How to interpret data:
The esophagus emptying is assessed over time (Fig. 8) with the heights and widths of the barium column.
The barium height (Fig. 9a) is the distance from the distal esophagus (identified by the bird´s beak appearance at the level of LES) to the top of the barium column (at the level at which the barium-foam interface is best defined),
and barium width (Fig. 9b) is the maximum diameter of the barium column,
measured perpendicular to the approximated long axis at its widest point.
When a barium-foam interface forms,
the measure must be done at the superior aspect of the barium column at a point where the margin is consistent and reasonably well defined (Fig. 10).
Fig. 8: Time barium esophagogram in a 29 year old woman with achalasia. Spot film 1,2 and 5 min after patient has ingested barium contrast material.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
Fig. 9: Quantitative analysis. A) The barium height is measured from the the bird´s beak (distal esophagus at the level of LES) to the top of the barium column at the level at which the barium-foam interface is best defined. B)The width is measured perpendicular to the approximated long axis at its widest point.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
Fig. 10: Barium-foam interface. A, B and C, three different cases with barium-foarm interface. The superior aspect of the barium column is measured at a point where the margin is reasonably well defined.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
The 1,2 and 5 minutes (Fig. 11) barium heights and widths are used for analysis of the degree of esophageal emptying and reduction in esophageal diameter (Fig. 12,
Fig. 13 ).
Fig. 11: Interpretation of timed barium esophagogram. Radiographs taken 1, 2 and 5 minutes after ingestion of 100 mL low density barium suspension by an achalasia patient.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
Fig. 12: Evaluation of treatment response. Baseline time barium esophagogram at 1 (A), 2 (B), and 5 minutes (C), shows a dilated esophagus and barium retention. Following Heller Myotomy, same examination (D, E, F) shows near complete esophageal emptying at 5 minutes.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
Fig. 13: Evaluation of treatment response. Baseline time barium esophagogram at 1 (A), 2 (B), and 5 minutes (C), shows the typical imaging findings in a patient with achalasia. Following pneumatic dilation, same examination (D, E, F) shows complete esophageal emptying at 2 minutes. Patient referred complete relief of all symptoms.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX
The percentage of change in this area from the 1 minute to the 5th-minute film is used to determine the degree of esophageal emptying.
A reduction of 50% or greater is indicative of response to treatment (Fig. 14).
Fig. 14: Interpretation of baseline and post myotomy timed barium esophagogram in a patient with achalasia. Shows improvement in esophageal emptying at 5 minutes.
References: Radiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México/MX