Imaging

Gastroesophageal Reflux Disease (GERD)

Preliminary Diagnosis: Gastroesophageal Reflux Disease (GERD)

I. What imaging technique is first-line for this diagnosis?

Fluoroscopic guided double contrasted upper GI examination using effervescent granules, thick liquid barium, and a barium pill

II. Describe the advantages and disadvantages of this technique for diagnosis of GERD.

Advantages

  • Highly portable and quick procedure

  • Adept in localizing ulcerations, strictures, webs, stenosis, extravasation, or other complications from reflux disease

  • Gold standard in evaluating for gastroesophageal reflux disease

Disadvantages

  • Highly operator dependent

  • Exposes patients to ionizing radiation

  • Less adept in detailing the surrounding soft tissue and osseous structures

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

  • May be contraindicated in patients unable to take PO contrast; alternatively, contrast may be administered via NG tube

IV. What alternative imaging techniques are available?

  • CT evaluation of the abdomen with PO contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of GERD.

CT evaluation of the abdomen with PO contrast

Advantages

  • Offers exquisite detail of the surrounding soft tissue, vascular, and osseous structures

  • Better evaluates for any secondary complications than other imaging modalities

Disadvantages

  • Less portable

  • Does not allow a dynamic evaluation of the gastroesophageal motility

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

CT evaluation of the abdomen with PO contrast

  • May be contraindicated in pregnant patients

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