Comparison of barium radiology with esophageal pH monitoring in the diagnosis of gastroesophageal reflux disease

Abstract

Objective: Barium radiology has recently been recommended as a screening procedure for gastroesophageal reflux disease. The aim of this study was to assess the accuracy of barium screening as a predictor of abnormal esophageal acid exposure on pH monitoring.

Patients and methods: One hundred and twenty-five patients underwent both barium radiology and esophageal pH monitoring at the Thomas Jefferson Hospital, Philadelphia, from October 1989 through July 1991. The presence or absence of spontaneous reflux, reflux during the water-siphon test, and a hiatus hernia was recorded and assessed retrospectively.

Results: The proportion of patients with a positive pH test did not differ among those with spontaneous reflux (21/31, 68%) and those with no reflux, on barium study (61/94, 65%). The proportion of patients with a positive pH test did not differ among those with a hiatus hernia (35/50, 70%) and those without (47/75, 63%). This was despite significantly higher median percent total times pH < 4 among those with spontaneous reflux or a hiatus hernia (p < 0.05). The additional application of a water-siphon test induced reflux in 91% of those tested. The sensitivities of spontaneous reflux and hiatus hernia were low (26% and 43%), and specificities were only modest (77% and 65%). The addition of the water-siphon test gave a sensitivity of 92%, but the specificity was zero.

Conclusion: A significantly greater degree of abnormal esophageal acid exposure occurs in patients who have either a hiatus hernia or spontaneous reflux, demonstrated during fluoroscopy. However, the sensitivity and specificity of barium radiology for abnormal degrees of acid reflux are insufficient for it to be worthwhile as a screening procedure.