Imaging of the pharynx and the esophagus

In the past year there have been an unusual number of new concepts developed concerning the pharynx and the esophagus. The normal swallowing mechanism has been studied in detail using a variety of techniques that have increased our understanding of the normal and abnormal swallowing mechanism. In the esophagus, simultaneous barium swallows and esophageal manometry have created new insights into esophageal peristalsis. Based on this material, new recommendations have been developed for a standard barium swallow for the evaluation of esophageal motility. Also, findings previously considered to be abnormal, such as mild tertiary contractions, have now been demonstrated to be within normal limits. For the first time, detailed criteria for abnormal esophageal peristalsis have been described. This article reviews the literature, emphasizing those areas in which new concepts will affect the practicing radiologist.