Evidence map›Paper›PMID 41642779›Full record

ArticleDigestion2026

Paratracheal Air Stripe Sign: A Useful Chest X-Ray Finding for Diagnosis in Patients with Esophageal Achalasia.

Naoto Ujiie, Yuto Muranami, Chiaki Sato, Yusuke Taniyama, Hiroshi Okamoto, Yohei Ozawa, Hirotaka Ishida, Ryohei Ando, Atsushi Kunimitsu, Michiaki Unno and 1 more

Abstract read
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Article in Digestion, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Naoto UjiieDivision of Surgery, Tohoku University, Sendai, Japan, naoto.ujiie.b8@tohoku.ac.jp.
Yuto MuranamiDivision of Surgery, Tohoku University, Sendai, Japan.
Chiaki SatoDivision of Surgery, Tohoku University, Sendai, Japan.
Yusuke TaniyamaDivision of Surgery, Tohoku University, Sendai, Japan.
Hiroshi OkamotoDivision of Surgery, Tohoku University, Sendai, Japan.
Yohei OzawaDivision of Surgery, Tohoku University, Sendai, Japan.
Hirotaka IshidaDivision of Surgery, Tohoku University, Sendai, Japan.
Ryohei AndoDivision of Surgery, Tohoku University, Sendai, Japan.
Atsushi KunimitsuDivision of Surgery, Tohoku University, Sendai, Japan.
Michiaki UnnoDivision of Surgery, Tohoku University, Sendai, Japan.
Takashi KameiDivision of Surgery, Tohoku University, Sendai, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionEsophageal achalasia is a rare motility disorder, and esophagogastroduodenoscopy (EGD) alone has limited diagnostic accuracy, often leading to delayed diagnosis. High-resolution manometry remains the diagnostic gold standard, but its availability in primary care is limited. Therefore, more accessible diagnostic methods are needed. Given the widespread use of chest X-ray, we investigated whether it reveals distinctive features in achalasia patients.

methodsIn this retrospective cohort study, 215 patients with esophageal achalasia treated between 2015 and 2024 were analyzed. Diagnostic yields of EGD, esophagography, and computed tomography (CT) were evaluated among patients who underwent these examinations in primary care facilities. Chest X-rays were systematically reviewed for paratracheal radiolucency, and a novel radiographic sign - the paratracheal air stripe sign (PASS) - was defined as a paratracheal radiolucent area with a minimum width of ≥5 mm and length of ≥20 mm. To assess specificity, an additional analysis was performed in 210 patients with esophageal cancer as a non-achalasia control cohort.

resultsDiagnostic yields in primary care were 41.1% for EGD, 88.4% for esophagography, and 34.8% for CT. PASS was present in 67.0% of achalasia cases and more frequent in patients with type I achalasia, sigmoid-type morphology, and advanced esophageal dilation. Among patients undiagnosed by EGD, 63.9% exhibited PASS. In the non-achalasia control cohort, PASS was observed in 18.0% of cases, predominantly in patients with structural esophageal changes such as tortuosity or dilatation.

conclusionPASS represents a novel and clinically useful chest X-ray feature associated with esophageal achalasia. Its relatively high prevalence, even among cases missed by EGD, and low occurrence in non-achalasia patients suggest that routine assessment of PASS in chest X-rays may aid early detection and timely referral for definitive diagnosis, particularly in primary care settings.

Indexed as

AchalasiaChest X-rayDiagnostic modalityParatracheal air stripe sign

Identifiers

PMID41642779
PMCPMC13008391

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.