The role of contrast-enhanced ultrasound in the diagnosis of gastroesophageal reflux

OBJECTIVE: To assess the use of contrast-enhanced ultrasonography in the diagnosis of gastroesophageal reflux and hiatal hernia, avoiding ionizing radiation. MATERIAL AND METHODS: Seven contrast-enhanced esophagogastric ultrasound examinations were performed in children between 5 months and 3 years of age, 5 to evaluate gastroesophageal reflux and hiatal hernia, and 2 for gastroesophageal reflux. An ultrasound machine with specific software for contrast visualization, a multi-frequency probe, and sonographic contrast agent were used. Findings were correlated with upper gastrointestinal series in 4 cases. RESULTS: Of the 7 patients, 4 were awaiting percutaneous endoscopic gastrostomy (2 with a nasogastric tube and 2 with vomiting, 1 of them also with a nasogastric tube), and the remaining three had undergone surgery: 1 for hypertrophic pyloric stenosis, another for esophageal atresia, both also with vomiting; and the last was a patient with percutaneous endoscopic gastrostomy and suspected gastroesophageal reflux disease. The following were observed: 2 cases without gastroesophageal reflux, 4 with mild reflux on ultrasound (1 while coughing and another while crying) but not on fluoroscopy, and 1 with massive reflux and hiatal hernia. No side effects were reported. CONCLUSIONS: Contrast-enhanced ultrasound allows confirming or ruling out the presence of GER and hiatal hernia. Its great advantage is the absence of ionizing radiation and the possibility of a real-time study, making it easier to detect reflux.