Gastroesophageal reflux--reassessment of the value of fluoroscopy based on manometric evaluation of the lower esophageal segment.

The value of fluoroscopic gastroesophageal reflux examination by barium swallow was assessed in 51 symptomatic patients. Using electronic esophageal manometry, these patients were divided in groups with frank reflux, intermittent reflux, and symptoms of other etiology. Although a high incidence between presence of an hiatal hernia and manometric reflux (0.86) was apparent, fluoroscopy was only able to identify 33% of patients suffering from reflux disease diagnosed on clinical grounds and by electronic manometry. It is concluded that the fluoroscopic test is insufficient to separate patients with reflux disease from those with similar symptoms of other etiology which may be done reliably by esophageal manometry. The role of fluoroscopy is limited to the morphological evaluation of the gastroesophageal junction.