## Investigation of Choice for Chronic Esophagitis with Stricture **Key Point:** Barium swallow and esophageal manometry are the gold-standard investigations for assessing stricture morphology, length, and functional consequences in chronic esophagitis. ### Why Barium Swallow & Manometry? 1. **Barium swallow** provides excellent anatomical detail: - Visualizes stricture length, caliber, and appearance (smooth vs. irregular) - Assesses degree of luminal narrowing - Evaluates esophageal motility patterns - Cost-effective and widely available 2. **Esophageal manometry** measures: - Pressure gradients across the stricture - Esophageal body motility (often impaired in chronic inflammation) - Lower esophageal sphincter (LES) function - Guides therapeutic decisions (dilation vs. surgery) ### Role of Other Investigations | Investigation | Role | Limitation in This Case | |---|---|---| | CT chest | Staging malignancy, mediastinal involvement | Does not assess functional stricture; poor for mucosal detail | | EUS | Assessing wall layers, lymph nodes | Better for Barrett's esophagus or early malignancy; not for stricture morphology | | pH monitoring | Detecting acid reflux | Assesses reflux, not stricture; already have tissue diagnosis | **Clinical Pearl:** In chronic esophagitis, the combination of barium swallow (anatomy) and manometry (function) allows risk stratification—strictures with poor motility may require surgical intervention rather than repeated dilation. **High-Yield:** Barium swallow is superior to CT for stricture characterization because it shows real-time flow dynamics and can detect subtle narrowing; manometry is essential before dilation to assess safety and predict response.
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