State-of-the-art barium examination of gastroesophageal reflux disease

The Authors define the role of barium examination in patients with symptoms of gastroesophageal reflux disease (GERD). After a short review of the anatomy of the esophagogastric region, detection of GERD is faced explaining the different performances of 24-hour pH monitoring (the gold standard), 99mTc-scintigraphy, and barium studies, in diminishing order of accuracy. However, a skilled fluoroscopy allows one to evaluate rate and efficiency of esophageal clearance and to detect esophageal and gastroduodenal dysmotility as well as peptic strictures. Moreover, barium studies are more sensitive than endoscopy in demonstrating hiatal hernias (not negligible information, especially if surgical treatment is scheduled), accurate for severe and moderate reflux esophagitis (biphasic study, including single- and double-contrast examination) but hardly sensitive at all for mild esophagitis. Radiological double-contrast criteria for identification of patients at high, moderate or low risk of Barrett's esophagus are reviewed, although endoscopy should be considered as a gold standard in this evaluation. Finally, the authors highlight cost-effectiveness of barium study versus endoscopy in patients with GERD.