The purpose of this study was to determine if patients who had normal lower esophageal sphincter parameters on high-resolution manometry (HRM) also had normal upright and prone bolus transit time (BTT) on barium esophagography (BE) and if there was a correlation between these variables and self-reported dysphagia. If BTT on BE can be quantified, it may become the standard by which the efficacy of esophageal peristalsis is measured. The study population consisted of patients who had normal values for the lower esophageal sphincter and who underwent BE according to established protocols between 2017 and 2020. Using the distal contractile integral (>450 mm Hg-s-cm) cutoff, patients were categorized into 11 subgroups based on the frequency with which they performed normal swallows (10 normal swallows to 0 normal swallows). Prone barium swallow testing was performed using a liquid barium bolus. On a scale from 0 (no) to 4 (extremely difficult), patients reported their level of difficulty swallowing (very severe). The correlation (and the rate of change) between BTT, peristalsis, and dysphagia was investigated using fractional polynomial and logistic regression analysis. An overall sample size of 146 patients was used. An increase in prone BTT was associated with a decline in normal swallowing frequency (P<0.001). There were 2 points at which the correlation between peristaltic function and prone BTT broke down completely independently of one another: at 50% normal swallows for 40 seconds and at 30% normal swallows for 80 seconds. When comparing patients with a prone BTT of more than 40 seconds to those with a prone BTT of less than 40 seconds, the likelihood of having 0% normal swallows on HRM increased by nearly 6 times (P=0.002). Having a higher proneness to BTT was correlated with having a higher grade of dysphagia (P≤0.036). BE is a useful tool for measuring esophageal motility. Dysphagia and the frequency with which normal esophageal swallows are performed are both associated with a prone BTT.
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