Oesophageal function tests: are they of value?

Oesophageal function was assessed in 15 unselected control patients, eight patients with systemic sclerosis, 10 diabetics with autonomic neuropathy and 24 diabetic controls, by water bolus transit time derived from oesophageal scintigraphy, barium swallow and by timing the transit of a barium sulphate-filled capsule through the oesophagus. Water transit times and capsule transit times were significantly prolonged in patients with systemic sclerosis and diabetics with autonomic neuropathy, compared with controls. Barium swallow was abnormal in seven of eight patients with systemic sclerosis, whereas water transit time was abnormal in all eight and capsule transit time was abnormal in six of seven. Nine of 10 patients with diabetic autonomic neuropathy had abnormal barium swallows and water transit times but all 10 had prolonged capsule transit times. Eleven of 24 diabetic controls had abnormal barium swallows and water transit times, but 21 had abnormally prolonged capsule transit times. Six of 15 controls had abnormal barium swallows, four had abnormal water transit times and 12 had abnormal capsule transit times. In conclusion, water and capsule transit times are sensitive tests of oesophageal function and are as effective as barium swallow in detecting oesophageal motility disorders associated with systemic sclerosis and diabetic autonomic neuropathy. Capsule transit time is cheaper, involves a smaller radiation exposure than oesophageal scintigraphy and may be more sensitive.