Pharyngeal manifestations of gastroesophageal reflux disease.

This article discusses the extraesophageal manifestations of gastroesophageal reflux disease, focusing primarily on the gamut of pharyngeal abnormalities that can be detected on barium swallows. Abnormalities of pharyngeal swallowing caused by gastroesophageal reflux are illustrated. We particularly emphasize how pharyngoesophageal relationships can guide the radiologist for performing tailored barium swallows to optimally evaluate pharyngeal abnormalities in patients with underlying gastroesophageal reflux disease.

Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings.

Objective: To determine the clinical, radiographic, and endoscopic findings of sleeve stenosis after sleeve gastrectomy and to correlate treatment with outcomes.

Methods: We identified 43 patients who underwent barium studies to evaluate upper GI symptoms after laparoscopic sleeve gastrectomy. The clinical, radiographic, and endoscopic findings were reviewed and correlated with treatment and outcomes.

Hyperirritable stomach as a cause of obstructive symptoms after sleeve gastrectomy: clinical and radiographic findings.

Purpose: To characterize clinical and radiographic features of a hyperirritable stomach after sleeve gastrectomy.

Materials/methods: Radiology reports revealed that 10/76 patients (13%) with obstructive symptoms after sleeve gastrectomy had a hyperirritable stomach.

Results: All 10 patients presented with nausea, vomiting, and/or regurgitation.

Diseases of the esophagus: a pattern approach.

The esophagus may be involved by a variety of morphologic abnormalities, including nodules and plaques, ulceration, distal esophageal strictures and rings, upper or midesophageal strictures, and diffuse narrowing (also known as a small-caliber esophagus). The use of a pattern approach for evaluating esophageal disease on barium studies facilitates diagnosis of a host of pathologic conditions associated with these morphologic abnormalities. This article therefore presents an approach for diagnosing esophageal disease on barium studies that emphasizes the radiographic and clinical features used to differentiate the underlying causes of disease and the diagnostic pitfalls associated with performing and interpreting these studies.

History and Evolution of the Barium Swallow for Evaluation of the Pharynx and Esophagus.

This article reviews the history of the barium swallow from its early role in radiology to its current status as an important diagnostic test in modern radiology practice. Though a variety of diagnostic procedures can be performed to evaluate patients with dysphagia or other pharyngeal or esophageal symptoms, the barium study has evolved into a readily available, non-invasive, and cost-effective technique that can facilitate the selection of additional diagnostic tests and guide decisions about medical, endoscopic, or surgical management. This article focuses on the evolution of fluoroscopic equipment, radiography, and contrast media for evaluating the pharynx and esophagus, the importance of understanding pharyngoesophageal relationships, and major advances that have occurred in the radiologic diagnosis of select esophageal diseases, including gastroesophageal reflux disease, infectious esophagitis, eosinophilic esophagitis, esophageal carcinoma, and esophageal motility disorders.

Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease.

Objective: The Society of Abdominal Radiology established a panel to prepare a consensus statement on the role of barium esophagography in gastroesophageal reflux disease (GERD), as well as recommended techniques for performing the fluoroscopic examination and the gamut of findings associated with this condition.

Conclusion: Because it is an inexpensive, noninvasive, and widely available study that requires no sedation, barium esophagography may be performed as the initial test for GERD or in conjunction with other tests such as endoscopy.

Esophageal Lichen Planus: Clinical and Radiographic Findings in Eight Patients.

Objective: The purpose of this study is to present the clinical and radiographic findings of esophageal lichen planus.

Materials And Methods: A search of computerized medical records identified 15 patients with pathologic findings of esophageal lichen planus on endoscopic biopsy specimens. Three other patients had presumed esophageal lichen planus, although no biopsy specimens were obtained.

Findings of Esophagography for 25 Patients After Peroral Endoscopic Myotomy for Achalasia.

Objective: The purpose of this study is to better characterize the findings of esophagography after peroral endoscopic myotomy for achalasia.

Materials And Methods: We evaluated 25 patients who underwent peroral endoscopic myotomy for achalasia. The findings noted on pre- and postprocedural esophagrams were reviewed retrospectively and were correlated with clinical outcomes.

