What is the difference between an Upper Gastrointestinal (GI) series and an Esophagram?

From the Guidelines

For patients presenting with dysphagia or suspected esophageal pathology, an esophagram is the preferred initial diagnostic test due to its high sensitivity in detecting structural and functional abnormalities of the esophagus, as evidenced by a biphasic esophagram having 96% sensitivity in diagnosing cancer of the esophagus or gastroesophageal junction 1.

Key Differences Between Upper GI Series and Esophagram

• An esophagram specifically focuses on the esophagus, making it ideal for evaluating dysphagia, reflux, hiatal hernias, esophageal strictures, and motility disorders.
• An upper GI series, on the other hand, is more comprehensive, examining the esophagus, stomach, and duodenum, and is better suited for conditions like peptic ulcers, gastritis, malabsorption, and tumors of the stomach or duodenum.
• The choice between these tests should be guided by the patient's specific symptoms and the suspected condition, with esophagram being preferred for primarily esophageal concerns and upper GI series for suspected stomach or duodenal pathology.

Diagnostic Capabilities

• The biphasic esophagram is highly effective in detecting both structural lesions (such as esophagitis, strictures, rings, and carcinoma) and functional abnormalities (including gastroesophageal reflux and motility disorders) of the esophagus 1.
• It has been found to depict about 95% of all lower esophageal rings and has a sensitivity of about 95% for the detection of peptic strictures, sometimes revealing strictures that are missed with endoscopy 1.
• Videofluoroscopy, a component of the esophagram, has an overall sensitivity of 80% to 89% and specificity of 79% to 91% for diagnosing esophageal motility disorders compared with esophageal manometry 1.

Clinical Decision Making

• The decision to use an esophagram over an upper GI series should be based on the clinical presentation, with a focus on symptoms related to the esophagus.
• Given the high sensitivity of the esophagram for esophageal pathology, including cancer, it is a critical tool in the diagnostic workup of patients with dysphagia or suspected esophageal disease 1.
• While endoscopy is highly accurate for detecting esophageal cancer and subtle forms of esophagitis, the esophagram remains a valuable initial diagnostic tool due to its ability to detect a wide range of esophageal abnormalities, including those that may be missed by endoscopy 1.

From the Research

Comparison of Upper GI Series and Esophagram

• The upper GI series and esophagram are both diagnostic tests used to evaluate the upper gastrointestinal tract, but they have different focuses and uses 2, 3.
• An esophagram is a more comprehensive test that enables the assessment of morphologic abnormalities, oropharyngeal swallowing function, esophageal motility, and gastroesophageal reflux 2.
• A barium upper GI series is useful for evaluating a variety of esophagogastric disorders, including gastroesophageal reflux disease, hiatal hernia, and esophageal motility disorders 3.

Diagnostic Capabilities

• The esophagram is better at demonstrating anatomic findings after anti-reflux surgery, especially in symptomatic patients 4.
• The barium esophagram provides additive and/or confirmatory information to endoscopy and is the more accurate means of yielding diagnosis 5.
• Esophageal physiologic tests, including barium esophagram, can evaluate obstructive symptoms, typical and atypical GERD symptoms, and behavioral symptoms 6.

Clinical Use

• The barium esophagram is an integral part of the assessment and management of patients with gastroesophageal reflux disease (GERD) before and after antireflux procedures 4.
• Targeted utilization of esophageal physiologic tests, including barium esophagram, can lead to definitive diagnosis of esophageal disorders and help rule out organic disorders while making a diagnosis of functional esophageal disorders 6.
• The GI radiologist should be an important member of the foregut surgery team, and barium upper GI series is an important part of the diagnostic workup and follow-up after operation for esophagogastric disorders 3.