Introduction The gold standard for diagnosis of primary oesophageal dysmotility (POD) is high-resolution manometry (HRM). Barium swallow (BS) studies remain integral to many diagnostic algorithms for dysphagia. Our aim was to assess the sensitivity and specificity of BS in the diagnosis of POD including achalasia as defined using HRM.
Method Patients that had a BS and HRM within a year of each other over a period of 10 years were identified. Those with a history of upper gastrointestinal surgery were excluded. The HRM diagnosis was algorithmically deduced from the raw dataset using the appropriate Chicago classification1. All HRM diagnoses and barium term extractions were manually verified by the authors. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and accuracy for BS were calculated for each of the positive BS terms identified. Subset analysis for achalasia specifically and all spasticity excluding achalaisa were performed.
Conclusion Given the increasing number of interventions available, both endoscopically and surgically, we should strive for better accuracy in the diagnosis of POD than our data suggests BS provides. In centres where HRM is readily available we would advocate this as the first line investigation of choice for POD including achalasia.
Disclosure of Interest None Declared
- Barrett’s Oesophagus
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