Esophageal motility disorders are conditions in which the muscles of the esophagus fail to function properly, often resulting in difficulty swallowing. Diagnosing these disorders can be challenging, as traditional approaches such as the timed barium esophagram (TBE) often rely on subjective assessments, including how quickly a swallowed barium solution moves through the esophagus or whether a swallowed tablet gets stuck. Even with the introduction of standardized TBE protocols, limitations remain, particularly when relying on a single measure like the height of the retained barium column. This can reduce diagnostic accuracy and delay appropriate treatment. Accurate diagnosis is critical, especially when treatment options are invasive. Scientists have now developed a more accurate and standardized approach to interpreting this common test used to evaluate esophageal motor disorders.

Scientists at Northwestern Medicine (Chicago, IL, USA) have created a three-tiered classification model designed to enhance the interpretation of the TBE test. In their study, 290 adult patients with esophageal motility disorders underwent multiple diagnostic tests, including TBE, esophageal manometry (which assesses muscle coordination and strength during swallowing), and functional lumen imaging probe (FLIP) panometry (which measures esophageal diameter). These tests provided a comprehensive data set that the researchers used to inform their new model. The model included variables such as maximum esophageal body width and swallowed tablet passage status to support a more holistic interpretation of esophageal function. This innovative approach allowed for more accurate identification of achalasia—a serious esophageal motility disorder where the esophagus muscles fail to move food into the stomach properly.

The model was tested and validated by comparing its performance to traditional diagnostic methods. The new classification model outperformed conventional approaches, achieving an accuracy rate of 88.3 percent compared to 82.2 percent, with higher sensitivity (84.2 percent) and specificity (92.1 percent). The findings, published in Gastroenterology, suggest that integrating multiple standardized metrics into the TBE protocol can significantly improve diagnostic accuracy for achalasia. This advancement has the potential to lead to more precise diagnoses, better treatment decisions, and improved quality of life for patients suffering from esophageal motility disorders. Moving forward, the research team plans to refine their diagnostic methods further by determining when single or multiple tests are most effective for accurate diagnosis and working toward broader implementation at other medical centers.

"By incorporating these multiple metrics on the standardized, time-barium esophagram protocol, we found we could provide an improved approach to diagnose achalasia compared with other approaches that just used column height or barium tablet," said Dustin Carlson, MD, assistant professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern Medicine and senior author of the study. “Our next step is to better determine at what point the best diagnosis can be made. For example, when do we need multiple esophageal motility tests and when can we reach a reliable and accurate diagnosis with one or two of them? Ultimately, we’re focused on continuing to improve and develop accurate diagnostic models that can be implemented for broad use at other centers.”

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