Barium radiology: a sensitive test for gastro-oesophageal reflux

Fifty patients, 19 with heartburn and 31 with noncardiac chest pain were studied using radiology, endoscopy and 24h ambulatory intraoesophageal pH monitoring. Barium radiology was performed using a 'physiological' method and a 'compression' method to induce reflux. Double contrast oesophograms were also obtained. Thirty-four patients had significant acid reflux detected by a pH probe. Using this as a standard, the 'physiological' method detected 17, the 'compression' method 24 and endoscopy 17 patients with reflux, with two, four and one false positives respectively. Compression barium was the most sensitive (71%) and accurate (72%), while endoscopy was the most specific (94%) but least accurate (64%) in detecting patients with acid reflux. Using a double contrast barium technique, measurement of the internal diameter of the cardiac oesophagus (more than 25 mm abnormal) had a sensitivity of 74%, specificity 86% and accuracy 78% in detecting patients with acid reflux. When the results of the compression method and measurement of internal diameter were combined, sensitivity was 87%, specificity 69% and accuracy 81%. These results suggest that, by combining a test to provoke reflux with a double-contrast technique to measure the internal diameter of the cardiac oesophagus, barium radiology becomes a sensitive screening test for reflux.