the refluxate is indicative of duodenogastroesophageal reflux (DGER). A recent study showed that a significant number of persistent symptoms occurred in association with bile reflux as measured by Bilitec [71]. However, the limited availability of the Bilitec and the dietary restrictions that patients should follow during the test, make its future quite obscure. Barium esophagogram should be considered primarily in GERD patients that present with dysphagia [52]. The external anatomy of the esophagus and the proximal stomach can be visualized with an esophagogram. This can also show the type and size of an associated hiatal hernia. This diagnostic tool is reasonably accurate in cases of severe (98.7%) or moderate (86%) esophagitis, but it has a very low accuracy with mild esophagitis (24.6%) [72-74]. Moreover,