X-Ray Imaging of the Esophagus and Lower Esophageal Sphincter and Its Role in the Diagnosis of Gastroesophageal Reflux Disease

Dorot. Medical Center for Rehabilitation and Geriatrics, Netanya, Israel

*Corresponding Author: Michael D Levin, Dorot. Medical Center for Rehabilitation and Geriatrics, Department of Pediatric Radiology of the 1-st State Hospital, Minsk, Belarus, Dorot. Medical Center for Rehabilitation and Geriatrics, Amnon veTamar, Netanya, Israel, Tel: 972-538281393, Email: [email protected]

Received Date: May 02, 2025

Published Date: May 24, 2025

Citation: Levin MD. (2025). X-Ray Imaging of the Esophagus and Lower Esophageal Sphincter and Its Role in the Diagnosis of Gastroesophageal Reflux Disease. Mathews J Gastroenterol Hepatol. 10(2):31.

Copyrights: Levin MD. © (2025).

ABSTRACT

Currently, the use of pH monitoring and pH-impedance monitoring is recommended to document the diagnosis of gastroesophageal reflux disease (GERD). However, these methods give about 30% false negative conclusions. X-ray examination is not recommended, as it is considered to have low reliability. The purpose of the work is to evaluate the reliability, x-ray examination when using the highest possible pressure in the stomach. Material and methods. 60 patients were examined, including 3 adolescents. The rest were aged from 53 to 76 years (62 ± 4). They had at least one GERD symptom that they could not control, including 53 patients receiving proton pump inhibitors. Of the 39 patients undergoing endoscopy (from 1 to 4 times), only 1 (3%) was diagnosed with GERD and 18 (46%) with gastritis. In 2 cases where pH monitoring was performed, the DeMeester value was <4%. Method. The patient drink barium in a horizontal position without interruption. When the barium ends, the patient raises his straight legs, which serve as a sign to take an x-ray. After 5 minutes, a repeat radiograph is taken at rest. Increased pressure in the stomach causes increased tone of the upper and lower esophageal sphincters (LES). In healthy people, barium enters the stomach without delay. In patients with GERD, barium tightly fills the esophagus between the contracted sphincters. The length of the LES is defined as the space without contrast agent between the barium in the esophagus, and in the stomach. This method allows you to diagnose GERD based on functional and anatomical changes relative to the norm, including shortening of the LES, dilation of the esophagus, formation of the phrenic ampulla, the presence of longitudinal folds, changes in contours, identification of functional and peptic narrowing of the esophagus. Results. X-ray examination with provocation of maximum pressure in the stomach, the diagnosis of GERD was established in 59(98%) of 60 patients with symptoms that occur with GERD, including in 2 (3%) of 59 patients in whom the DeMeester score was <4%, and in 38 (64%) patients in whom it was not detected by endoscopy. All patients had an organic nature of the disease. This made it possible to prescribe complex pathogenetic treatment for GERD. Conclusion. X-ray examination of the esophagus with provocation of maximum pressure in the stomach, provides high accuracy of the diagnosis of GERD (98%). The most reliable sign of GERD was shortening of the LES less than the lower limit of the age norm. At the same time, high diagnostic accuracy of clinical symptoms was proven, which allows starting not "ladder", but complex treatment of the disease, regardless of the clinical symptoms. The proposed diagnostics showed the absence of functional diseases, including   2 (3%) cases, in whom the DeMeester score was <4%. In doubtful cases, endoscopy and/or x-ray examination with maximal gastric pressure are recommended to clarify the diagnosis.

Keywords: Gastroesophageal Reflux Disease, Lower Esophageal Sphincter, X-Ray Diagnostics, Physiology of the Gastroesophageal Junction, High Stomach Pressure, Esophageal pH Monitoring, Pathophysiology, Gastroscopy.