Gastroesophageal reflux - grading on barium study

In 1977, a grading system of gastroesophageal reflux on barium study was devised. It is based on the extent of retrograde flow of barium.

Grade Description
I reflux into distal esophagus only
II reflux extending above carina
III reflux into cervical esophagus
IV free persistent reflux into cervical esopagus with a wide open cardia (chalasia)
V reflux of barium with aspiration into the trachea or lungs
D delayed reflux - barium is seen in esophagus on delayed films


1. McCauley RG, Darling DB, Leonidas JC, Schwartz AM. Gastroesophageal reflux in infants and children: a useful classification and reliable physiologic technique for its demonstration. American Journal of Roentgenology 1978;130(1), 47-50.