Gastroesophageal reflux disease (GERD) is a chronic disorder that is characterized by reflux of gastric contents into the esophagus. GERD is usually not caused by excessive production of stomach acid, but by the failure of the lower esophageal sphincter (LES), which normally separates the esophagus from the stomach and prevents gastric reflux. In addition to considerable patient discomfort and decreased quality of life, GERD is associated with a number of potentially serious complications, including strictures (narrowing of the esophagus due to repeated injury and scarring), hiatal hernia (distension of the stomach above the diaphragm), and precancerous or cancerous changes to the esophagus. GERD is also associated with problems swallowing and impaired esophageal motility. The primary pharmacologic therapy for GERD is an 8-week course of treatment with a proton pump inhibitor (PPI). Treatment may also include other medications, as well as lifestyle changes and surgery. Diagnostic strategies may include a trial of PPI therapy, endoscopy, esophageal manometry (a measure of LES function), and ambulatory monitoring of esophageal pH. Upper gastrointestinal contrast-enhanced imaging using barium (barium swallow examination [BSE]) is typically considered the imaging method of choice for assessing patients with GERD. The goal of the BSE is usually not to identify reflux, but to evaluate patients with dysphagia (difficulty swallowing) or other potential complications of GERD. Barium imaging is often performed as a part of a multiphasic exam that combines single-contrast, double-contrast, and mucosal relief views with static and dynamic imaging approaches to thoroughly assess esophageal structure and function.
After reading this article, the participant should be able to:
- Describe the causes and symptoms of GERD and its potential complications
- Identify appropriate imaging procedures to diagnose GERD and/or rule out other causes of GERD-like symptoms
- Explain the rationale for using barium esophagram to image patients with GERD and indications for the separate techniques
Categories: X-ray, Fluoroscopy