Table Of ContentMorphodynamic Imaging
in Achalasia
This book embarks on a journey never taken before, approaching the imaging of the disease
of achalasia with new pathophysiological assumptions in mind, coming from the Chicago
Classifcation of Manometric Diagnosis. Using state-of-the-art, modern X-ray technology,
the authors have developed a schematic and simple approach to detection, diagnosis, and
patient stadiation and prognostic stratifcation for radiologists, clinicians, and students.
Key Features:
1. Serves as a useful guide to structured and comprehensive reporting of barium
swallows, both in achalasia and other esophageal motility disorders.
2. Allows radiologists, specialists, and trainees to comprehensively understand
achalasia from anatomic, pathophysiologic, therapeutic points of view, allowing
for exact comprehension, detection, and reporting of the radiologic hallmarks of
the disease.
3. Empowers readers to diagnose and defne the exact achalasia subtype in each
patient, due to the specifcally developed Fatebenefratelli (FBF) score.
Morphodynamic
Imaging in Achalasia
Edited by Giovanni Fontanella
Boca Raton London New York
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Library of Congress Cataloging-in-Publication Data
Names: Fontanella, Giovanni, editor.
Title: Morphodynamic imaging in achalasia / edited by Giovanni Fontanella.
Description: First edition. | Boca Raton : CRC Press, 2023. | Includes bibliographical references and index.
Identifers: LCCN 2022028592 (print) | LCCN 2022028593 (ebook) | ISBN 9781032335858 (hardback) |
ISBN 9781032335841 (paperback) | ISBN 9781003320302 (ebook)
Subjects: MESH: Esophageal Achalasia—diagnostic imaging | Fluoroscopy | Barium Sulfate
Classifcation: LCC RC815.7 (print) | LCC RC815.7 (ebook) | NLM WI 258 | DDC 616.3/207572—
dc23/eng/20221026
LC record available at https://lccn.loc.gov/2022028592
LC ebook record available at https://lccn.loc.gov/2022028593
ISBN: 978-1-032-33585-8 (hbk)
ISBN: 978-1-032-33584-1 (pbk)
ISBN: 978-1-003-32030-2 (ebk)
DOI: 10.1201/9781003320302
Typeset in Times
by Apex CoVantage, LLC
Contents
Preface vii
Acknowledgements ix
Foreword xi
Editor Biography xiii
List of Contributors xv
List of Abbreviations xvii
Introduction xix
1 Historic Overview of Achalasia 1
Giovanni Fontanella and Simona Borrelli
2 Evolution of Fluoroscopy and Barium Swallow 7
Simona Borrelli
3 Esophageal Anatomy and Physiology 21
Biondo Francesco Giuseppe, Russo Maurizio,
Parente Emilio, and Pacifco Fabio
4 Pathophysiology of Achalasia 35
Giuseppe Fuggi, Francesca Russo, and Rocco Granata
5 Clinical Overview of Achalasia 47
Giuseppe Fuggi, Francesca Russo, and Rocco Granata
6 Fluoroscopy and Dynamic Barium Swallow 59
Simona Borrelli
7 Image Interpretation and FBF Scoring System 71
Giovanni Fontanella and Simona Borrelli
8 Structured Reporting 83
Giovanni Fontanella
9 Pictorial Essay 89
Giovanni Fontanella
v
vi Contents
10 Conclusions 181
Giovanni Fontanella
Index 183
Preface
One of the directions I reckon that the scientifc progress and research should always fol-
low is that of the unknown. No progress can actually be defned as such without an initial
step, sometimes even a tiny one, into the unknown. Of course, when selecting the matter
of research, many factors have to be taken into account, some of them being quite limit-
ing. In my case, I cannot recall the exact moment I started researching on achalasia—it
just started, somehow, in a moment in the past, after my frst encounter with this disease,
some 15 years ago. I have always had a soft spot for little known or rare diseases, those
that you are most likely not to encounter in a whole career. Achalasia was presented to me
as a rare disease, and it still is, but I have always been exposed to clinical environments
in which patients with this condition were more frequent than normal. This means I had
the chance to talk to them, take their clinical history, feel the actual discomfort or pain
they felt, and understand the psychological issues that achalasia inficted on them. This
experience most likely was etched somehow on my mind and stimulated me to walk in the
direction of the unknown, or perhaps, little known of achalasia. The rare disease became
real people, not more nor less important than those affected by other conditions, but very
worthy of research and clinical attention. This simple collection of frames and notes, writ-
ten primarily for myself, kept growing during the years, until it reached the fnal form you
are now holding in your hands.
I sincerely hope you do appreciate our efforts towards a better clinical knowledge of
this condition.
Giovanni Fontanella, MD FRSA
vii
Acknowledgements
I would like, frst and foremost, to express my gratitude to the Most Compassionate and
Most Merciful, the One that enabled myself to be in the world, through the grace of the
best parents one can possibly desire, Mirella and Eugenio. I would not be in the position I
am now, had it not been for their patience and constant, daily guidance towards hard work
and humility. The foundations of everything I do lie in both of them.
I am immensely thankful to the person who has been my everything for the last few
years, Simona—without her, I would not be here right now. She helps me to be a better per-
son, to strive towards a better future and do what I love, and she does so by example. Her
infuence and support in the making of this book have been tremendous: editing and writing
of the technical section are hers, and so are some of the anatomical and technical drawings.
Thank you to my furry daughter, Ivana, teacher of unconditional love.
It would be impossible to cite here all the important fgures I have met in my profes-
sional life and who, knowingly or not, somehow changed my life, my beliefs, my way of
thinking and working. One of them is prof. Gina Brown, whose research has been inspira-
tional in my formation years and still is to this very day—to her goes our sincere gratitude
for writing a foreword for this monograph.
Sincere thanks go to Biondo Francesco Giuseppe, Giuseppe Fuggi, Francesca Russo,
Rocco Granata and all the contributors for their expertise and invaluable help in making this
volume.
A huge thank you goes to Giovanni Limone, one of the few remaining craftsmen of
barium imaging—the images he produces are not only of invaluable diagnostic quality but
also unique pieces of didactic art.
Last but not least, thank you to my hospital, Sacro Cuore di Gesù, in Benevento, Italy, and
to the wider family of the Brothers Hospitaliers of Saint John of God/Fatebenefratelli, to whom
the FBF score is dedicated.
Giovanni Fontanella, MD FRSA
ix
