Diagnostic Services
There has been a slow but steady decline in the volume of barium studies performed in the United States during the past 25 years. This trend is related to a variety of factors, including the increasing availability of endoscopy and advanced cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance (MR). As imaging has evolved, we see two possible scenarios for the future of barium radiology: The decline in gastrointestinal (GI) fluoroscopic procedures could continue and even accelerate, as the barium study becomes an increasingly obsolete tool in radiology practice, or, alternatively, the volume of GI fluoroscopic procedures could stabilize and even increase, as the barium study continues to be performed as a safe, cost-effective diagnostic test for patients with a gamut of GI conditions. The purpose of this editorial is threefold: (a) to consider the reasons for the continuing decline in barium studies nationwide and the effect of this trend on the quality of GI fluoroscopic procedures, (b) to review in general terms the role of barium studies in the diagnosis of GI disease and the reasons for continuing to use these studies in modern medical practice, and (c) to suggest strategies for rejuvenating the barium study.
The HSG helps the doctor check out two important factors: 
Barium radiology has been replaced to a large degree by a myriad of competing endoscopic and imaging tests. Endoscopy, manometry, and 24-hour esophageal pH monitoring are some of the diagnostic procedures that have supplanted barium esophagography for evaluating patients with dysphagia or reflux symptoms. Other patients with epigastric pain or dyspepsia are often treated with an empirical trial of antisecretory agents (usually proton pump inhibitors) followed by endoscopy rather than a double-contrast upper GI study if they fail to respond to medical treatment.