Gastroesophageal Reflux

  • Etiology: laxity of the gastroesophageal sphincter, gastric outlet obstruction
  • UGI: before beginning exam pull any nasogastric tube present up into the esophagus as a nasogastric tube can stent open the gastroesophageal junction and induce gastroesophageal reflux, contrast refluxing from stomach into esophagus, must describe how high reflux extends up into esophagus, determine whether patient has gastric outlet obstruction, realize the UGI study is only assessing for reflux for a few minutes out of a 24 hour day
  • DDX: gastric outlet obstruction
  • Complications: aspiration pneumonia, esophagitis resulting in esophageal strictures
  • Treatment: positioning during feeding, medicine, Nissen fundoplication
  • Clinical: present with vomiting with feeds or recurrent pneumonia, gold standard for diagnosis is 24 hour pH probe

Cases of Gastroesophageal Reflux

CXR of pH probe
CXR AP shows a catheter with markers on it projecting within the esophagus which represents a pH probe whose sensor port, which appears as a minus (-) sign, is in appropriate position 3-5 cm above the gastroesophageal junction
Upper GI of aspiration due to gastroesophageal reflux
Upper GI exam shows a markedly distended stomach with marked gastroesophageal reflux rising to the level of the oropharynx and entering into the trachea clearly outlining the trachea to the right of the esophagus on the AP image (left) and anterior to the esophagus on the lateral image (right).
Upper GI of esophagitis and esophageal stricture from gastroesophageal reflux
Lateral spot image from an upper GI shows multiple small ulcerations in the esophageal mucosa and a fixed tight narrowing of the distal esophagus in the middle of the image which never opened up during the exam. Gastroesohageal reflux was also demonstrated throughout the exam
Upper GI of malrotation with midgut volvulus
AP image from an upper GI shows complete obstruction of the duodenum at the junction of the second and third parts of the duodenum and associated massive gastroesophageal reflux. A final image taken 5 minutes later was unchanged.