Barium studies for detecting esophagopharyngeal reflux events

Esophagopharyngeal reflux (EPR) is among the factors involved in the supraesophageal complications of reflux disease, and is diagnosed by the regurgitation of barium from the upper third of the esophagus into the pharynx in the absence of swallow during a videofluoroscopic swallowing study. EPR is detected in approximately 20% of patients undergoing these studies, and occurs in different clinical groups without disease-specific associations. The vast majority of patients with EPR show esophageal motor abnormalities on swallowing studies. Notably, prolonged esophageal clearing time is independently and strongly associated with EPR. Our data suggest that the oropharyngeal phase of deglutition is impaired in >50% of patients with both gastroesophageal reflux disease and EPR. In the subset of patients with EPR, oral abnormalities are mostly related to tongue function. Based on the data emerging from our videofluoroscopic swallowing studies, it seems plausible that EPR occurs as a result of an underlying esophageal motor dysfunction facilitated by an impaired oral deglutition. As a consequence, when examining patients for EPR, both esophageal and oropharyngeal abnormalities should be sought.