Esophageal retention on modified barium swallow study: Limited predictive value for true esophageal pathology

Dysphagia is a prevalent condition affecting over 15 million adults in the United States, posing serious health risks and contributing to rising healthcare costs. Early evaluation, often initiated by speech-language pathologists (SLPs) using the modified barium swallow study (MBSS), is essential to identify underlying causes. Although SLPs have traditionally focused on oropharyngeal swallowing, emerging guidelines now support esophageal visualization during MBSS. However, standardized practices and consensus remain limited. This study hypothesizes that incidental esophageal retention observed on MBSS do not correlate with clinically relevant esophageal dysphagia.

To assess whether abnormal esophageal retention on MBSS predicts clinically relevant esophageal disease based on subsequent diagnostic studies.

We conducted a retrospective cohort study of patients with abnormal MBSS findings who were referred to gastroenterology (GI) for dysphagia between September 2017 and August 2023. Patients with prior foregut/head/neck surgery or without esophageal phase evaluation on MBSS were excluded. Baseline characteristics, MBSS findings and results from subsequent esophageal studies within one year of MBSS were analyzed. Patient profiles were evaluated by two raters to determine whether subjects had confirmed esophageal pathology. χ ² tests compared MBSS findings with esophageal study abnormalities.

Of 199 referrals to GI with abnormal MBSS findings, 122 patients had subsequent esophageal studies or GI clinic follow-up. Esophagram was performed in 64 patients, esophagogastroduodenoscopy (EGD) in 53 patients, manometry in 31 patients, and anti-reflux monitoring in 11 patients. Confirmed esophageal pathology was identified in 27 patients. No significant association was observed between esophageal retention on MBSS and confirmed esophageal pathology (χ ² = 0.30, P value = 0.58) or with abnormal pathology on EGD, esophagram, manometry or anti-reflux testing in both unadjusted and adjusted analyses.

Esophageal retention on MBSS does not reliably predict esophageal pathology and is not an effective standalone screening tool for esophageal dysphagia, though it may offer limited theoretical insights.