For the USMLE, what study to do in order to diagnose Achalasia?

[Knicks]

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What to do 1st: Barium or Manometry?

 

[WashMe]

What to do 1st: Barium or Manometry?

My guess would be manometry, but I'm interested to know the answer. I hear barium swallow isn't really done for much anymore.

 

[NOsquid]

AFAIK, barium is the first part of the workup for dysphagia to look for evidence of structural anomalies. For sure the test for achalasia is manometry. Depends on how the question is worded I guess.

 

[MilkmanAl]

This sounds more like a Step 2 (i.e., "What would you do next?) kind of question. I doubt they'd ask something like that. They'd be a lot more likely to give you the manometry results or a picture of a barium swallow and either ask what condition they're showing/describing (easy) or what causes it (a little harder).

In actual practice, you'd probably do a swallow study, then a barium swallow, and then manometry last to prove achalasia if you didn't feel like the swallow was diagnostic but were still convinced achalasia was in play. I'm not sure how that'd ever happen, but that's what the boards want. The first two studies would likely be ordered concurrently or at least in quick succession. In any event, I believe manometry is the definitive test unless I'm forgetting something.

 

[ArcGurren]

Just make sure you can recognize the "bird's beak" sign on a barium swallow for achalasia as I know for a fact that's turned up on some peoples' exams.

 

[MilkmanAl]

It was on mine.

 

[jdh71]

What to do 1st: Barium or Manometry?

Manometry will be more sensitive and specific for achalasia. You do the barium, you see the stricture could be something else like a cancer or idiopathic stricture or an old scar from trauma. The barium will be very sensitive, and therefore a good screening test, it's also much less cumbersome as it's essentially an xray. So if you're looking for achalasia (or doing a w/u of dys/odynophasia) then barium swallow, if you're attempting to diagnose achalasia, specifically, then you need the manometry.

 

[jdh71]

This sounds more like a Step 2 (i.e., "What would you do next?) kind of question. I doubt they'd ask something like that. They'd be a lot more likely to give you the manometry results or a picture of a barium swallow and either ask what condition they're showing/describing (easy) or what causes it (a little harder).

In actual practice, you'd probably do a swallow study, then a barium swallow, and then manometry last to prove achalasia if you didn't feel like the swallow was diagnostic but were still convinced achalasia was in play. I'm not sure how that'd ever happen, but that's what the boards want. The first two studies would likely be ordered concurrently or at least in quick succession. In any event, I believe manometry is the definitive test unless I'm forgetting something.

this is good ^^

I need to read the whole thread first (or did this come through while I was typing mine?)

 

[OveractiveBrain]

What to do 1st: Barium or Manometry?

Knicks is studying for Step 2

Knicks, I think you're looking for this...

Pt: Dysphagia to food AND solids, "knot" or "ball" gets stuck in chest

Dx: Barium ---> Manometry ---> EGD with Bx
..(Birds Beak)..(Fails to Relax)..(Absent Auerbach Plexus)

Tx: Botox or Balloon Dilation --> Heller Myotomy

 

[Knicks]

Thank you to everyone in this thread thus far.