Abstract
Background The prevalence of gastroesophageal reflux disease (GERD) is increasing in Japan. Anti-acid secretion medication, such as H2-receptor antagonists and proton pump inhibitors, can effectively ameliorate its symptoms. Reflux esophagitis is usually diagnosed by endoscopic examination, but the degree of inflammation and the severity of subjective symptoms do not necessarily agree. Hiatal hernia and barium reflux, readily detectable in a barium meal study, may be associated with GERD symptoms. Methods Double contrast barium and gas upper gastrointestinal X-ray films and video tapes from 1680men and 580 women with an average age of 50.1 years, who attended a health appraisal program, were reviewed, concentrating, on hiatal hernia, barium reflux, and other findings suggestive of lower esophageal inflammation. The relationship between these X-ray findings and subjective symptoms, such as heartburn and dyspepsia, was then analyzed. Results On barium meal examination, a hiatal hernia was found in 19.6% of the time, and barium reflux was positive in 40.0% and 5.4% of the time in the prone right anterior oblique and flat supine positions, respectively. The presence of heartburn was significantly associated with hiatal hernia with an odds ratio of 3.5 (95% CI: 2.7-4.5), barium reflux in the prone right anterior oblique position of 3.6 (2.8-4.6) and in the flat supine position of 2.1 (1.3-3.2), and changes in the esophagus such as granular mucous image of 3.9 (3.0-5.2), thickened longitudinal folds of 2.5 (1.9-3.4), and small erosions of 2.8 (1.6-5.2). The association between these X-ray findings and other subjective symptoms, including dyspepsia and stomachache, was weak. Conclusion Hiatal hernia and gastroesophageal barium reflux on upper GI series, as well as esophageal changes suggestive of esophagitis, are significantly associated with heartburn.
