0
Education, Teaching, and Quality Improvement |

The Sensitivity and Specificity of Barium Swallow in Diagnosing Gastroesophageal Reflux in Patients With Chronic Cough

Scott Kopec, MD; Jingli Ma, MD; Joseph Ferrucci, MD
Author and Funding Information

University of Massachusetts, Worcester, MA


Chest. 2013;144(4_MeetingAbstracts):525A. doi:10.1378/chest.1703214
Text Size: A A A
Published online

Abstract

SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Gastroesophageal Reflux (GERD) is the third most common cause of chronic cough. Barium swallow study (BSS) is one of the most common tests ordered by clinicians when evaluating patients for GERD-induced cough. However, we know of no studies that explore the sensitivity or specificity of a BSS for diagnosis of GERD. We compared BSS to 24-hr esophageal pH/impedance probe monitoring to determine the sensitivity and specificity of BSS in diagnosing GERD.

METHODS: We retrospective review patients referred to our Cough Clinic from April 2012 to February 2013 for evaluation of possible GERD-induced cough. All patients had both BSS and 24-hr pH/impedance probe within a 48-hour time interval. All BSS were performed by a GI radiologist using a standard protocol, and were reported as either positive or negative for radiographic evidence of GERD. Patients then underwent fluoroscopic placement of an esophageal pH/impedance probe followed by monitoring for 24 hr. Any of the following findings from the 24-hr pH/impedance probe was considered abnormal and diagnostic for GERD: total number of reflux >73, number of acid reflux >55, number of non-acid reflux >27, pH<4 in distal esophagus >5.3% of the time, and/or Johnson/DeMeester score >22. We then calculate sensitivity, specificity, PPV and NPV of BSS, compared to data from 24-hr pH impedance studies.

RESULTS: A total of 44 patients had both BSS and 24-hr pH/impedance studies. There were 3 false positive, 14 true negative, 17 false negative and 10 true positive BSS. Sensitivity of BSS for predicting GERD was 37.0%, with a specificity of 82.4%, PPV 76.9%, and NPV 45.2%.

CONCLUSIONS: When compared to a 24-hr pH/impedance probe study, BSS has a poor sensitivity for diagnosing GERD in patients with cough. However, it is highly specific; when positive, it may be very helpful in confirming the diagnoses of GERD. A negative BSS does not rule out pathological GERD in patients with chronic cough.

CLINICAL IMPLICATIONS: Physicians should not rule out GERD as a cause of chronic cough in patients with a negative BSS.

DISCLOSURE: The following authors have nothing to disclose: Scott Kopec, Jingli Ma, Joseph Ferrucci

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543