Normal solid bolus swallowing erect position

Individuals with structural and functional abnormalities of the esophagus are frequently symptomatic when swallowing solids and have been reported to demonstrate delay during nuclide examinations. This study was performed in symptomatic individuals to determine how often a solid bolus (13 mm barium tablet or 10 mm bagel bread sphere) passed through the esophagus without delay and whether erect solid bolus swallowing occurred without significant bolus hesitation during fluoroscopic evaluation. All individuals referred for an upper gastrointestinal examination or barium swallow who complained of dysphagia, heartburn, or chest pain were evaluated with a solid bolus. Individuals demonstrating gastroesophageal reflux, a hiatal hernia, a Schatzki B ring, or any esophageal motility disturbance were given a solid bolus. Twenty-six (27%) of 98 symptomatic individuals given a barium tablet had no delay in its passage. Thirteen (8%) of 150 symptomatic individuals given a bagel sphere had an erect solid bolus swallow with no delay in its passage. Only one individual of 26 given both solids (4%) showed no delay in transit of either bolus. Solid bolus swallows without delay were noted to occur in two ways: (1) The entire solid bolus passed in less than 3 s without delay of any kind, and (2) some temporary delay (less than 5 s) occurred at regions of anatomic esophageal narrowing (circopharyngeus, thoracic inlet, transverse aorta, left mainstem bronchus, or diaphragm). These temporarily delayed swallows were assisted by coincidentally swallowed fluid or the following peristaltic wave. No additional swallows were required to complete passage into the stomach. Bolus passage was accomplished predominantly by oral thrust, gravitational pull, esophageal relaxation, and possibly because of intraluminal esophageal pressure differentials. Therefore, solid bolus erect swallowing can occur without significant delay of bolus passage into the stomach in a symptomatic population.