Objective Gastro-oesophageal reflux (GER) is often reported on barium swallow studies. Our aim was to investigate whether GER on barium oesophagography (GERB) correlates with GER on pH-impedance monitoring (GERpH). Design Children who underwent both pH-impedance monitoring and barium studies between 2018 and 2022 were retrospectively identified at a high-volume tertiary paediatric hospital. All pH-impedance studies were independently reanalysed to extract acid exposure time (AET), number of reflux episodes, proximal reflux episodes, reflux-symptom association and mean nocturnal baseline impedance (MNBI). GERpH was diagnosed based on the Lyon Consensus 2.0 criteria and compared with GERB. Results Within the study timeframe, 90 children (median age 10 years (IQR 4–15 years), 56.7% female, median body mass index 17.6 kg/m 2 ) fulfilled inclusion criteria. Overall, GERpH was seen in 20 patients (22.2%) and GERB in 38 (42.2%) patients, with no differences whether testing was performed off (26.2% vs 38.1%, respectively, p=0.491) or on (18.8% vs 45.8%, respectively, p=0.716) acid suppressive therapy. Neither conclusive GERpH nor individual reflux metrics were associated with GERB (p≥0.157 vs no GERB). 10 patients had hiatal hernia (HH), of which nine (90%) had GERB (p=0.002 compared with no HH); four of these also had GERpH with 72 (IQR 37–92) reflux episodes compared with 68 (IQR 35–98) without HH (p=0.314). In fact, HH was associated with GERB only when GERpH was negative. Conclusions In a symptomatic paediatric cohort evaluated for reflux symptoms, GERB does not associate with objective pathological reflux. Barium studies cannot be substituted for oesophageal testing with endoscopy and/or ambulatory reflux monitoring for objective GERD diagnosis.
Davis et al. (Sat,) studied this question.