DETECTION OF GASTROESOPHAGEAL REFLUX - VALUE OF BARIUM STUDIES COMPARED WITH 24-HR PH MONITORING

OBJECTIVE. Monitoring of esophageal pH is widely held to be the most s ensitive test for gastroesophageal reflux, but it is expensive and is not available in all centers. Controversy surrounds the role of barium studies in the detection of reflux despite years of experience with t heir use. We studied the efficacy of fluoroscopic detection of spontan eous and provoked gastroesophageal reflux compared with 24-hr monitori ng of esophageal pH. SUBJECTS AND METHODS. In 117 subjects with clinic al findings suggestive of gastroesophageal reflux, we recorded fluoros copic observations; of spontaneous reflux and of reflux elicited by co ughing, the Valsalva maneuver, rolling from supine to the right latera l position, and the water-siphon test. Subjects were considered to hav e reflux if 24-hr monitoring of esophageal pH within 14 days of the ba rium examination showed esophageal pH to be less than 4 for intervals exceeding the 95th percentile values previously reported for a control group.RESULTS, Barium studies showed unprovoked, spontaneous reflux i n 26% of subjects proved by pH measurements to have gastroesophageal r eflux. When the water-siphon test was used, the sensitivity of fluoros copic detection rose to 70%, with a specificity of 74% and positive pr edictive value of 80%. Clinically significant reflux was detected radi ographically in five patients in whom it was not detected by pH monito ring. CONCLUSION. These data are contrary to prior reports and indicat e that barium studies are useful for screening patients with clinical findings suggestive of gastroesophageal reflux. The sensitivity of bar ium studies is highest when maneuvers are used to elicit reflux.