Esophageal Transit Time Research Articles

Radionuclide imaging for the assessment of esophageal motility disorders in mixed connective tissue disease patients: relation to pulmonary impairment

Esophageal functional abnormalities may lead to regurgitation, chronic esophagitis and life-threatening conditions such as aspiration pneumonia. In mixed connective tissue disease patients, previous reports showed that esophageal dysfunction varies according to the method employed for investigation. Our study was conceived to: (i) assess esophageal motility and mucosal aspects in patients with mixed connective tissue disease by endoscopy, cine-esophogram and scintigraphy focusing on the prevalence of each exam; and (ii) verify the association between pulmonary and esophageal dysfunctions. Twenty-four mixed connective tissue disease patients were enrolled for this study. Cine-esophogram and upper digestive endoscopy with mucosal biopsy were performed according to previous standardization. Radionuclide esophageal scintigraphy was performed with a semisolid meal with (99m)Tc. Eleven healthy individuals voluntarily submitted to scintigraphy as controls. Cine-esophogram showed esophageal delayed emptying in 90% of patients. At scintigraphy there was a significant delay in total esophageal transit time in the group of patients when compared to healthy controls (35.3 +/- 8.2 s. vs. 13.6 +/- 9.5 s.; P < 0.0001). The whole esophageal body showed dysmotility in 96% of patients. The cine-esophogram detected functional esophageal impairment similar to scintigraphic findings. Histopathologic examination found esophagitis in 95% of studied patients. Reduced lung volumes were associated with esophagitis and delayed esophageal clearance at scintigraphy, observed at the distal portion of the esophagus. Esophageal scintigraphy is easy to perform, with good acceptance by patients with low radiation exposition. It is a useful non-invasive test for follow-up and interventional studies concerning esophagus dysfunction.

Role of caffeic acid phenethyl ester, an active component of propolis, against NAOH-induced esophageal burns in rats

This study was evaluated to investigate the efficacy of caffeic acid phenethyl ester (CAPE), which is a natural honeybee product exhibits a spectrum of biological activities including anti-microbial, anti-inflammatory, antioxidant and anti-tumoral actions, on the prevention of stricture development after esophageal caustic injuries in the rat. Thirty healthy male Wistar albino rats were utilized in this study. The rats were randomly allotted into one of three experimental groups: group A (sham) animals were uninjured. Caustic esophageal burn was created by applying 1 ml 37.5% NaOH to the distal esophagus. Group B rats were injured but untreated. Group C rats were injured and received CAPE (10 micromol/kg/day i.p. for 28 days). Efficacy of the treatment was assessed by measuring the esophageal transit time, stenosis index, histopathologic damage score and biochemically by determining tissue hydroxyproline content, lipid peroxidation and antioxidant enzyme activities. The esophageal transit time, the stenosis index, histopathologic damage score and the hydroxyproline level were significantly increased in the untreated group compared with the sham and CAPE-treated groups. Treatment with CAPE decreased tissue hydroxyproline levels, histological damage, and the stenosis index, but except the esophageal transit time. Caustic esophageal burn also increased the lipid peroxidation and decreased the antioxidant enzyme activities in the untreated group. CAPE treatments decreased the elevated lipid peroxidation and also increased the reduced antioxidant enzyme activities. In corrosive esophageal burn group with no treatment, the most consistent findings were degenerative changes and increased in submucosal collagen content, and the luminal narrowing. CAPE treatment protected esophagus. Nevertheless, there was the slight increase in submucosal collagen. It is concluded that CAPE has a preventive effect on the stricture development after esophageal caustic injuries in the rat.

