Refined barium X-ray test for acid reflux disease and GERD involves the patient swallowing some barium very quickly and then the esophagus is distended with gas from a fizzy powder.

In a variation on this technique, you are asked first to swallow a tablespoonful of alkaline solution, then about half a cup of barium, a tablespoon of an acid solution, and three drops of a ‘bubble-breaker’. Double-contrast X-rays show the lining of the esophagus in great detail, even highlighting small ulcers. The radiologist has a very clear picture of the extent of the reflux and how much damage it has done to the esophagus.

So barium swallow X-rays are still of value. However, few patients are now subjected to the measurements of pressure or acid inside the esophagus that I wrote about in detail when first writing about hiatus hernia in 1997 (Coping Successfully with Your Hiatus Hernia, Sheldon Press). These tests are now virtually restricted to volunteers in research programs, and patients can be thankful that they are, because they were quite difficult to tolerate.

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