (62 days). Conclusions This study highlights significant delays in the diagnostic pathway of patients referred from GP with dysphagia and suspected cervical oesophageal cancer. It appears that this group of patients enters a pathway without a clear diagnostic consensus. Patients with red flag dysphagia symptoms for suspected malignancy should have direct visualisation of the oesophagus irrespective of whether the initial assessment occurs within head and neck or upper gastrointestinal suspected cancer pathways.

Changing Roles of a Radiographer in Fluoroscopy:

Fluoroscopic imaging services in Zambia have been available since 1972 when the first equipment was installed at the University Teaching Hospital (UTH). However, there is limited fluoroscopy equipment use due to a critical shortage of radiologists who are traditionally trained to carry out this role. Radiologists work alongside radiographers who provide technical support and patient care. To address the shortage of radiologists, radiographers in the United Kingdom (UK) have explicitly expanded their scope of practice and started performing and reporting on fluoroscopic examinations such as barium swallow, barium meal, small bowel follow-through, barium enema, and videofluoroscopy after undergoing appropriate training. Literature from the UK shows that gastrointestinal (GI) radiographers’ performance is of a high-quality standard. The initiative has been very effective and made a significant contribution to the delivery of fluoroscopic services in that country. Therefore, the aim of this article was to review the literature on role extension for GI radiographers to guide the development and practice of fluoroscopic studies in Zambia. It is anticipated that this article will bring awareness to stakeholders such as the Ministry of Health (MOH), Schools of Radiography, the Radiological Society of Zambia (RSZ), and the Zambia Medical Association (ZMA) on this important subject.

Exploring the neural mechanisms underlying achalasia: A study of functional connectivity and regional brain activity

Background and AimsThe pathophysiology of achalasia, which involves central nuclei abnormalities, remains unknown. We investigated the resting-state functional MRI (rs-fMRI) features of patients with achalasia. MethodsWe applied resting-state functional MRI (rs-fMRI) to investigate the brain features in patients with achalasia (n = 27), compared to healthy controls (n = 29). Focusing on three regions of interest (ROIs): the dorsal motor nucleus of the vagus (DMV), the nucleus ambiguus (NA), and the nucleus of the solitary tract (NTS), we analyzed variations in resting-state functional connectivity (rs-FC), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo). ResultsAchalasia patients demonstrated stronger functional connectivity between the NA and the right precentral gyrus, left postcentral gyrus, and left insula. No significant changes were found in the DMV or NTS. The fMRI analysis showed higher rs-FC values for NA-DMV and NA-NTS connections in achalasia patients. Achalasia patients exhibited decreased fALFF values in the NA, DMV, and NTS regions, as well as increased ReHo values in the NA and DMV regions. A positive correlation was observed between fALFF values in all six ROIs and the width of the barium meal. The NTS fALFF value and NA ReHo value displayed a positive correlation with integrated relaxation pressure (IRP), while the ReHo value in the right precentral gyrus showed an inverse correlation with the height of the barium meal. ConclusionsAbnormal rs-FC and regional brain activity was found in patients with achalasia. Our study provides new insights into the pathophysiology of achalasia and highlights the potential of rs-fMRI in improving the diagnosis and treatment of this condition.

Esophageal Radiography Interpretation: a Primer for the Gastroenterologist.

Radiological studies can be helpful when evaluating patients with suspect esophageal disorders. From benign strictures to malignancy and motility disorders such as achalasia, imaging modalities play a significant role in diagnosis. This review explores the role of different imaging modalities in the most frequently encountered esophageal pathologies. Conventional barium esophagram has long been considered the primary imaging modality of the esophagus. In the same fashion, a timed barium esophagram is a valuable tool in the evaluation of achalasia and esophagogastric junction outlet obstruction. Over the last few decades there has been an increase in CT and MRI studies, which also play a role in the evaluation of esophageal pathologies. However, not infrequently, these newer imaging techniques can result in incidental esophageal findings. It is important that gastroenterologists appreciate the value of different modalities and recognize key imaging features. The diagnosis and management of esophageal disorders is evolving. A basic understanding of esophageal radiology is essential to any gastroenterologist caring for patients with esophageal complaints.

