The diagnostic imaging evaluation of patients with suspected esophagogastrointestinal transit disorders is changing. Anatomical methods, e.g., barium studies, endoscopy, manometry, radiopaque markers, have long been the techniques available and used for diagnosis. The one exception has been gastric emptying, where radionuclide scintigraphy has been the standard for decades. Esophageal transit scintigraphy is an old and reliable methodology but probably underutilized. The diagnostic use of small and large intestinal transit scintigraphy is increasing, in part, because of the limitations of the other methods but, most importantly, because it is truly physiologic, i.e., the transit of radiolabeled food can be imaged and quantified from the mouth to rectum. Limitations to its wider use have been the lack of standardization, general availability, and reimbursement issues. Radionuclide methods are increasingly being used to evaluate esophagogastrointestinal transit in a single study, from top to bottom.