Air oesophagogram: a frequent, but not a specific sign of oesophageal involvement in connective tissue diseases

SUMMARY Objective. This study investigates the role of the air oesophagogram in conventional chest X-rays for the diagnosis of oesophageal dysmotility in patients with connective tissue diseases. Methods. Fifty-one patients with connective tissue diseases were studied by oesophageal manometry and lateral and posterior‐ anterior chest X-rays. The presence or absence of oesophageal air on chest X-rays were evaluated separately in the upper, middle and distal segment of the oesophagus. Forty-seven chest X-rays of patients without connective tissue diseases, who had undergone manometry for the evaluation of oesophagus-related symptoms and who had normal oesophageal function, were analysed as a control. Results. A total of 23/51 patients with connective tissue diseases showed oesophageal dysfunction in manometry; 16/51 patients (31%) had air in two or more oesophageal segments on the lateral chest X-ray. There was a significant association of manometrically proven oesophageal dysmotility and air in two or three oesophageal segments (P< 0.05; sensitivity 48%, specificity 82%). However, the prevalence of an air oesophagogram showed no significant diVerence between patients with connective tissue diseases and the control group (10/47; 21%). Conclusion. The radiological sign of an air oesophagogram is neither sensitive nor specific enough to omit oesophageal motility studies in patients with connective tissue diseases.