Longitudinal Analysis of Dysphagia and Factors Related to Postoperative Pneumonia in Patients Undergoing Esophagectomy for Esophageal Cancer

AbstractFew studies have quantified longitudinal changes in swallowing in patients undergoing esophagectomy for esophageal cancer. This study longitudinally analyzed the changes in the Modified Barium Swallow Study Impairment Profile (MBSImP™) scores, swallowing kinematic measurements, and swallowing-related symptoms in patients undergoing esophagectomy. We also examined the association between identified swallowing impairment and aspiration pneumonia after surgery. We included consecutive patients who underwent esophagectomy and completed laryngoscopy and videofluoroscopy before, two weeks, and three months after surgery. We analyzed physiological impairments using the MBSImP. We also assessed the swallowing kinematics on a 5 mL thickened liquid bolus at three time points. Vocal fold mobility was assessed using a laryngoscope. Repeated measures were statistically examined for longitudinal changes in swallowing function. The association between the significant changes identified after esophagectomy and aspiration pneumonia was tested. Twenty-nine patients were included in this study. Preoperative swallowing function was intact in all participants. The timing of swallowing initiation and opening of the pharyngoesophageal segment remained unchanged after surgery. Tongue base retraction and pharyngeal constriction ratio worsened two weeks after surgery but returned to baseline levels three months after surgery. Three months after surgery, hyoid displacement and vocal fold immobility did not fully recover. Aspiration pneumonia occurred in nine patients after surgery and was associated with postoperative MBSImP pharyngeal residue scores. Decreased hyoid displacement and vocal fold immobility were observed postoperatively and persisted for a long time. The postoperative pharyngeal residue was associated with pneumonia and thus should be appropriately managed after surgery.

Endoscopic pressure study integrated system for the diagnosis of achalasia.

The endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia. This case-control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high-resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24-h pH-impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP-Max), pressure difference, and the gradient of the waveform. All patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP-Max demonstrated the best diagnostic accuracy for achalasia, with a cut-off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut-off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76). This study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.

Assessing mechanical function of peristalsis with functional lumen imaging probe panometry: Contraction power and displaced volume.

The distal contractile integral (DCI) quantifies the contractile vigor of primary peristalsis on high-resolution manometry (HRM), whereas no such metric exists for secondary peristalsis on functional lumen imaging probe (FLIP) panometry. This study aimed to evaluate novel FLIP metrics of contraction power and displaced volume in asymptomatic controls and a patient cohort. Thirty-five asymptomatic controls and adult patients (with normal esophagogastric junction outflow/opening and without spasm) who completed HRM and FLIP panometry were included. The patient group also completed timed barium esophagram (TBE). Contraction power (estimate of esophageal work over time) and displaced volume (estimate of contraction-associated fluid flow) were computed from FLIP. HRM was analyzed per Chicago Classification v4.0. In controls, median (5th-95th percentile) contraction power was 27 mW (10-44) and displaced volume was 43 mL (17-66). 95 patients were included: 72% with normal motility on HRM, 17% with ineffective esophageal motility (IEM), and 12% with absent contractility. Among patients, DCI was significantly correlated with both contraction power (rho = 0.499) and displaced volume (rho = 0.342); p values < 0.001. Both contraction power and displaced volume were greater in patients with normal motility versus IEM or absent contractility, complete versus incomplete bolus transit, and normal versus abnormal retention on TBE; p values < 0.02. FLIP panometry metrics of contraction power and displaced volume appeared to effectively quantify peristaltic vigor. These novel metrics may enhance evaluation of esophageal motility with FLIP panometry and provide a reliable surrogate to DCI on HRM.

Protocol for an international multicenter randomized controlled trial assessing treatment success and safety of peroral endoscopic myotomy vs endoscopic balloon dilation for the treatment of achalasia in children.