Esophageal transit of the weekly film-coated risedronate (Actonel ®) placebo tablet in subjects with Kyphosis

Risedronate sodium is a pyridinyl bisphosphonate of proven effectiveness for the treatment and prevention of osteoporosis and Paget's disease of the bone. The aim of this study was to compare the esophageal transit and gastric emptying of the placebo film-coated risedronate tablet when taken with 50 or 120 mL of water in subjects with Kyphosis. A total of 23 patients with radiologically documented osteoporosis participated in a single-center, open-label, crossover gamma scintigraphy study. The mean esophageal transit times were 15.6 s (50 mL) and 12.0 s (120 mL) and the mean gastric emptying half-times were 20.5 min (50 mL) and 14.3 min (120 mL). There was no relationship between the degree of Kyphosis measured from lateral standing radiographs and the esophageal transit time. This study demonstrated that even when taken with a minimal volume of water the esophageal transit and gastric emptying of the film-coated 35 mg weekly risedronate placebo tablet was similar in kyphotic subjects to previously obtained results from healthy control subjects.

New physiological method of evaluating oesophageal transit.

A method of measurement of oesophageal transit time in the upright posture of a chewed solid bolus has been developed and assessed in normal volunteers (n = 16) and in 32 patients with oesophageal disease: organic stricture (n = 5), oesophageal motility disorders (n = 19) and reflux oesophagitis without stricture formation (n = 8). The test involves swallowing a 10 ml poached egg white bolus labelled with 99mTc sodium pertechnetate and external scanning by a gamma camera. An on-line computer program allows detailed analysis by the condensed image technique (which demonstrates the pattern of oesophageal transit) and activity-time curves for the whole, the upper, middle and lower thirds of the oesophagus. The reproducibility of the test is good (coefficient of variation of the total transit of 14 per cent). The results on the normal volunteers have shown that oesophageal transit slows in an aboral direction with transit being faster in the upper, when compared with the middle and lower thirds. The test clearly differentiates patients with oesophageal disease from the normal. The condensed image analysis appears to be useful in outlining the pattern of transit in patients with motility disorders. Patients with reflux oesophagitis have delayed oesophageal transit.

Oesophageal transit of marshmallow after the Angelchik procedure.

The oesophageal transit time of half a marshmallow was measured radiologically in 17 controls, 28 patients with gastro-oesophageal reflux pre-operatively, 36 patients soon after implantation of the Angelchik prosthesis (2-9 weeks) and in 23 patients later postoperatively (9-48 months). Sixteen postoperative patients also underwent oesophageal manometry. All control and pre-operative patients had a marshmallow transit time of less than 1 min; 67 per cent of the early postoperative patients had prolonged transit and 70 per cent of the late tests were similarly abnormal. Prolonged oesophageal transit as measured by marshmallow swallow correlated well with symptoms of solid food dysphagia. Most, but not all, patients with an abnormal marshmallow swallow had abnormal manometric findings. The oesophageal transit of solid food is significantly slowed after the Angelchik procedure and this is not a transient postoperative phenomenon.

To Study the Incidence of Barrettʼs Esophagus in Patients with Liver Cirrhosis

Purpose: GERD is increasing in the general population. In cirrhotic patients, incidence may even be higher because of the use of alcohol, presence of ascites and use of drugs like beta-blockers, which reduce the LES pressure. de la Pena et al showed that the sclerosant used for sclerotherapy provokes GERD. COX-2 gene is overexpressed in patients with cirrhosis and hypothetically may worsen GERD (Grover et al). In patients with esophageal varices, esophageal transit time is delayed and GERD is common in up to 64% of the patients (Fass R et al). Sclerotherapy can decrease the mean amplitude of esophageal contractions and normal peristalsis may be occasionally replaced by non-propagating simultaneous contractions that may cause chest pain and/or dysphagia in the absence of stricture. Cirrhotics have screening EGD's to evaluate for esophageal and gastric varices. The investigators have noted an increased incidence of high-grade dysplasia in cirrhotics. We hypothesize that there may be an increased risk of Barrett's esophagitis in patients with cirrhosis. Methods: Inclusion criteria: All patients with biopsy proven cirrhosis who underwent EGD's at UMass between 1/1/98 to 6/30/03 and control patients who underwent EGD in the month of April 2004 for any other indication. Exclusion criteria: Inability to find the patients in the Meditech system. Also, patients with known Barretts who presented for a surveillance EGD were excluded. Data collection: 249 cirrhotics and 153 controls met the criteria. The control group was divided into two groups, namely subjects with symptoms of GERD (pain, heartburn) and those with all other indications for the EGD. Results: In the cirrhotic group(ages 17 to 82 years, 80 females,168 males), 19/249 had endoscopic appearance of Barretts esophagus, with 14/19 having had a biopsy. 8/14(3.2%) patients had biopsy findings consistent with Barretts esophagus. In the controls with GERD symptoms (ages 29–80 years, 26 females, 10 males), 2/37 had endoscopic Barretts, with 1 with positive biopsy (2.7). In the third group (ages 22–83 years, 51 males and 54 females), 3/105 had endoscopic appearance but only 1/3 (0.95%) had biopsy proven Barretts. Conclusions: This data supports the hypothesis that patients with cirrhosis may be at increased risk of developing Barretts esophagus. A larger, prospective study is needed. If this relationship can be proven, it might become a standard of care to regularly screen cirrhotic patients for Barretts esophagus.

