Esophageal radiography and manometry: correlation in 172 patients with dysphagia.

Radiographic and manometric examinations of the esophagus were correlated in 172 patients with dysphagia. Esophageal manometry was abnormal in 66 (38%), with diagnoses of nonspecific esophageal motor disorder (26), achalasia (19), nutcracker esophagus (12), diffuse esophageal spasm (seven), and scleroderma (two). Compared with manometry, radiographic sensitivities were 95% (18 of 19) for achalasia, 71% (five of seven) for diffuse esophageal spasm, and 46% (12 of 26) for nonspecific esophageal motor disorder. Nutcracker esophagus was not diagnosed specifically on the radiographic examination. Overall radiographic sensitivity was 56% (37 of 66) but increased to 89% by excluding nutcracker esophagus and nonspecific esophageal motor disorders. In 106 manometrically normal patients, radiographic specificity was 91% with 10 false-positive diagnoses of nonspecific motor disorder. We conclude that radiographic examination of the esophagus is useful in patients with dysphagia for evaluating functional esophageal abnormalities, although detection rates vary widely with the type of motor disorder.