To the Editor.—Hoffman and Vansant reported in the Archives (114:727-728, 1979) on "32 patients with gastrointestinal (GI) symptoms suggestive of reflux esophagitis," but they failed to identify those symptoms. They also failed to specify whether any of these patients were likely to have refluxed duodenal contents, as they would if previous peptic ulcer surgery had been performed.
There are only three tests that directly identify gastroesophageal (GE) reflux. These are barium swallow, pH probe, and GE scintiscan. Barium swallow is generally considered to be the least sensitive of these tests,1 so it was a surprise to learn that the authors believe otherwise. It is noted that "maneuvers were included to demonstrate evidence of GE reflux...." Again, Hoffman and Vansant were vague and did not indicate what these maneuvers were. If water siphonage was one such maneuver, it is a test that theoretically should induce GE reflux in everyone