Achalasia is a rare neurodegenerative esophageal motility disorder characterized by incomplete lower esophageal sphincter (LES) relaxation, increased LES tone and absence of esophageal peristalsis. Achalasia requires invasive treatment in all patients. Conventional treatment options include endoscopic balloon dilation (EBD) and laparoscopic Heller's myotomy (LHM). Recently, a less invasive endoscopic therapy has been developed; Peroral Endoscopic Myotomy (POEM). POEM integrates the theoretical advantages of both EBD and LHM (no skin incisions, less pain, short hospital stay, less blood loss and a durable myotomy). Our aim is to compare efficacy and safety of POEM vs. EBD as primary treatment for achalasia in children. This multi-center, and center-stratified block-randomized controlled trial will assess safety and efficacy of POEM vs EBD. Primary outcome measure is the need for retreatment due to treatment failure (i.e. persisting symptoms (Eckardt score > 3) with evidence of recurrence on barium swallow and/or HRM within 12 months follow-up) as assed by a blinded end-point committee (PROBE design). This RCT will be the first one to evaluate which endoscopic therapy is most effective and safe for treatment of naïve pediatric patients with achalasia.

THU232 Genetic Study In A Series Of 29 Triple A Syndrome Patients From 19 Sudanese Families - Identification Of Two Novel AAAS Mutations

Abstract Disclosure: K. Koehler: None. F. Quitter: None. D. Landgraf: None. E. Streiff: None. M.A. Abdullah: None. S.S. Hassan: None. A. Huebner: None. S.A. Musa: None. Triple A syndrome (MIM*231550) is a rare autosomal recessive multisystemic disorder characterized by adrenal insufficiency, achalasia, alacrima and neurologic impairments. It is caused by defects in the nucleoporin ALADIN due to mutations in the encoding AAAS gene. We report the genetic and clinical data of triple A syndrome in a series of Sudanese children treated at the Gaafar Ibn Auf Children’s Tertiary Hospital, the largest children's referral hospital in Sudan. The initial diagnosis of triple A syndrome was based on pathognomonic clinical signs and symptoms. Furthermore, early morning serum cortisol levels below the reference range (&amp;lt;6 μg/dl) with high ACTH levels (&amp;gt;100 pg/ml) and/or cortisol below 500 nmol/l in an ACTH stimulation test as well as pathological barium swallow and Schirmer-test were criteria for diagnosis. The medical diagnosis was finally confirmed by mutation detection in the AAAS gene.We genetically investigated 19 families including 29 patients with clinically diagnosed triple A syndrome. We identified six different AAAS mutations mainly in a homozygous form including three nonsense mutations, one frameshift mutation leading to a truncated protein and two splice defects, among them the North African founder mutation c.1331+1G&amp;gt;A (intron 14) in 32 % (6 families). An 8 bp-deletion at the junction of exon 4/intron 4 in two families is a novel, yet undescribed mutation (c.394_399+2delCTGTCTGT). As this mutation destroys a donor splice site, it results in alternative splicing skipping exon 4, altering the protein sequence after amino acid E102 and leading to a premature stop codon shortly after. This is most likely associated with functional impairment of the truncated ALADIN protein. The second novel AAAS mutation is a 1 bp-deletion in exon 9 in three families, which results in a frameshift at amino acid tryptophan 284 and consequently a premature stop codon at position 7 of the new reading frame (c.852_852delG, p.Trp284Cysfs*7, or shortly p.W284fs). The most frequent mutation in this large Sudanese patient series was a previously described mutation in exon 9 (c.934C&amp;gt;T, p.Arg312*) present in 37 % (seven families).Genotype/phenotype analyses revealed a highly variable occurrence of the three main symptoms, age of onset and severity of the disease between patients with the same AAAS mutation and even within one family. The rate of 95 % mutations in a homozygous form reflects the high rate of consanguinity in the Sudanese population.In summary, triple A syndrome seems to be an underdiagnosed disease outside a specialized paediatric endocrinological department in Sudan as many cases presented late with adrenal crises. An early molecular genetic diagnosis, e.g. in siblings, can be important to avoid hypoglycaemic crises with a potential lethal outcome. Presentation: Thursday, June 15, 2023

