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Videofluoroscopy: the gold standard exam for studying swallowing and its dysfunction.

Costa MMB. Videofluoroscopy: the gold standard exam for studying swallowing and its dysfunction. Videofluoroscopy is the standard exam for evaluating swallowing dynamics. Nevertheless, a number of other methodologies are also used. In this current edition of ARQUIVOS de GASTROENTEROLOGIA two insightful manuscripts entitled Clinical evaluation of oropharyngeal dysphagia in Machado-Joseph disease (2) and Effect of age on proximal esophageal response to swallowing (8) utilizes other methodologies. The authors of the first study classified their results based on dysphagia severity scale, which was created with videofluoroscopy and they adopted cervical auscultation for the clinical evaluation of the pharyngeal phase of deglutition. Certainly, videofluoroscopy would allow to confirm and to give more reliability of the results. The second manuscript utilized flux manometry with flawless methodology to study the upper, proximal segment of the esophagus, like the pharynx, is composed of striated muscle. This region is different of the distal esophagus, which is composed of smooth muscle. The contractility of the proximal third of the esophagus is determined by motor unit depolarization, like the pharynx. In this study, the manometric results allowed the authors to propose that older subjects had less effective upper esophageal contractions than younger subjects; they concluded that age may affect the response of the proximal esophagus to wet swallows. The observed outcomes may have been due to subclinical dysfunction in the oral and/or pharyngeal deglutition phases, which would only be detected by videofluoroscopy. Videofluoroscopy is considered the gold standard method in studying swallowing and its dysfunction. Nevertheless, in Brazil, this technique remains underutilized. Many physicians do not know much about it, while others consider X-ray necessary, and still others use less effective methods due to their accessibility. Very frequently, it comes to our attention that many practitioners and health plans companies do not know the method; they have never heard of it, and often ask: " video what? " The good news is that videofluoroscopy of swallowing, as videodeglutogram, now has a Brazilian Medical Association (AMB) codification number (4.08.06.02-2). Videofluoroscopy of swallowing is the process of recording dynamic deglutition events using X-ray and storing this information in magnetic media. The method enables high resolution real-time recording at 30 frames/ sec, which enables not only the morphological analyses, but also the physiological evaluation. The events can be viewed and reviewed, without new exposures. Being able to visualize the region frame by frame and/or in slow motion constitute the clear advantages …