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      Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol.

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          Abstract

          The modified  barium swallow (MBS) study is a videofluoroscopic evaluation of oropharyngeal swallow function. Esophageal imaging is not routinely performed during an MBS, and few guidelines for implementation or interpretation exist. Aims of the current investigation were to (1) delineate the percentage of normal, oropharyngeal, esophageal, and mixed swallowing dysfunction, (2) develop operational definitions for rating our standardization cursory view of esophageal bolus flow, and (3) determine inter-rater reliability between speech pathology (SLP) and physician raters for categorizing esophageal abnormalities. A two-phase retrospective review of 358 patient charts and MBS studies was conducted. Esophageal bolus flow was operationally defined as (1) normal, (2) anatomic abnormality, (3) dysmotility and (4) combined. Descriptive statistics, a Chi square with alpha set at 0.05, and Kappa analysis were performed. Esophageal dysfunction was identified in 80 (26%) patients and included: anatomic abnormality (69%), dysmotility (17%), and combined abnormality (14%). Phase one reliability testing yielded fair agreement between SLP and MD raters k = 0.5. Following revision of definitions and consensus training, phase two reliability testing resulted in excellent agreement between the same raters k = 0.9. Multiphase or primary esophageal dysphagia was found in 26% of our sample using a standardized protocol rating esophageal bolus flow from the upper esophageal sphincter through the lower esophageal sphincter during the MBS. Improved agreement between SLP and MD raters after definition revision and training suggests these operational definitions are concise, objective and reliable. An expanded MBS study may lead to early identification of esophageal disorders, encourage multidisciplinary patient care, and improve patient health outcomes.

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          Author and article information

          Journal
          Dysphagia
          Dysphagia
          Springer Science and Business Media LLC
          1432-0460
          0179-051X
          February 2019
          : 34
          : 1
          Affiliations
          [1 ] Center for Swallowing Disorders, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA. srandal1@health.usf.edu.
          [2 ] Center for Swallowing Disorders, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
          Article
          10.1007/s00455-018-09966-5
          10.1007/s00455-018-09966-5
          30635777
          466e9f89-3b4b-43f4-8942-9243d040c23a
          History

          Deglutition,Esophageal dysphagia,Esophagus,Oropharyngeal dysphagia,Protocol,Screening,Videofluoroscopy

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