SAT539 Thyroid Cancer Presenting as Aspiration Pneumonia

Abstract Disclosure: S. Aslam: None. M. Asif: None. I. Nadeem: None. W.J. Khan: None. Background Goiter, most often, is first noticed as a visible neck mass; however, some patients may present with signs and symptoms of hypothyroidism, or hyperthyroidism. Retrosternal extension can cause compression of the trachea, esophagus, and jugular veins resulting in dysfunction of these viscera. CaseA 68-year-old male presented with SOB, and weakness for 5 days. He had SaO2 79% on room air requiring oxygen, RR 28/min, HR 78/min and Temp.101.6 F, BP 94/48 mmHg. The lung exam revealed bilateral rhonchi and coarse crypts. Minimal non-tender nodularity was noted on the thyroid palpation not previously noticed by the patient or his family. Chest x-ray showed bilateral airspace opacities. CT chest revealed a large upper mediastinal mass displacing the trachea and esophagus to the right, a nodule in the left lobe of thyroid, subcarinal and right hilar lymphadenopathy and bilateral dependent consolidative opacities suggesting aspiration pneumonia but no PE. A barium esophagogram showed a 7.5 cm mediastinal mass causing 50% narrowing and displacement of esophagus and compression with left sided deviation of trachea. A barium swallow study was done, and the patient was found to have aspiration with all administered food types due to an abnormal swallowing mechanism. The patient was advised NPO and placed on NG tube feeding to prevent further aspiration. The patient underwent bronchoscopy and EBUS from station 4 lymph node, the pathology of which did not show any malignant cells. However, due to high clinical suspicion of a malignant process, the patient underwent a CT-guided biopsy of the mediastinal mass that showed bland thyroid tissue. Ultrasound of thyroid revealed multiple right and left lobe nodules. TSH and free T4, and calcitonin were WNL. The patient's hypoxia and fever resolved after completion of the antibiotics including ceftriaxone and doxycycline and being nothing per oral within 7 days. Due to persistent dysphagia, he was placed on PEG tube feeding and discharged from the hospital to a nursing home. The patient underwent ultrasound-guided fine needle biopsy of 1 right-sided and 2 left-sided thyroid nodules that resulted as papillary thyroid cancer. He underwent a successful right-sided thoracotomy and removal of large sized thyroid mass. The patient is seeing endocrinology as an outpatient for radioactive iodine and hormone replacement therapy. Conclusion We treated a patient of follicular carcinoma who presented with extrathyroidal symptoms. Retrosternal or ectopic thyroid tumors can present as euthyroid state without obvious enlargement of the normal thyroid gland. A meticulous clinical evaluation should include the differential diagnosis of retrosternal goiter or ectopic thyroid with cancer when treating patients who preset with sign and symptoms concerning for mediastinal disease. Presentation Date: Saturday, June 17, 2023

S591 Utility of the Esophageal Screen During Modified Barium Swallow Study to Identify Esophageal Transit Abnormalities

S591 Utility of the Esophageal Screen During Modified Barium Swallow Study to Identify Esophageal Transit Abnormalities

S583 The Diagnostic Value of Reflux Seen on a Barium Swallow Compared to Ambulatory Reflux Monitoring in Symptomatic Patients

S583 The Diagnostic Value of Reflux Seen on a Barium Swallow Compared to Ambulatory Reflux Monitoring in Symptomatic Patients

Comparison of clinical value and diagnostic rate between barium meal radiography and spectral CT scan in the diagnosis and treatment of gastric cancer and benign gastric tumor

Comparison of clinical value and diagnostic rate between barium meal radiography and spectral CT scan in the diagnosis and treatment of gastric cancer and benign gastric tumor

Diagnostic Accuracy Of Barium Swallow For Dysphagia, Keeping Rigid Esophagoscopy As The Gold Standard

