A gastroenterologist's perspective on the role of barium esophagography in gastroesophageal reflux disease

Although endoscopy is a sophisticated technique for evaluating patients with gastroesophageal reflux disease (GERD), the single diagnostic test that enables the most comprehensive assessment for GERD is a well-performed video esophagram. Not only does the barium study permit assessment of morphologic abnormalities in the pharynx and esophagus, but also oropharyngeal swallowing function, esophageal motility, and gastroesophageal reflux. These factors are especially important for detection of anatomic findings such as strictures and hernias, for assessment of esophageal motility before and after fundoplication, and for excluding conditions that mimic GERD. Thus, esophagography and esophagoscopy are complementary procedures that provide a more comprehensive and therapeutically actionable plan for patients with GERD than either diagnostic test alone.