Editor, – I refer to Professor Richard Smallwood's article 'The management of acid peptic disease' (Aust Prescr 1995;18:97-9).
Respectfully I disagree with Professor Smallwood's view that 'Barium studies are seldom (my emphasis) definitive and probably most helpful in locations where endoscopy is not readily available'. I find the first half of his sentence completely unacceptable and indefensible, and the second half discriminatory.
There are numerous excellent text books and scientific articles devoted to the particular and special ability to demonstrate gastrointestinal disorders conclusively with double contrast barium swallow and meal. This investigation, properly conducted with modern apparatus and techniques by an experienced gastrointestinal radiologist, will give similar results to those obtained at endoscopy in almost all clinically significant causes of dyspepsia.
There are a number of recent articles in the radiological literature1,2,3, confirming the value of double contrast barium meal in the specific diagnosis of Helicobacter pylori infection. This examination, when combined with non -invasive breath and serum testing, obviates the need for invasive endoscopy in this particular disorder.
In my opinion, the Health Insurance Commission, other third party payers and, no doubt, the NHMRC would welcome any reduction in costs, without significant loss of diagnostic efficacy, by the reintroduction of referred barium studies in place of self-referred endoscopy. As pointed out by Gelfand4 'if endoscopy had been performed for decades and radiological examinations had become available subsequently with their relative cheapness, negligible mortality and morbidity, minimal discomfort and high accuracy, then it is likely that radiology would be recommended as the desirable initial examination of the gastrointestinal tract'.
Gerald T. Davies
Radiologist
St Georges, S.A.