Objective: To determine the diagnostic accuracy of Barium Swallow in detection of patients presenting with dysphagia.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Study Setting &amp; Duration: Department of Otorhinolaryngology, Head &amp; Neck Surgery, District Headquarter Hospital Rawalpindi from 01-09- 2022 to 01-03-2023.&#x0D; Materials and Methods: Approval of the study was obtained from the Hospital Ethical Committee. A total of 111 patients both male and female patients were selected. The patients suffering from dysphagia as per operational definitions and who have reported for work-up to the Department of ENT, District Headquarters Hospital, Rawalpindi, and fulfill the complete inclusion and exclusion criteria, were selected. Informed consent was obtained from all the patients. Patients were selected by consecutive non-probability sampling technique. The data was analyzed using SPSS 24.&#x0D; Results: A total of 111 patients were included in this study. The mean age of these patients was 50.79 ± 13.01 years, ranging from 28 to 70 years. The frequency distribution of females 70.27 % was found to be more than that of males 29.73 %. Majority of patients' barium swallow (74.77%) revealed pathologies, while only a small percentage of patients (25.23%) had normal barium swallow. Most of patients (87.39%) had pathologies found during rigid esophagoscopy, while just a small number (12.61%) had normal rigid esophagoscopy. Comparing both investigating tools, esophagoscopy discovered 87.39% of pathologies while Barium swallow detected 74.77%, indicating that esophagoscopy was a more accurate procedure. Patients had esophageal web 55 (25.2%) on barium swallow and 69 (62.2%) on the Rigid esophagoscopy. Barium Swallow had esophageal stricture 28 (52.2) and no Pathology was detected in 28 (25.2 %) patients. As well as Rigid esophagoscopy had esophageal growth13 (11.7), esophageal stricture 15 (13.5), and no Pathology was detected in 14 (12.6 %). Rigid esophagoscopy is more efficient in detecting esophageal pathology than Barium Swallow. In Barium swallows most patients had esophageal web 55 (25.2%) than the esophageal stricture 28 (52.2) and no pathology was detected 28 (25.2). In rigid esophagoscopy most patients had esophageal web 69 (62.2%) than the esophageal growth13 (11.7), esophageal stricture 15 (13.5) and no pathology detected 14 (12.6).&#x0D; Conclusion: A range of diseases are associated with dysphagia can be found in patients. Two often used diagnostic methods are barium swallow and rigid esophagoscopy. Both Barium swallow and Rigid esophagoscopy are successful in the diagnosis of esophageal cancer. The use of a Rigid esophagoscopy is still a gold standard diagnostic and therapeutic tool for upper aerodigestive tract pathologies.

Factors Influencing Laryngeal Vestibular Closure in Healthy Adults.

Our study aims were (a) to examine laryngeal vestibular closure (LVC) temporal measures in healthy adults across tasks used in the Modified Barium Swallow Impairment Profile (MBSImP) protocol to establish normative reference values and (b) to examine influences of age, gender, and swallow task on LVC temporal measures. A retrospective analysis of 195 healthy adults (85 men, 110 women; age range: 21-89 years) who participated in a videofluoroscopic swallowing study was completed. Seven swallow tasks of standardized viscosities and volumes, as per the MBSImP protocol, were analyzed to measure time-to-LVC and LVC duration (LVCd). Descriptive statistics were employed for all measures of interest. Regression modeling was used to explore relationships between LVC temporal measures (time-to-LVC, LVCd) with age, gender, and swallow task. The relationship between time-to-LVC and LVCd was also explored. Significant findings included an increasing trend in LVCd across age (older individuals had a longer LVCd), with women demonstrating a greater increase. Related to viscosity, LVCd was significantly shorter for pudding compared to thin liquid. Furthermore, when compared to 5-ml tasks, LVCd was significantly longer in cup tasks, while time-to-LVC was significantly shorter. An association was also observed between time-to-LVC and LVCd: As time-to-LVC decreased, LVCd increased. LVCd was influenced by age, gender, and swallow task. Longer time-to-LVC was observed in older individuals, particularly older women, and with thin liquids. Study findings contribute to adult normative reference values for LVC temporal measures (time-to-LVC and LVCd) across MBSImP swallowing tasks. https://doi.org/10.23641/asha.24126432.

87 Infant Malrotation with Midgut Volvulus Presenting in the Paediatric Emergency Department or the Neonatal Intensive Care Unit: A Retrospective Review for a Quality Improvement Initiative

