Patient perception and localization of dysphagia -- barium study correlation.

We assessed the accuracy of patient localization of the site of dysphagia and its implications for radiological practice during the barium swallow examination. Several current texts dispute the value of such information. Fifty-two consecutive patients with dysphagia were asked to localize the site of discomfort on the skin surface. The ability of each patient to do so precisely or vaguely was noted. A detailed barium examination of the pharynx, esophagus and stomach was performed. Results suggested that patients who had symptoms more cranial than the sternal notch were highly accurate at localizing disease. Localization became less precise as symptoms moved caudally towards the epigastrium. Lateralization of symptoms was highly accurate in determining the site of pathology. In conclusion, we feel that in certain circumstances the barium examination can be usefully tailored to accelerate examination times, thus reducing radiation exposure and cost whilst improving diagnostic accuracy.