Effects of radiation therapy on oesophageal transit in patients with inner quadrant breast tumour

The aim of this study was to evaluate quantitatively the effect of low doses of radiation therapy on the oesophageal transit in patients with inner quadrant breast carcinoma. Eighteen female patients with locally advanced inner quadrant breast tumour were included in this study. A total dose of 5000 cGy in 25 fractions of 200 cGy was applied from four different treatment portals to all patients. Oesophageal motility was evaluated before and immediately after radiotherapy using oesophageal scintigraphy. The oesophageal transit times (ETTs) for the upper one-third, the lower two-thirds portion and the whole oesophagus were calculated. The upper one-third portion of the oesophagus received a mean dose of 600 cGy and the lower two-thirds portion received a mean dose of 1530 cGy as a result of 5000 cGy dose application. All of the patients developed grade 1 oesophageal toxicity. Post-radiation therapy ETT values were significantly higher compared to pre-radiation therapy ETT values (P<0.001). Before irradiation, ETT values for the upper one-third, distal two-thirds of the oesophagus and the whole oesophagus were 4.77+/-1.08, 11.22+/-2.85 and 11.61+/-2.97 s, respectively. After irradiation, ETT values for the upper one-third, distal two-thirds of the oesophagus and the whole oesophagus were 6.92+/-2.15, 23.30+/-5.65 and 23.74+/-5.70 s, respectively. Oesophageal transit seems to be affected by radiation even without a clinically significant oesophageal symptom and oesophageal scintigraphy allows sensitive, non-invasive and quantifiable assessment of the oesophageal transit time.

Therapeutic efficacy of isosorbide dinitrate for dysphagia after endoscopic injection sclerotherapy for varices in cirrhotic patients

Background: Isosorbide dinitrate (ID) improves dysphagia of achalasia patients by lowering the low esophageal pressure. Dysphagia occurs in cirrhotic patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices even with no structural abnormalities as its sequela. We tested whether ID can be therapeutic for dysphagia of this type.Methods: ID was given for 2–6 weeks to 13 patients with dysphagia lasting for longer than 4 weeks after EIS despite no esophagolumenal stricture on endoscopy and barium swallows. EIS was done three to six times as an injection series of ethanolamine oleate into the varices at intervals of 1–2 weeks until they were obliterated. The therapeutic efficacy of ID was evaluated by symptom severity four‐degree scorings. Esophageal transit time and emptying time were calculated from the time–activity curves on esophageal scintigraphy.Results: At 2 weeks after ID medication, dysphagia was decreased by one score in 12 of 13 patients, and by two scores in one patient. However, dysphagia at the same extent recurred in nine patients within 6 weeks after stopping ID medication, which was improved similarly by remedication. Two patients in whom dysphagia of one and two scores disappeared after ID medication dropped out because of headache. The remaining two patients remained asymptomatic for longer than 6 months after the first medication. Esophageal scintigraphy disclosed the shortening of the emptying time after ID administration in two patients.Conclusions: ID may be effective for relieving functional dysphagia after EIS for esophageal varices in cirrhotic patients.

