Diagnosis of Hiatal Hernia & Reflux
An upper GI series is often used to diagnose hiatal hernia. A barium swallow allows the radiologist to study the GE junction and detect the hernia and reflux of barium that was in the stomach back into the lower esophagus.
If the hernia is not detected in the upright position, which is the way most upper GI series are begun, it may be more obvious with the patient lying down. By watching the junction, an experienced radiologist can determine whether a hernia is present and whether there is reflux, and can evaluate the amount of damage to the esophageal lining.
Reflux can be difficult to detect using imaging tests. Often it is difficult to demonstrate actual reflux during the study. Some radiologists use various methods to demonstrate reflux such as, giving the patient water to drink to see if it will "siphon" the barium in the stomach back into the distal esophagus. In general, an experienced radiologist is able to put fluoroscopic images together with the films and make an accurate diagnosis.