Abstract Background In neonates, bilious vomiting is considered malrotation with midgut volvulus (MV) until proven otherwise, given its associated high morbidity and mortality. The diagnosis is time-critical, requiring prompt identification to avoid complications. Many of these patients are described as clinically well at time of presentation, possibly delaying definitive management. Objectives This study was a retrospective quality initiative aimed to evaluate the clinical presentation of infants and children with MV in a single paediatric tertiary care centre emergency department (ED) and neonatal intensive care unit (NICU). The study also aimed to identify delays in the management pathway. Design/Methods Patients with a final diagnosis of MV presenting to the ED/NICU were identified between January 2015 and May 2022. Patient demographics, signs and symptoms at presentation, initial laboratory studies, imaging, and surgical findings were recorded. The following time points were recorded: (1) first medical evaluation, (2) radiologic investigations (abdominal X-ray [AXR], ultrasound [US], upper gastrointestinal radiography [UGI]), (3) consultation with surgical team, and (4) time to surgery. Results During the study period, 29 paediatric patients presented a diagnosis of MV (ED: 21, NICU: 8). The median age at presentation was 7 days (3-13.5), with 27/29 (93%) being less than 3 months. From them, 21 patients (72%) were male. Bilious green (17/26) and/or yellow (13/26) vomiting was the most frequent presentation in 26/26 (100%), the three other patients had missing data. Five patients (17%) had a pH &amp;lt; 7.30 (with base deficit &amp;lt; -5) and seven (24%) patients had a glucose value &amp;gt; 7 mmol/L. Abdominal radiograph was performed in 17/29 (59%) patients. All (100%) had ultrasound (US) which was diagnostic in 24/29 (83%) cases. Six upper gastrointestinal series (UGI) were performed, being diagnostic in all cases (100%). The Ladd’s procedure was the standard treatment for every patient (100%). Median time between arrival and US was 151 minutes (71 – 243), UGI was 347 min (246 – 800) and surgery was 299 minutes (204-371). In the NICU specifically, six cases were referrals, with the median time between the first documented bilious vomit and the call from the referral centre being 660 minutes (335-1104). Of the 29 cases, 27 (93%) survived and from them, one suffered a short bowel complication. Conclusion Bilious (green/yellow) vomiting is a reliable clinical sign of MV in infants, being always aware that yellow may be bile. Ultrasound is a rapid test with more than 80% diagnostic accuracy. Delay for definitive surgery was considered slightly high. This quality initiative will help develop a clinical practice guideline and algorithm to reduce delays for infants presenting with MV.

Videofluoroscopic analysis of the laryngeal movement of older adults in swallowing.

Even without diseases that cause dysphagia, physiological swallowing function declines with age, increasing the risk of aspiration. This study analyzed age-related changes in laryngeal movement in older adults. The study population consisted of 10 volunteers in their 80s and six in their 20s. A videofluoroscopic study of 3 and 10mL barium swallows was performed laterally using a digital fluorographic. The recorded images were retrieved to a personal computer and analyzed frame-by-frame using video analysis software. The movement of the larynx during swallowing, barium's pharyngeal transit time (PTT), and laryngeal elevation delay time (LEDT) were analyzed. Results were compared between the 20s and 80s age groups using statistical analyses. The PTT was shorter in the 20s than in the 80s age group. The PTT was significantly longer in the 80s group than in the 20s for both 3 and 10mL barium swallows. LEDT in the 80s was statistically significantly longer than that in the 20s for the 10ml barium. No statistically significant differences were found; however, there was a tendency for the 80s group to have more types of laryngeal movement velocity peaks. In this study, LEDT was prolonged in the 80s with 10ml barium swallowing than in the 20s. Two peak patterns of laryngeal elevation during swallowing were observed. The velocity peaks showed a two-peak pattern when the patients were in their 80s and when the barium volume was tested at 10mL. Our results suggest that aging's effect on swallowing relates to laryngeal elevation.

Unraveling Functional Dysphagia: A Game-Changing Automated Machine-Learning Diagnostic Approach

(1) Background: Dysphagia affects around 16% of the US population. Diagnostic tests like X-ray barium swallow and endoscopy are used initially to diagnose the cause of dysphagia, followed by high-resolution esophageal manometry (HRM). If the above tests are normal, the patient is classified as functional dysphagia (FD), suggesting esophageal sensory dysfunction. HRM records only the contraction phase of peristalsis, not the distension phase. We investigated the utilization of esophageal distension–contraction patterns for the automatic classification of FD, using artificial intelligent shallow learners. (2) Methods: Studies were performed in 30 healthy subjects and 30 patients with FD. Custom-built software (Dplots 1.0) was used to extract relevant esophageal distension–contraction features. Next, we used multiple shallow learners, namely support vector machines, random forest, K-nearest neighbors, and logistic regression, to determine which had the best performance in terms of accuracy, precision, and recall. (3) Results: In the proximal segment, LR produced the best results, with accuracy of 91.7% and precision of 92.86%, using only distension features. In the distal segment, random forest produced accuracy of 90.5% and precision of 91.1% using both pressure and distension features. (4) Conclusions: Findings emphasize the crucial role of abnormality in the distension phase of peristalsis in FD patients.