Endoskopische Injektion von Botulinumtoxin A bei einem Patienten mit diffusem Ösophagusspasmus

A 67-year-old man complained of recurrent retrosternal pain for 3 - 5 minutes as the only symptom for 3 - 4 years. Only when dysphagia occurred in the course of the disease was a gastroenterologist consulted. The diagnosis of diffuse esophageal spasm was confirmed by esophageal manometry and radiology. Upper gastrointestinal endoscopy revealed no further pathological findings. 100 units of botulinum toxin were injected in 10 divided doses, into the tubular esophagus, 1 cm apart, beginning at the z-line of the gastroesophageal junction, deeply into the muscular coat of the posterior part of the esophageal wall. This achieved improvement of symptoms as well as esophageal transit time measured by scintigraphy. The symptomatic benefit has now lasted for several months. The treatment of patients with diffuse esophageal spasm with botulinum toxin is a promising therapeutic option, which can be safely performed in such patients. But this regime needs evaluation in controlled prospective clinical studies.

Saliva transport to the distal esophagus

Objective. During esophageal acid clearance, saliva should reach the most distal esophagus. The mechanisms responsible for saliva transport are not completely understood but it is assumed that normal peristalsis plays a significant role. The aim of this study was to assess the role of esophageal peristalsis and gravity in saliva transport to the distal esophagus. Material and methods. Esophageal transit and presence times of a 2-ml bolus of radiolabeled artificial saliva were assessed using concurrent scintigraphy and manometry in 10 healthy volunteers in the upright and supine positions before and after disruption of esophageal motility with sildenafil (50 mg). Results. With normal peristalsis, there was no difference in saliva transit to the distal esophagus between supine and upright positions 3.9 (1.5– > 60.0) versus 3.3 s (1.3–8.3). Low amplitude contractions did not affect saliva transit but the disappearance of contractions after sildenafil was associated with prolonged saliva transit in supine position 7.4 (1.0– > 60.0). Saliva presence time was significantly prolonged in both the upright and supine positions by esophageal dysmotility. Conclusions. Saliva transport to the distal esophagus does not require complete normal peristalsis or gravity and mainly depends on an efficient pharyngeal pump. However, subjects in supine position with severe esophageal dysmotility might have both impaired volume clearance and delayed saliva transport, leading to abnormal acid clearance and esophagitis.

Correlation between percentage of lower esophageal sphincter relaxation and response of technetium esophageal transit time to isordil in idiopathic achalasia

Generally the waters of the Ria Formosa Lagoon, Portugal have a short residence time, in the order of 0.5 days (Tett, P., Gilpin, L., Svendsen, H., Erlandsson, C.P., Larsson, U., Kratzer, S., Fouilland, E., Janzen, C., Lee, J., Grenz, C., Newton, A., Ferreira, J.G., Fernandes, T., Scory, S., 2003. Eutrophication and some European waters of restricted exchange. Continental Shelf Research 23, 1635–1671). This estimation is based on the measurements of currents and the modelling of water exchange at the outlets to the ocean. However, observations of the temperature and salinity in the inner channels imply that residence time is greater in these regions of the lagoon. To resolve this apparent contradiction, spatial measurements of the temperature and salinity were made with a meter for conductivity, temperature and depth along the principal channels of the western portion of the lagoon, with a sampling frequency of two per second. Evaporation rates of 5.4 mm day−1 were measured in a salt extraction pond adjacent to the lagoon and used to determine the residence time through salinity differences with the incoming seawater. In June 2004, the water flooding in from the ocean had an average salinity of 36.07 which contrasted with a maximum of 37.82 at mid ebb on a spring tide, corresponding to a residence time of >7 days; the mean residence time was 2.4 days. As the tide flooded into the channels, the existing water was advected back into the lagoon. Although there was a small amount of mixing with water from another inlet, the water body from the inner lagoon essentially remained distinct with respect to temperature and salinity characteristics. The residence time of the water was further prolonged at the junction between the main channels, where distinct boundaries were observed between the different water masses. As the water ebbed out, the shallow Western Channel was essentially isolated from the rest of the outer lagoon, and the water from this channel was forced down the Ramalhete Channel, from where it was unable to exit the lagoon in one tidal cycle due to the extensive path length of ∼14 km to the sea.Although the overall exchange rate of water is short in the outer lagoon, this study emphasizes that management models should take into account additional complexities that might arise from the much longer exchange rates of the inner lagoon. For example, the principal sewage discharge for the urban area of Faro is into the section of the Ramalhete Channel where efficient flushing is impeded by the relatively high residence times of the water body in this channel.The implementation of the techniques used for this study are a quick and relatively cost effective approach to testing assumptions about water quality and exchange in shallow coastal systems.

