Barium studies should be first step in diagnosing complications from reflux disease surgery

May 07, 2003

Barium studies should be the first line of defense in diagnosing problems that can occur following surgery for reflux disease, a new study shows.

The study reviewed 53 patients who continued to have symptoms of reflux disease, even after they'd undergone surgery (laparoscopic fundoplication). All patients had a barium study (where the patient drank barium then had a series of x-rays), an endoscopy or a second surgery, says Frank Miller, MD, chief of body imaging at Northwestern University in Chicago, and one of the authors of the study.

Laparascopic fundoplication entails having part of the stomach wrapped around the distal esophagus to prevent the reflux from going into the esophagus. Forty-one of the patients had radiographic signs of unwrapping, and 12 were normal says Dr. Miller. Twenty-two patients had abnormal collections of contrast media noted on their x-rays. If the x-ray showed that the barium had collected above the diaphram, it was a strong indication that the surgically created wrap had come unwrapped, notes Dr. Miller. The barium studies were less reliable if there was abnormal contrast media collection below the diaphram, he says. Eighteen of these 22 patients were confirmed (by surgery or endoscopy) to have defects with their fundoplication, he says.

There were also signs of hernias on the x-rays, Dr. Miller says. Upper gastrointestinal barium studies detected 16 hernias, including three that were missed by endoscopy. Endoscopy, on the other hand, detected 10 hernias, with one that was not seen on the x-rays. One hernia was missed by both the barium study and endoscopy. The second surgery confirmed that 18 patients were suffering from hernias, Dr. Miller says.

Surgery for reflux disease has increased four-fold in the last decade, with more than 40,000 procedures done each year. As many as 30% of these patients need to be re-evaluated, because they have symptoms that indicate a possible complication, says Dr. Miller. "Because of this large increase in these types of surgery, and because of the rate of complications, it is essential that radiologists be aware of what to look for in these patients. Barium studies cost less and are easier on the patient," he says. "Our study indicates that it is also very effective in diagnosing complications. It is therefore a good first step in diagnosing complications from fundoplication," Dr. Miller says.

Dr. Miller's group will present the results of the study May 7 at the American Roentgen Ray Society Annual Meeting in San Diego.
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American College of Radiology

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