Radiological demonstration of gastroesophageal reflux. Diagnostic value of barium and bread studies compared with 24-hour pH monitoring.

OBJECTIVE

To correlate gastroesophageal reflux (GER), demonstrated by a radiological method using food, with the reflux events, as determined by 24-h pH monitoring.

METHODS

One hundred and seventeen patients with a median age of 47 years (86 male and 31 female) were examined. In the supine left position, the patient consumed 360 ml of barium contrast. Fluoroscopy was performed with the patient in the supine right oblique position during mastication and swallowing a piece of rye bread with liver pate and barium. The test was positive if barium was observed > or =5 cm proximal to the gastroesophageal junction. An antimony pH-probe was placed 5 cm above the lower esophageal sphincter, previously determined by manometry. The position was controlled by radiography after positioning and before removal. The total time of esophageal pH<4 exceeding 5.0% was considered pathological.

RESULTS

The radiological method had a specificity of 100% and a sensitivity of 52% compared to 24-h pH monitoring.

CONCLUSIONS

The high specificity of this radiological method justify direct therapeutic consequence of a positive test. However, a negative test still renders the problem unsolved.