Oesophageal scintigraphy for the investigation of dysphagia: in ans out of favour - underused when available.

Oesophageal scintigraphy has been used for more than 25 years and allows quantifiable, safe, rapid, non-invasive and well-tolerated assessment of oesophageal transit time and function. As technology improves, more complex image analysis is becoming possible. Many studies have addressed its usefulness in assessing oesophageal dysmotility using manometry as the gold standard: this literature is reviewed with reference to both the sensitivity and the specificity of the test as well as its application and effectiveness in various disease states. The use of scintigraphy in oesophageal cancer is specifically addressed - including in co-existing dysmotility.

Early esophageal transit study after laparoscopic fundoplication: how useful is it?

Background: Early complications of laparoscopic fundoplication, if immediately recognized, may be promptly treated laparoscopically with minimal morbidity. A suggested strategy for identification is a routine postoperative esophageal transit study. Objective: To investigate the role of early postoperative esophagogram with Gastrografin in predicting major complications, failures, or severe dysphagia. Design: Esophagograms performed in 92 patients, 24 hours after laparoscopic fundoplication, were correlated to major complications. Esophageal transit time was scored and correlated with dysphagia. Results: Esophagogram detected two of three observed complications: acute paraesophageal hernia and intrathoracic migration, but not a fundic perforation. Only a severe transit impairment predicted a disabling dysphagia (specificity 82%, sensitivity 70%). Conclusions: Postoperative swallow is an appropriate investigation to diagnose anatomical abnormalities but may be deceptive for perforations. Severe transit delay may predict the risk of severe dysphagia. Although useful, postoperative routine transit studies would probably not change the therapeutic strategies in most patients.

Monitoring esophageal transit of wax-polished alendronate in healthy postmenopausal women: A new technique for the study of pill transit time

Background: Alendronate sodium is an oral nitrogen-containing bisphosphonate that has been proven effective in the prevention and treatment of osteoporosis. Although adverse events are no more common with alendronate than with placebo in clinical trials, there have been postmarketing case reports of esophagitis and esophageal erosions in alendronate-treated patients. Delay in the transit of the tablet through the esophagus may contribute to the development of upper gastrointestinal (GI) symptoms, but few published techniques exist for the study of esophageal pill transit. Objective: The purpose of this pilot study was to describe a novel method to investigate the esophageal transit time of pills, using alendronate as a model. Methods: A total of 30 bisphosphonate-naive, healthy postmenopausal women were administered alendronate 10-mg, oval wax-polished tablets labeled with technetium Tc 99m pertechnetate. Simultaneous emission/transmission images were acquired at 1 second per frame. Two measures of esophageal transit time were calculated from the images: time to pass below the diaphragm and time-activity curves in a region of interest (ROI) drawn over the esophagus. Results: Median transit time from oropharynx to below the diaphragm was 3 seconds (range, 2–6 seconds). Using the ROI technique, median transit time for the whole esophagus was 5 seconds (range, 2–17 seconds). In 25 of 30 subjects (83%), esophageal transit time was ≤6 seconds. In the 5 subjects in whom transit time was ≥6 seconds, virtually all of this time was in the distal third of the esophagus; transit through the proximal two thirds was ≤3 seconds in all 30 subjects. Conclusions: As measured by this technique, oval wax-polished alendronate tablets pass through the esophagus rapidly. This technique could be used to investigate the effect of tablet shape or coating on esophageal transit as well as changes in dosing regimens for patients with normal or abnormal upper GI anatomy.

