Gastroesophageal disease (GERD) is when stomach acid refluxes into the esophagus through the lower esophageal sphincter. This common condition can produce symptoms such as burning sensations in the stomach area, chest, dry cough, swallowing difficulties and other symptoms. Sometimes your doctor will order an esophagram to further look for the reason behind your symptoms and to identify any complications.
Minor cases may produce no visible abnormalities on esophagrams or endoscopy despite patients having symptoms. In more advanced cases, abnormalities are often seen. Most commonly, I see reflux of the swallowed barium into the esophagus either spontaneously or when I ask the patient to bear down. Not seeing reflux does not exclude it.
I sometimes see delayed or abnormal passage of barium contrast through the esophagus. Other patients have findings of an inflamed esophagus, abnormal areas of narrowing and hernias where the stomach protrudes into the chest. These hernias are often associated with reflux.
One of the more important abnormalities associated with reflux disease is Barrett esophagus. This is a precursor to cancer of the esophagus. Unfortunately, this is usually not seen on esophagram and is therefore not adequate for screening. This is a finding that is seen on endoscopy and biopsy done by a gastroenterologist. Even early cancer of the esophagus is frequently not identified on an esophagram. Endoscopy is needed for more complete evaluation.
Treatment is medical for more minor cases of gastroesophageal reflux. A fundoplication is a surgery done for more advanced cases where a fold of the stomach is wrapped around the lower part of the esophagus near the stomach. The esophagogram is therefore one piece of the testing done for gastroesophageal reflux disease. Often you will see a gastroenterologist for further management and testing.