Esophageal retention on modified barium swallow study: Limited predictive value for true esophageal pathology

Table 1 Demographics and clinical characteristics, n (%)

Variable	Patients with follow-up (n = 122)	Patients lost to follow-up (n = 77)
Birth sex: Male	55 (45.1)	37 (48.1)
Age [mean (SD)]	64.02 (16.0)	64.7 (16.4)
Body mass index [mean (SD)]	26.1 (6.2)	26.58 (7.7)
Modified barium swallow study: Esophageal retention present	84 (68.9)	57 (74.0)
Main presenting symptom in gastroenterology clinic (n = 76)		N/A
Dysphagia	63 (82.9)
Reflux	2 (2.63)
Dyspepsia	5 (6.58)
Other (cough, belching, diarrhea, etc.)	6 (7.89)
Esophagogastroduodenoscopy (n = 53, some patients with > 1 abnormality)		N/A
Any abnormality	27 (50.9)
Achalasia	6 (11.3)
Diverticulum	5 (9.4)
Eosinophilic esophagitis	5 (9.4)
Esophagitis (non-eosinophilic)	7 (13.2)
Hiatal hernia > 4 cm	4 (7.5)
Stricture	5 (9.4)
Esophagram: Abnormality present (n = 64)	39 (60.9)	N/A
Manometry: Chicago classification (n = 31)		N/A
Normal	17 (54.8)
Achalasia	4 (12.9)
Esophagogastric junction outflow obstruction	6 (19.4)
Hypercontractile	1 (3.2)
Ineffective esophageal motility	3 (9.9)
Anti-reflux testing: DeMeester (n = 11)		N/A
< 14.7	7 (63.6)
> 14.7	4 (36.4)
Anti-reflux testing: Potential of hydrogen total acid exposure (n = 11)		N/A
< 4%	8 (72.7)
4%-6%	0 (0)
> 6%	3 (27.3)
Confirmed esophageal pathology1		N/A
No	56 (45.9)
Yes	27 (22.1)
Equivocal/Incomplete testing	39 (32.0)

¹Based on comprehensive evaluation of gastroenterology clinic notes and esophageal studies by two board-certified gastroenterologists with specialized training in esophageal disorders.

N/A: Not applicable.

Table 2 Comparison of esophageal retention on modified barium swallow study with esophageal pathology per physician expert and subsequent esophageal testing results

		Confirmed esophageal pathology1 (n = 83)			Esophagogastroduodenoscopy abnormality (n = 53)			Esophagram abnormality (n = 64)			Manometry abnormality2 (n = 31)			Anti-reflux abnormality3 (n = 11)
		No	Yes		No	Yes		No	Yes		No	Yes		No	Yes
Modified barium swallow study	No	20	8	χ2 = 0.30	7	8	χ2 = 0.05	10	11	χ2 = 0.96	8	5	χ2 = 0.41	1	1	χ2 = 0.20
	Yes	36	19	P = 0.58	19	19	P = 0.83	15	28	P = 0.33	9	9	P = 0.52	6	3	P = 0.66

¹Based on comprehensive evaluation of gastroenterology clinic notes and esophageal studies by two board-certified gastroenterologists with specialized training in esophageal disorders.

²Based on Chicago Classification 3.0.

³Based on DeMeester > 14.7 or total acid exposure > 6.

Table 3 Logistic regression analyses comparing esophageal retention on modified barium swallow study with esophageal pathology per physician expert and subsequent esophageal testing results, controlling for age, sex and body mass index, with results reported as odds ratio (95%CI)

	Confirmed esophageal pathology1 (n = 83)	Esophagogastroduodenoscopy abnormality (n = 53)	Esophagram abnormality (n = 64)	Manometry abnormality2 (n = 31)	Anti-reflux abnormality3 (n = 11)
Modified barium swallow study	1.17 (0.42-3.27)	0.71 (0.17-2.95)	1.67 (0.49-5.84)	0.79 (0.15-4.14)	0.16 (0.00-452.98)

¹Based on comprehensive evaluation of gastroenterology clinic notes and esophageal studies by two board-certified gastroenterologists with specialized training in esophageal disorders.

²Based on Chicago Classification 3.0.

³Based on DeMeester > 14.7 or total acid exposure > 6.