Diagnostic Medical Sonography
Sonographic Findings for Achalasia in Relation to the GE Junction
A study was performed to describe the sonographic features of patients with Achalasia ( a rare disorder that occurs when the nerves in the esophagus become damaged and overtime it makes hard to digest food ; resulting in the food collecting in the esophagus and washing back up the mouth ) and those without any esophageal disease . The patients with Achalasia showed dilation , retention of fluid and smooth narrowing of the distal esophagus ( resembling a bird ’ s beak ). These findings were not identified in those without any esophageal disease . Those with Achalasia had a mean thickness of the esophageal wall at the GE junction , which ranged from 3.6-7.2 mm . The thickening seen in these patients was regular , symmetric and localized to the GE junction . The volunteers with no esophageal disease had a mean thickness of the esophageal wall ranging from 1.4-3.5 mm . Transabdominal sonography in Achalasia patients clearly shows the thickening of the esophageal wall , water retention , dilation of the distal esophagus and the bird ’ s beak appearance . With this information , sonography may play a key role in differentiating Achalasia from carcinoma or peptic stricture of the GE junction , which is difficult to do using other imaging modalities .
In another study , transabdominal sonography images of the GE junction were compared with barium studies for evaluating gastroesophageal junction disease . During this study , fifty-five patients participated in a barium and ultrasound study which was performed independently by two radiologists . The normal findings were verified by esophagoscopy or a clinical follow-up , and all the abnormal findings were verified by biopsy , surgery or manometry . During the ultrasound studies , a normal GE junction had multiple layers of echogenicity that varied with a mean wall thickness of 4.9 mm . The twenty cancer cases all appeared as a mass-like thickening with a mean of 14.9 mm on the sonographic images . While the barium study findings misinterpreted two cancer studies as Achalasia , in both the ultrasound and barium studies a benign structure was misinterpreted as cancer . Of the four cases of Achalasia , three were revealed by sonography as normal GE junctions with proximal dilation . The conclusion of this study showed that transabdominal sonography is useful for revealing extra mucosal components of the GE junction . Sonography is also extremely useful for distinguishing between Achalasia and infiltrative cancer . The barium study showed smooth circumferential narrowing .
These two studies show the importance of using Sonography to detect esophageal disease . Ultrasound has better sensitivity than barium studies , so detecting small herniations is more accessible . Important length measurements of the esophagus can also be identified . Additional functional data as well as morphological data may be acquired by ultrasound . The GE junction is a key indicator for esophageal diseases and can be identified , measured and studied through ultrasound .
Mattea Callahan