A pharmacologic aid in the radiographic diagnosis of obstructive esophageal lesions

Double-contrast examination of the oesophagus: the radiological changes of peptic oesophagitis

A simple method for obtaining double-contrast views of the oesophagus as part of the routine double contrast examination of the upper gastrointestinal tract using high-density low-viscosity barium is described. The typical radiological changes of early peptic oesophagitis (confirmed by endoscopy) which can be readily demonstrated with this technique are illustrated as an example of its practical value. These consist of 'smudged' or 'cobble-stone' mucosa with thickened and distorted longitudinal folds. Superficial erosions and deep ulcers may also be seen. It is suggested that endoscopic confirmation of these characteristic radiological signs of peptic oesophagitis is unnecessary.

The lower esophagus and glucagon

A bolus impaction of the lower esophagus in a 54-year-old woman was rapidly and safely relieved by the administration of intravenous glucagon. This case report reviews a known but little appreciated use of this drug. The history, pharmacology, and uses of glucagon are discussed.

Intravenous glucagon in the management of esophageal food obstruction

The use of intravenous glucagon in patients with obstructing esophageal food impaction of at least 24-hours duration has recently been described. Two cases of acute esophageal obstruction were relieved within ten minutes by intravenous infusion of 1 mg of glucagon. Esophagram performed both before and after glucagon administration confirmed the original obstruction and the passage of the food bolus. Therapy for bolus obstruction of the esophagus has classically included proteolytic enzyme digestion, as well as esophagoscopy with manual extraction. Each entails risk of esophageal perforation and mediastinitis. Also, the dose of proteolytic enzymes, such as papain, may take several hours to administer while endoscopic examination is generally not feasible as an outpatient emergency procedure. Intravenous glucagon can dissolve food other than meat and has the further advantage of safety in the patient in which anticholinergics, another occasionally employed therapy, are contraindicated. A protocol for management of these patients is included.

Double-contrast examination of the esophagus

A simple technique for double-contrast esophagography is described. The technique involves successive swallows of an excellent coating barium mixture and water to create the double contrast effect. Clinical and radiologic situations in which double contrast esophagography have proven helpful include: (a) the detection of small esophageal tumors; (b) delineation of the morphologic features of neoplastic and inflammatory disease; and (c) assessment of the total vertical extent of esophageal disease. Accurate and/or confident diagnosis is aided considerably with double-contrast esophagography.