Concurrent Modified Barium Swallow Study and Esophagrams Superior to Either Alone in Diagnosing Dysphagia

by Linda Kossoff •

How often do providers perform both modified barium swallow (MBS) study and esophagrams simultaneously for patients with dysphagia, and does doing so result in better understanding and more accurate treatment?

BOTTOM LINE

Concurrent MBS and esophagrams may improve diagnostic accuracy, but they minimize additional studies.

BACKGROUND: Left untreated, dysphagia is associated with increased morbidity, mortality, and healthcare costs. Although MBS is the favored investigative tool for oropharyngeal dysphagia, it cannot show the esophagus in its entirety or the cardia of the stomach, as esophagrams can. Esophagrams, however, cannot evaluate oropharyngeal dysphagia and carry a relatively high radiation exposure.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

SYNOPSIS: Researchers conducted a retrospective chart review at a single institution and identified 124 patients who underwent concurrent MBS and esophagram between January 2016 and June 2019 as part of their dysphagia evaluation. Ninety of the physicians who ordered concurrent testing were otolaryngologists. After undergoing the procedures, 71.8% of patients had a change from their original diagnosis, with 85.1% of unremarkable MBS or esophagrams paired with abnormal findings in the corresponding esophagram or MBS, respectively. The data suggest that, together, MBS and esophagrams provide superior diagnostic accuracy to either when performed alone. Authors note, however, that MBS and esophagrams may fail to reveal any abnormalities despite continued dysphagic symptomatology or may reveal abnormalities that require further evaluation by other medical specialists and/or additional diagnostic studies such as esophagogastroduodenoscopy or transnasal esophagoscopy. This suggests, they say, that MBS and esophagrams have a synergistic value not only in revealing the pathology underlying dysphagia but also as a screening method to determine if more invasive testing is needed. Study limitations included the small size of the study population.

CITATION: Hawkins D, Cabrera CI, Kominsky R, et al. Dysphagia evaluation: the added value of concurrent MBS and esophagram. Laryngoscope. 2021;131:2666-2670.