title: Evaluation of the Splash Time Test as a Bedside Test for Hiatal Hernia.
abstract: BACKGROUND
  Hiatal hernias may present with heartburn, acid regurgitation, dysphagia, chest pain, pulmonary symptoms and globus jugularis. Due to the heterogeneous presentation, there is a need for a simple diagnostic instrument when hiatal hernia is suspected. Hiatal hernia may impair esophageal bolus transportation. The splash time test is a rough measurement of esophageal bolus transportation, where time is measured from the start of swallowing a liquid bolus to the appearance of a "splashing" sound at xiphoid level. We aimed to test the hypothesis that the splash time test is prolonged in patients with hiatal hernia compared to normal subjects.
  
  
  METHODS
  In 30 patients with hiatal hernia, time was measured from swallow to splash using audiosignal recording. Thirty healthy subjects were used as controls.
  
  
  RESULTS
  Median time from swallow to splash was 4.9 seconds in the patient group and 4.4 seconds in the control group. Five patients, but none of the controls, performed swallows with absence of splash. Using only absence of splash as a pathological result, sensitivity was 23% and specificity was 100%.
  
  
  CONCLUSIONS
  The splash time test is not a sensitive instrument in diagnosing hiatal hernias. The absence of splash, however, seems to be a specific marker of hiatal hernia. Further research is needed regarding which other conditions besides hiatal hernia may cause absence of splash. The splash time test can be replaced by the even simpler "splash test".
authors: Department of Clinical Physiology, Blekingesjukhuset Karlskrona, Karlskrona, Sweden; Department of Clinical Physiology, Centralsjukhuset Vaxjo, Vaxjo, Sweden.
authors: Thomas Akesson
authors: TA
authors: Lindow
authors: Department of Surgery and Department of Clinical and Experimental Medicine, Linkoping University, Norrkoping, Sweden.
authors: Thomas
authors: T
authors: Franzen
keywords: Diagnostic test; Esophageal function; Esophagus; Splash time test; Swallowing