Esophageal Motility Disorders - What's New?

Esophageal motor disorders are an important cause of dysphagia but can also be associated with retrosternal pain and heartburn as well as regurgitation. In extreme cases, patients are not able to eat appropriately and lose weight. Repetitive aspiration can occur and may cause pulmonological complications. Achalasia represents the most important and best-defined esophageal motor disorder and is characterized by insufficient relaxation of the lower esophageal sphincter in combination with typical disturbances of esophageal peristalsis. Additional defined motor disorders are distal esophageal spasm, hypercontractile esophagus, absent contractility and ineffective peristalsis. Patients with appropriate symptoms should primarily undergo esophagogastroduodenoscopy for exclusion of e.g., tumors and esophagitis. Esophageal high-resolution manometry is the reference method for diagnosis and characterization of motor disorders in non-obstructive dysphagia. An esophagogram with barium swallow may deliver complementary information or may be used if manometry is not available. Balloon dilatation and Heller myotomy are long established and more or less equally effective therapeutic options for patients with achalasia. Peroral endoscopic myotomy (POEM) enhances the therapeutic armamentarium for achalasia and hypertensive/spastic motor disorders since 2010. For hypotensive motor disorders, which may occur as a complication of e.g., rheumatological diseases or idiopathically, therapeutic options are still limited.

Capsule Endoscopy in Inflammatory Bowel Disease: A Systematic Review

AbstractThe role of video capsule endoscopy (VCE) in inflammatory bowel disease (IBD) has evolved from small bowel to a panenteric evaluation tool over the past two decades. We systematically reviewed the techniques, applications, outcomes, and complications of VCE in IBD. A systematic literature search was performed using PubMed, Embase, and Medline. All relevant original articles involving VCE in IBD were included from 2003 to July 2022. After screening 3,089 citations, finally 201 references were included. The diagnostic yield of VCE in suspected Crohn's disease (CD) was highly variable (6–80%) with excellent sensitivity (77–93%) and specificity (80–89%). The diagnostic yield in known CD was 52 to 88.3% leading to a change in management (26–75%) and disease reclassification with variable retention rates. VCE was superior to small bowel series, computed tomography (CT) and could be better than magnetic resonance enterography (MRE), especially for proximal and superficial lesions. Colon or panenteric VCE has strong correlation to ileo-colonoscopy (IC) and combined magnetic resonance imaging and IC, respectively. The VCE retention rate in CD is higher in known CD which significantly decreases after the negative patency capsule test or CT/MRE. VCE can identify lesions beyond the reach of IC in postoperative CD. Colon Capsule Endoscopy is a noninvasive monitoring tool in ulcerative colitis (UC) having a strong correlation with IC and may uncover small bowel involvement. VCE is specifically useful in IBD-unclassified (IBD-U) which can lead to the diagnosis of CD in 16.7 to 61.5%. Various scoring systems have been established and validated for small bowel CD (Lewis score and capsule endoscopy CD activity index—CECDAI), UC (capsule scoring of UC: Capsule Scoring of Ulcerative Colitis), panenteric evaluation (Capsule Endoscopy Crohn's Disease Activity Index, Elaikim score), and flare prediction (APEX score). Technological advances include double head, three-dimensional reconstruction, sampling system, panoramic view (344 and 360 degree lateral), and panenteric capsule. Artificial intelligence and software like TOP100 and Quickview can help reduce capsule reading time with excellent sensitivity and specificity. VCE in IBD has widespread application in suspected and known small bowel CD, monitoring of UC, postoperative CD, IBD-U, and for panenteric evaluation. Patency capsule testing helps to reduce retention rates significantly. Artificial intelligence and technical advances can help evolve this novel technology.