Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children

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Abstract
Gastro-esophageal reflux can lead to peptic esophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anemia and failure to thrive. The anatomy of the esophago-gastric junction is described. The inferior esophageal sphincter is the main barrier to reflux, and marks the functional junction between esophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. A hiatus hernia can cause problems due to its bulk but the main problem of peptic esophagitis is due to gastro-esophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic esophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-esophageal junction remains the quickest, simplest and most convenient and safe technique as long as its limitations are appreciated.