Elevated Z line: a new sign of Barrett's esophagus on double-contrast barium esophagograms.

We describe an elevated Z line as a new radiographic sign of Barrett's esophagus characterized by a transversely oriented, zigzagging, barium-etched line extending completely across the circumference of the midesophagus. An elevated Z line is rarely seen in other patients, so this finding should be highly suggestive of Barrett's esophagus on double-contrast barium esophagograms. If the patient is a potential candidate for surveillance, endoscopy and biopsy should be performed to confirm the presence of Barrett's esophagus.

Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass.

Aim: To determine the utility of barium studies for detecting abnormalities responsible for recurrent weight gain after gastric bypass surgery.

Methods: A computerized search identified 42 patients who had undergone barium studies for recurrent weight gain after gastric bypass and 42 controls. The images were reviewed to determine the frequency of staple-line breakdown and measure the length/width of the pouch and gastrojejunal anastomosis.

Comparison of small bowel follow through and abdominal CT for detecting recurrent Crohn's disease in neoterminal ileum.

Purpose: To assess the findings of recurrent Crohn's disease in the neoterminal ileum on small bowel follow through (SBFT) and computed tomography (CT) as well as the overall diagnostic performance of these imaging tests.

Methods: Our radiology database yielded 52 patients with an ileocolic anastomosis for Crohn's disease who underwent SBFT and CT. The images were reviewed to determine the sensitivity, specificity, PPV, and NPV for individual findings of recurrent Crohn's disease in the neoterminal ileum.

Comparison between esophagography and chest computed tomography for evaluation of leaks after esophagectomy and gastric pull-through.

Purpose: To assess the diagnostic performance of esophagography and chest computed tomography (CT) for detecting leaks after esophagectomy and gastric pull-through.

Materials And Methods: Our database revealed 29 patients who had undergone esophagography and chest CT after esophagectomy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for postoperative leaks were determined for esophagography and CT, separately and combined, on the basis of a retrospective image review.

Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients.

Aim: To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.

Methods: A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.

The small-caliber esophagus: radiographic sign of idiopathic eosinophilic esophagitis.

Purpose: To evaluate a small-caliber esophagus at barium esophagography with idiopathic eosinophilic esophagitis (IEE) and determine if there is a useful threshold diameter for suggesting this diagnosis.

Materials And Methods: The institutional review board approved this retrospective study and waived informed consent. This study was HIPAA compliant.

Feline esophagus and gastroesophageal reflux.

Objective: The purposes of this study were to reassess the relation between a feline esophagus (transient transverse esophageal folds) and gastroesophageal reflux (GER) and to determine whether a feline esophagus is observed more often during swallowing or during reflux of barium.

Materials And Methods: A computerized search of double-contrast esophagrams was performed to generate four equal groups of 56 patients with marked, moderate, mild, and no GER. The imaging findings were reviewed to determine the frequency of a feline esophagus in these groups and whether this sign was detected during swallowing or reflux of barium.

Utility of routine barium studies after adjustments of laparoscopically inserted gastric bands.

Objective: The purposes of this study were to assess the utility of barium studies after adjustments of laparoscopically inserted gastric bands and to identify a threshold stomal diameter for predicting which bands should be loosened because of excessive tightening.

Materials And Methods: A total of 246 patients with laparoscopically inserted adjustable gastric bands underwent 668 routine band adjustments and barium studies after each adjustment. Forty-one barium studies of 30 patients with tight bands necessitating readjustment were compared with barium studies of 41 patients acting as controls.

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients.

The aim of this study was to reassess the clinical and radiographic findings in a series of patients with gastric bezoars. Radiology files revealed 19 patients with bezoars; 10 patients had CT and 10 had endoscopy before or after the barium studies. 11 patients (58%) had risk factors for gastroparesis and 6 (32%) had had previous gastric surgery, including 3 having had a gastric bypass or vertical banded gastroplasty.

Energy absorption is reduced with oleic acid supplements in human short bowel syndrome.

Background: Oleic acid premeal supplements have been described as a method to trigger the ileal brake and thus lengthen transit time and the opportunity for nutrient absorption. The aims of this study were to determine whether oleic acid supplements would lengthen transit time and improve absorption of nutrients in study participants with short bowel syndrome as well as affect diarrhea or patient weight.

