The role of single and double-contrast radiography in the diagnosis of reflux esophagitis.

Abstract

Sixty-seven patients with endoscopically proved esophagitis and 25 patients who had no esophageal disease were examined by double-contrast esophagography, followed by a single-contrast examination. The radiographs were evaluated separately and as a combined examination technique by three independent radiologists in a blind analysis. The respective sensitivities were 77% for the single-contrast examination, 80% for the double-contrast examination, and 88% for the combined examination method with no significant statistical difference (P = 0.05). The sensitivity increased for all methods with an increased severity of esophagitis. False positives more frequently occurred with double-contrast radiography, leading to similar accuracy rates for all methods (74% to 77%). The double-contrast examination technique showed an advantage over single-contrast radiography only if a granular pattern and erosions were the only radiographically detectible features of esophagitis. The use of the combined examination technique is recommended.

Predictive relationship of hiatal hernia to reflux esophagitis

“…Hiatal hernia, when present, was classified as minor or major, depending on the extent of displacement of the esophagogastric landmarks above the level of the esophageal hiatus: A minor hernia was defined when the landmarks were within 2 cm of the diaphragmatic hiatus, and a major hernia when the landmarks were greater than 2 cm above the hiatus. [18] " PPV, positive predictive value. b NPV, negative predictive value.…”

Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease

“…A reticular pattern on barium esophagram is neither sensitive (26%) nor specific (50%) when compared to endoscopy with biopsy (11). Barium radiography is reasonably accurate in cases of severe esophagitis (80% or better), but is much less accurate with mild esophagitis (less than 25%) (12)(13)(14)(15). Finally, reflux of barium during radiographic evaluation is only positive in 25-75% of symptomatic patients and is falsely positive in up to 20% of normal controls (15,16).…”

Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: Evaluation of the individual techniques

“…Consequently, mucosal relief and double-contrast films must be included for this purpose [1,2]. The need for a combination of techniques to examine the esophagus thoroughly is an opinion increasingly shared by others [2,20].…”