A small amount of reflux is considered normal and is cleared by the secondary wave of peristalsis. Reflux beyond the aortic knuckle is likel...
A small amount of reflux is considered normal and is cleared by the secondary wave of peristalsis. Reflux beyond the aortic knuckle is likely to be symptomatic. Most patients with reflux have a hiatus hernia (because this reduces lower oesophageal pressure) or a wide GOJ. Not all hernias cause reflux. In the long term, reflux causes oesophagitis and Barrett disease.
BARIUM SWALLOW
• Contrast refluxes above the GOJ—best demonstrated in the prone position.
• Fixed, thickened transverse folds with ‘stepladder’ appearance of the distal oesophagus.
• Granular appearance of the mucosa with or without ulceration.
• Luminal narrowing.
• Schatzki ring (thought to be due to reflux)—a slender, symmetrical narrowing at GOJ, usually only symptomatic if the narrowing is <12 mm.
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