Barium Esophagogram Case Study

pH measuring at the upper esophagealspincter, laryngoscopy, esophagoscopy and impedence testing are more definite as a diagnostic tool according to literature. Even empirical course of medical therapy has been listed as a more practical diagnostic tool.
REFLUX FINDING SCORE
As there is an apparent known association of laryngopharyngeal reflux and upper aerodigestive tract carcinoma, laryngeal examination is a must in all cases of suspected laryngeal pharyngeal reflux disease
In 2001 an endoscopic grading scale for laryngopharyngeal reflux disease was developed by Belafsky and colleagues. Based on eight findings that are graded on severity was made and it yields a score from 0 – 26
Subglottic edema - 0 (absent) 2 (present)
Ventricular edema - 2

ESOPHAGOGRAM
Barium esophagogram is an inexpensive, convenient and noninvasive diagnostic tool. It can also diagnose structural and functional abnormalities of esophagus, including hiatal hernia, strictures, esophageal ring, diverticula, esophageal shortening, erosive esophagitis, Barret’s esophagus, extrinsic compression motility disorders, cricopharyngeal spasm, possible malignancy and aspiration.
The significance of Barium studies before planning of antireflux surgery is proved without doubt. Fluoroscopic evaluation is often used to look for the presence of reflux, and is combined with provocative maneuvers, such as Valsalva’s maneuver, water siphon test (the patient is asked to drink 60 ml water through a straw in supine position and rolling from supine to the right lateral position. Barium esophagogram can detect GER with a sensitivity between 20% and 60%, a specificity of 64% to 90% and an accuracy of 69%. On addition of water siphon test the sensitivity of barium esophagogram in the evaluation of reflux increases to 70%, with a specificity of 74% and with 80% positive predictive value.
The relevance of Barium esophagography in patients with EER is less

These substances neutralize the pH of the stomach acid, and they can thereby prevent the tissue damage caused by bile salts and deactivate pepsin at a higher pH. Antacids have been shown to increase LES resting pressure. Antacids may be used as a first-line therapy in patients with minor EER or as an adjunct to other treatment modalities.
H2 blockers
H2 blockers act at the histamine type 2 receptor by competitive binding, and thereby reducing the gastric acid secretion along with pepsin production. H2 blockers may be used as a first line therapy in patients with minor EER, as adjunct therapy, or as step down therapy to wean patients from PPIs.
Proton Pump Inhibitors
PPI’s act against the enzyme hydrogen-potassium adenosine triphospatase in the parietal cell, thereby blocking the final step of gastric acid production. These drugs are more effective than H2 blockers for the long term reduction of basal and stimulated levels of gastric acid production. The PPI’s include pantoprazole,omeprazole, lansoprazole, rabeprazole, and