Timed Esophogram Procedure For Achalasia

Timed esophogram procedure is done to evaluate how the esophagus empties.  It is often ordered for Achalasia.  I have seen it ordered for other conditions such as eosinophilic esophagitis.   Timed barium esophograms are done in the radiology department using fluoroscopy which is a continuous X-ray.

A ruler is taped to the fluoroscopy table.   We have the patient drink about 250 cc of barium contrast.  We take pictures after 1, 2, and 5 minutes after the patient is done drinking.   We measure the column of the remaining barium at 1,2, and 5 minutes.  The radiology doctor will compose a report and send it to the referrer who is often a gastroenterologist.

This test is most commonly done to follow patients with Achalasia after treatment.  It is an objective measure of emptying,  Achalasia is impaired relaxation of the lower esophageal sphincter which results in food stasis in the esophagus.  Patients often present with difficulty swallowing, chest pain and regurgitation of food.

Complications of Achalasia include esophageal cancer, pneumonia from aspiration of esophageal contents, and infections of the esophagus such as that with candida fungus.  On fluoroscopy we see a dilated esophagus with stasis of contents.  The lower esophageal sphincter fails to relax.  We see contractions of the esophagus which do not propel food.  A birds beak sign is seen with a narrowed appearance of the lower esophagus.

Treatment is aimed at facilitating emptying of the esophagus.  Treatment consists of dilation of the esophagus but this has a risk of perforation.  Botulinum toxin injection is another option but this is temporary.  Surgical option includes a myotomy.  This involves an incision to relax the lower esophageal sphincter.  This is often done with a fundoplication to preserve some tone.  Fundoplication involves wrapping a portion of the stomach around the lower esophagus.

Patiemts will be followed with timed esophogram procedures.  Often times the subjective improvement after treatment may not be accurate, since the goal is to allow emptying of the esophagus in Achalasia.  The timed esophogram procedure allows an objective measurement of emptying.   In cases where there is complete emptying, we often continue with a regular esophogram to look at the lining and function of the esophagus.