Methods: A double-blind, controlled, random-order crossover trial was conducted in 8 study participants with longstanding and severe short bowel syndrome, employing blue food color appearance, breath hydrogen testing, and radio-opaque markers as measures of transit time.

Pattern approach for diseases of mesenteric small bowel on barium studies.

Despite an array of sophisticated imaging techniques, the barium examination remains a valuable diagnostic test for evaluating structural abnormalities of the small bowel. Most patients can be examined with conventional small-bowel follow-through studies, in which periodic imaging of the entire small bowel is performed by using fluoroscopic guidance; however, some patients may benefit from enteroclysis, in which contrast agents are instilled into the small bowel via a catheter placed in the proximal jejunum for optimal distention and better depiction of individual small-bowel loops. This review for residents discusses the major diseases involving the mesenteric small bowel and presents a pattern approach for the wide spectrum of abnormalities found on barium studies, including polypoid lesions, cavitated lesions, annular lesions, outpouchings, separation of loops, abnormal folds, nodules without abnormal folds, and dilated small bowel.

Chronic diverticulitis: clinical, radiographic, and pathologic findings.

Objective: The purpose of our study is to present a series of 14 patients with chronic diverticulitis on barium enema examinations and to correlate the radiographic findings with the clinical and pathologic findings in these patients.

Conclusion: Chronic diverticulitis is a distinct pathologic entity characterized by the frequent development of chronic obstructive symptoms and abdominal pain rather than the classic clinical findings of acute sigmoid diverticulitis. Barium enema examinations usually reveal a relatively long segment of circumferential narrowing in the sigmoid colon with a spiculated contour and tapered margins, sometimes associated with retrograde obstruction.

Hyperirritable stomach as a cause of nausea and vomiting: clinical and radiographic findings.

Objective: The purpose of our study was to characterize the clinical and radiographic features of the hyperirritable stomach and to determine if it is associated with extraintestinal causes of nausea and vomiting in the absence of gastric outlet obstruction, gastroparesis, or intestinal obstruction or ileus.

Conclusion: The hyperirritable stomach was characterized on barium studies in 15 patients by rapid emesis of ingested barium, a collapsed stomach with little or no retained debris or fluid, and normal emptying of residual barium into nondilated duodenum and proximal jejunum. Fourteen (93%) of these 15 patients had extraintestinal causes of nausea and vomiting, and 13 (93%) of 14 with clinical follow-up had marked improvement or resolution of symptoms after treatment.

Jejunal diverticulosis: findings on CT in 28 patients.

Objective: The purpose of our study was to better characterize the CT findings of jejunal diverticulosis by retrospectively reviewing abdominal CT scans of 28 patients with this condition on barium examinations.

Conclusion: Jejunal diverticula have characteristic findings on CT, appearing as discrete round or ovoid, contrast-, fluid-, or air-containing structures outside the expected lumen of the small bowel, with a smooth, barely discernible wall and no recognizable small-bowel folds. Not infrequently, these structures are seen to communicate directly with an adjoining small-bowel loop, a feature best recognized by scrolling the images.

An 8-year review of barium studies in the diagnosis of gastroparesis.

Aim: To determine the utility of barium studies for diagnosing gastroparesis in patients with nausea, vomiting, or other related symptoms.

Materials And Methods: Radiology files revealed gastroparesis without gastric outlet obstruction on upper gastrointestinal tract barium studies in 50 patients with nausea, vomiting, and other related symptoms. Original reports and images were reviewed to determine whether gastric peristalsis was decreased/absent and to investigate gastric dilatation, fluid or debris, and delayed emptying of barium.

Accuracy of retrograde ileostomy radiographic examination for detecting small-bowel abnormalities.

Objective: The purpose of this study was to assess the accuracy of retrograde ileostomy radiographic examination for detecting small-bowel abnormalities in patients with ileostomies.

Materials And Methods: Our database contained the records of 35 patients who had undergone retrograde ileostomy examinations from 1999-2005 and fulfilled our inclusion criteria. The images from the examinations were reviewed to determine the frequency and nature of small-bowel abnormalities, whether lateral views were obtained, and whether the catheter tip was withdrawn to the stoma.