The acid-barium test as an index of intermittent gastro-oesophageal reflux.

Abstract

The common symptoms of gastro-oesophageal reflux are heartburn and regurgitation and these are often readily recognizable. Reflux is also one of the causes of several other symptoms, e.g. globus pharyngis, chronic laryngitis and pulmonary fibrosis, and the knowledge that reflux is present may be of paramount clinical importance in these conditions. Conventional radiographic tests of reflux during barium meal examinations are unreliable, and pH monitoring and manometric tests are not practicable for routine use. In the acid-barium test, oesophageal peristalsis is observed during perfusion with barium sulphate suspension containing 0·35 per cent hydrochloric acid (pH 1·7). Delayed emptying and non-peristaltic contractions are the indicators of a positive test. The test was done in 350 patients and the results compared with the clinical evidence of reflux. The test correlated only moderately well with the clinical features, mainly because of unexpected positive tests in patients without other evidence of reflux. The reasons for this are discussed, and it is concluded that although the test detects sensitivity of the oesophagus to acid perfusion, a positive test does not necessrily indicate symptomatic reflux. Within limitations the test is of value in concert with clinical and other radiological tests, and because of its simplicity and safety, may be a useful screening test in selecting patients in need of more sophisticated and tedious tests of oesophageal function.