The details of the following photos may
support the R-CPD diagnosis, though they should not be considered diagnostic. Take note that all photos are non-channel scope images; that is, the scope is not able to insufflate (blow in) air.
The significance: the esophagus
is typically collapsed around endoscopes inserted into them and air is pumped in through a tiny channel
in order to gently expand the esophagus so that its walls can be seen. Here, the air the patient cannot belch/evacuate
is doing that work for us. And the esophagus remains open for extended time, the full duration of the examination.
Four findings are being evaluated and compared with normal esophagoscopy images (also without insufflated air to make the comparison valid):
Reflux from the lower esophagus, suggesting damage to the lower esophageal sphincter from constant upward pressure trying unsuccessfully to belch.
What we call an “aortic shelf,” meaning that rather than an indentation of the medial circumference of the aorta, dilation of the esophagus drapes its mucosa across the upper surface of the esophagus, making a “horizontal shelf.” Keep in mind again that this is without insufflating any air.
Continuous patency with very infrequent, partial “clamping” down of the lumen or, often no closure at all, suggesting that there is sustained opening pressure of unbelchable air and/or that the contractile ability of the esophagus is reduced, in similar fashion to what happens to an overly-distended urinary bladder.
Upper esophageal dilation in a medial-lateral axis so that the upper esophagus becomes stretched in an exaggerated “oval” rather than a more gentle oval or even “circle.”
Esophageal Stretching by Unburpable Air in R-CPD
This young man has had the classic syndrome of R-CPD lifelong. His esophageal findings at the end of a videoendoscopic swallow study are classic. The esophagus is mostly a collapsed muscular tube in young people, yet his esophagus is widely open on a continuous basis due swallowed air that he cannot burp up.
More Interesting Esophageal Findings of R-CPD (Inability to Burp)
The Esophagus Doesn’t Like Being Stretched for Years Due to Untreated R-CPD
Emerging Esophageal Findings
Dramatic Lateral Dilation of the Upper Esophagus
Dramatic Dilation of the Esophagus in a Person with R-CPD due to Buildup of Swallowed Air that He Cannot Belch to get Rid of.