Esophageal Diagnostic Advisory Panel Consensus of the American College of Surgeons, which states that all patients who are considered for antireflux surgery require a barium esophagram [6]. A biphasic esophagram can be useful for this indication. In addition to detecting the presence and size of a hiatal hernia, the esophagram will provide anatomic and functional information on esophageal length, esophageal stricture, presence of gastroesophageal reflux, and reflux esophagitis [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 its 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. If the hiatal hernia is large, an upper GI series evaluation should be included for complete assessment of the stomach. Fluoroscopy Single Contrast Esophagram A single-contrast esophagram may be considered in some instances. Although it may not reveal the mucosal irregularity resulting from reflux disease, it may delineate the hernia, reveal reflux, lower esophageal rings, or strictures [14]. If the hiatal hernia is large, an upper GI series evaluation should be included for complete assessment of the stomach. 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]. A double-contrast upper GI series is the most useful test for diagnosing a hiatal hernia.
Epigastric Pain. Esophageal Diagnostic Advisory Panel Consensus of the American College of Surgeons, which states that all patients who are considered for antireflux surgery require a barium esophagram [6]. A biphasic esophagram can be useful for this indication. In addition to detecting the presence and size of a hiatal hernia, the esophagram will provide anatomic and functional information on esophageal length, esophageal stricture, presence of gastroesophageal reflux, and reflux esophagitis [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 its 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. If the hiatal hernia is large, an upper GI series evaluation should be included for complete assessment of the stomach. Fluoroscopy Single Contrast Esophagram A single-contrast esophagram may be considered in some instances. Although it may not reveal the mucosal irregularity resulting from reflux disease, it may delineate the hernia, reveal reflux, lower esophageal rings, or strictures [14]. If the hiatal hernia is large, an upper GI series evaluation should be included for complete assessment of the stomach. 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]. A double-contrast upper GI series is the most useful test for diagnosing a hiatal hernia.