Fluoroscopy Single-Contrast Esophagram Although a biphasic examination is preferred to a single-contrast examination to assess for reflux/esophagitis, a single-contrast examination may be necessary because of patient capabilities. A single-contrast examination may be helpful by revealing reflux, lower esophageal rings, or strictures [12]. Fluoroscopy Upper GI Series The double-contrast upper GI series is a beneficial diagnostic test for evaluating structural and functional abnormalities of the esophagus, stomach, and duodenum [17]. Fluoroscopic evaluation of the esophagus may reveal findings of esophagitis as detailed above. In addition, evaluation of the stomach can be helpful in diagnosing gastritis, which may manifest as enlarged areae gastricae, disruption of the normal polygonal areae gastricae pattern by multiple uniform nodules, thickened gastric folds, erosions, or an ulcer with smooth folds radiating to the margin. In contrast, findings concerning for malignancy include an ulcer associated with nodularity of the adjacent mucosa, mass effect, or coarse, lobulated, or irregular radiating folds [17]. This examination should be performed when symptoms are nonspecific and differential possibilities of esophagitis, gastritis, or PUD are being considered. Epigastric Pain MRI Abdomen In general, MRI is not routinely used to diagnose GERD. For patients presenting with nonspecific symptoms when gastritis or peptic ulcer or duodenal ulcer is suspected, MRI may be able to suggest these diagnoses, but a CT examination is typically chosen over MRI because of its ability to detect free air associated with a perforated ulcer and its shorter time interval to obtain the examination. MRI Abdomen with MRCP There is no relevant literature to support the use of MR cholangiopancreatography (MRCP) sequences in the prospective diagnosis of acid reflux or esophagitis or gastritis or peptic ulcer or duodenal ulcer. Variant 2: Epigastric pain with clinical suspicion for gastric cancer. Initial imaging.
Epigastric Pain. Fluoroscopy Single-Contrast Esophagram Although a biphasic examination is preferred to a single-contrast examination to assess for reflux/esophagitis, a single-contrast examination may be necessary because of patient capabilities. A single-contrast examination may be helpful by revealing reflux, lower esophageal rings, or strictures [12]. Fluoroscopy Upper GI Series The double-contrast upper GI series is a beneficial diagnostic test for evaluating structural and functional abnormalities of the esophagus, stomach, and duodenum [17]. Fluoroscopic evaluation of the esophagus may reveal findings of esophagitis as detailed above. In addition, evaluation of the stomach can be helpful in diagnosing gastritis, which may manifest as enlarged areae gastricae, disruption of the normal polygonal areae gastricae pattern by multiple uniform nodules, thickened gastric folds, erosions, or an ulcer with smooth folds radiating to the margin. In contrast, findings concerning for malignancy include an ulcer associated with nodularity of the adjacent mucosa, mass effect, or coarse, lobulated, or irregular radiating folds [17]. This examination should be performed when symptoms are nonspecific and differential possibilities of esophagitis, gastritis, or PUD are being considered. Epigastric Pain MRI Abdomen In general, MRI is not routinely used to diagnose GERD. For patients presenting with nonspecific symptoms when gastritis or peptic ulcer or duodenal ulcer is suspected, MRI may be able to suggest these diagnoses, but a CT examination is typically chosen over MRI because of its ability to detect free air associated with a perforated ulcer and its shorter time interval to obtain the examination. MRI Abdomen with MRCP There is no relevant literature to support the use of MR cholangiopancreatography (MRCP) sequences in the prospective diagnosis of acid reflux or esophagitis or gastritis or peptic ulcer or duodenal ulcer. Variant 2: Epigastric pain with clinical suspicion for gastric cancer. Initial imaging.