Fluoroscopy Biphasic Esophagram Fluoroscopy continues to be an important radiologic modality for the evaluation of patients with epigastric pain due to reflux symptoms, esophagitis, or for nonspecific abdominal pain that could be due to GERD or PUD. Depending on the symptoms, the evaluation may be performed with an esophagram/barium swallow, an upper GI series, or a combination of the two. A barium swallow/esophagram can be performed as a multiphasic examination that includes upright double-contrast views with a high density barium suspension, prone single-contrast views with a low-density barium suspension, and mucosal-relief views with either density of barium suspension [14]. The double-contrast phase optimizes the ability to detect inflammatory or neoplastic diseases, whereas the single-contrast phase optimizes the ability to detect hiatal hernias and lower esophageal rings or strictures [14]. Barium esophagram provides anatomic and functional information on esophageal length, presence, and size of hiatal hernia, diverticulum, esophageal stricture, as well as the presence of gastroesophageal reflux events with provocation [6]. Reflux esophagitis may manifest as fine nodularity or granularity of the mucosa, erosions or ulcers, thickened longitudinal folds, inflammatory esophagogastric polyps, and scarring with strictures, sacculations, or fixed transverse folds [14]. Single-contrast examinations have a reported sensitivity of 77% for detecting endoscopically proven esophagitis. Double-contrast examinations have a higher sensitivity of 80% because of their ability to reveal mucosal abnormalities that cannot be visualized on single-contrast studies. An even higher sensitivity of 88% is achieved by using a combined technique [14-16]. As such, a combined technique is most favorable for this assessment.
Epigastric Pain. Fluoroscopy Biphasic Esophagram Fluoroscopy continues to be an important radiologic modality for the evaluation of patients with epigastric pain due to reflux symptoms, esophagitis, or for nonspecific abdominal pain that could be due to GERD or PUD. Depending on the symptoms, the evaluation may be performed with an esophagram/barium swallow, an upper GI series, or a combination of the two. A barium swallow/esophagram can be performed as a multiphasic examination that includes upright double-contrast views with a high density barium suspension, prone single-contrast views with a low-density barium suspension, and mucosal-relief views with either density of barium suspension [14]. The double-contrast phase optimizes the ability to detect inflammatory or neoplastic diseases, whereas the single-contrast phase optimizes the ability to detect hiatal hernias and lower esophageal rings or strictures [14]. Barium esophagram provides anatomic and functional information on esophageal length, presence, and size of hiatal hernia, diverticulum, esophageal stricture, as well as the presence of gastroesophageal reflux events with provocation [6]. Reflux esophagitis may manifest as fine nodularity or granularity of the mucosa, erosions or ulcers, thickened longitudinal folds, inflammatory esophagogastric polyps, and scarring with strictures, sacculations, or fixed transverse folds [14]. Single-contrast examinations have a reported sensitivity of 77% for detecting endoscopically proven esophagitis. Double-contrast examinations have a higher sensitivity of 80% because of their ability to reveal mucosal abnormalities that cannot be visualized on single-contrast studies. An even higher sensitivity of 88% is achieved by using a combined technique [14-16]. As such, a combined technique is most favorable for this assessment.