Is gastroesophageal reflux disease (GERD) with regurgitation and hoarseness of voice, awakening the patient from sleep, an indication for a Barium Swallow (esophagram)?

From the Guidelines

Yes, a barium swallow study is indicated for a patient experiencing heartburn with regurgitation and hoarseness of voice that awakens them from sleep. These symptoms suggest possible gastroesophageal reflux disease (GERD) with potential complications such as laryngopharyngeal reflux or aspiration. The barium swallow can help visualize the anatomy of the esophagus, identify structural abnormalities like hiatal hernias, detect esophageal strictures, and assess for reflux. The fact that symptoms are severe enough to disrupt sleep indicates a more serious condition that warrants investigation.

Key Points to Consider

• Before the procedure, the patient should fast for 6-8 hours.
• While waiting for the barium swallow, the patient might benefit from lifestyle modifications such as elevating the head of the bed, avoiding meals 2-3 hours before bedtime, and taking over-the-counter antacids or acid suppressants like omeprazole 20mg daily.
• However, these measures should not replace proper diagnostic evaluation.
• The barium swallow works by coating the esophagus with a contrast material that appears white on X-rays, allowing visualization of the esophageal contour and motility, which helps determine appropriate treatment for the patient's symptoms.
• According to the most recent study 1, extraesophageal reflux (EER) is a subset of gastroesophageal reflux (GER) that leads to troublesome symptoms/conditions that are not normally attributed to the esophagus, and diagnostic algorithms for EER are difficult because the manifestations of EER are heterogeneous and often overlap with other conditions.
• The study also suggests that patients with EER may not complain of heartburn or regurgitation; thus, the onus may lie on the clinician to determine whether acid reflux is a contributing factor of the symptoms.
• Another study 1 found that a modified barium swallow examination may be of benefit in this setting, particularly if structural abnormalities have been excluded by direct endoscopic visualization.
• The barium swallow can help identify structural abnormalities like hiatal hernias, detect esophageal strictures, and assess for reflux, which is essential in determining the appropriate treatment for the patient's symptoms 1.

From the Research

Heartburn with Regurgitation and Hoarseness of Voice

• Heartburn with regurgitation and hoarseness of voice are common symptoms of gastroesophageal reflux disease (GERD) 2, 3, 4, 5.
• These symptoms can be indicative of laryngopharyngeal reflux (LPR), a subtype of GERD that affects the larynx and pharynx 6.
• A study found that 21% of patients with voice hoarseness had LPR or LPR with GERD, and 79% of these patients reported symptom improvement with treatment 6.

Diagnostic Testing

• Diagnostic testing for GERD and LPR may include videostroboscopy, endoscopy, and pH monitoring 6.
• Barium swallow is not specifically mentioned as a diagnostic test for GERD or LPR in the provided studies.
• However, it may be used to evaluate the upper gastrointestinal tract and rule out other conditions that may be causing symptoms 2, 3, 4, 5.

Indications for Barium Swallow

• There is no direct evidence to suggest that heartburn with regurgitation and hoarseness of voice are indications for a barium swallow test.
• Further evaluation and diagnostic testing may be necessary to determine the underlying cause of symptoms and to guide treatment decisions 2, 3, 4, 5, 6.