Management of Dysphagia with Tertiary Contractions on Esophagram

Diagnostic Approach

• High-resolution esophageal manometry is the definitive test to characterize the motility disorder, with videofluoroscopy having 80-89% sensitivity and 79-91% specificity for diagnosing esophageal motility disorders compared to manometry, as recommended by the American College of Radiology 1, 2
• A biphasic esophagram should evaluate the entire esophagus and gastric cardia, as abnormalities in the mid or distal esophagus can cause referred dysphagia to the pharynx, according to the American College of Radiology 3

Diagnostic Evaluation

• The American College of Radiology recommends that manometry is required to definitively characterize motility disorders and guide treatment decisions 1, 2