, Volume 34, Issue 1, pp 34–42 | Cite as

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

  • Stephanie WattsEmail author
  • Joy Gaziano
  • John Jacobs
  • Joel Richter
Original Article


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.


Esophageal dysphagia Oropharyngeal dysphagia Esophagus Screening Protocol Deglutition Videofluoroscopy 


Author Contributions

SW Study concept and design; acquisition of data; drafting of the manuscript; statistical analysis, JG Data analysis, manuscript preparation, JJ Data analysis, JR Study concept and design, study supervision; critical revision of the manuscript for important intellectual content.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

455_2018_9966_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Swallowing DisordersUniversity of South FloridaTampaUSA

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