The use of scintigraphy to demonstrate the rapid esophageal transit of the oval film-coated placebo risedronate tablet compared to a round uncoated placebo tablet when administered with minimal volumes of water

As our population ages, and the consumption of pharmaceutical products rises, the incidence of solid oral dosage forms lodging in the esophagus is likely to increase and may be formulation dependent. The aim of this study was to compare the esophageal transit of the commercial film-coated risedronate tablet and a round uncoated tablet resembling the alendronate 10 mg tablet which is reported to cause esophagitis if ingested with little to no water. Water volumes of 30 ml and 50 ml were selected as these volumes can detect formulations prone to esophageal adhesion and a habits and practice study showed that these volumes are within the range preferred by women (7–385 ml). A total of 28 healthy postmenopausal women completed the four-way crossover scintigraphy study. For both volumes of water, the film-coated placebo risedronate tablet had a statistically significant faster esophageal transit time than the uncoated placebo tablet ( P=0.002 for 30 ml water and P<0.001 for 50 ml water). Among those taking the round, flat, uncoated tablet, five subjects had esophageal stasis (transit >20 s) and in three subjects the tablet remained in the esophagus at the end of the 10-min imaging period. No stasis was observed for the oval film-coated placebo risedronate tablet. This study demonstrates that tablet size, shape and coating are pharmaceutical parameters which can be controlled to minimize esophageal contact of a dosage form with esophageal tissue.

Evaluation of esophageal transit time in patients with diabetes by esophageal scintigraphy

Evaluation of esophageal transit time in patients with diabetes by esophageal scintigraphy

Digital Radiography in the Evaluation of Oesophageal Motility Disorders

AIMS: To develop a simple technique for examination of the oesophagus by digital radiography and to assess its role in the evaluation of motility disorders of the oesophagus.MATERIALS AND METHODS: Forty-nine patients and 44 control subjects underwent manometry and digital examination of the oesophagus. The digital study consisted of two parts: firstly examination of the pharynx and cervical oesophagus using 15ml of fluid barium in anterio-posterior (AP) and lateral views, with image acquisition of four frames/s for 2s. Secondly, examination of the thoracic oesophagus and oesophagogastric junction using 25ml of barium in two prone oblique and one supine AP series, with image acquisition of one frame/s for 20s. Oesophageal transit time (OTT) was measured in each case. Abnormal or non-peristaltic contractions were described regarding their morphology, time of visualization and length. The presence or absence of hiatal hernia, reflux or any associated organic lesions was noted.RESULTS: Digital radiography diagnosed 14 cases of achalasia and 28 cases of non-specific oesophageal motility disorder (NOMD). Normal OTT was 11.95±1.304s. The OTT was prolonged (16s or more) in all patients except five; four of these were cases of NOMD. Abnormal contractions were classified into circular and longitudinal types. The circular non-obliterating type was commoner. Achalasia was diagnosed in all cases, as failure of relaxation of the inferior oesophageal sphincter was always present and easily depicted by digital radiography. Abnormal contractions in the body of the oesophagus were elicited in 57% of cases of achalasia. The sensitivity of digital radiography in detecting oesophageal motility disorders was 85.7% based on the presence of abnormal contractions and 91.6% by eliciting a prolonged OTT.CONCLUSIONS: Examination of the oesophagus by digital radiography is simple, non-invasive, reproducible, rapid and without discomfort to patients. It allows the diagnosis of motility disorders of the oesophagus by detecting abnormal contractions and/or prolonged OTT and showed any associated organic lesions.Aly, Y. A. (2000). Clinical Radiology55, 561–568.

Esophageal transit of capsules in clinically normal cats.

To evaluate the esophageal passage of capsules in clinically normal cats and determine the incidence of prolonged transit or entrapment. 12 clinically normal adult cats. Esophageal transit of barium sulfate-filled capsules was evaluated fluoroscopically. Each cat was examined 3 times (36 examinations). Esophageal transit times were classified as normal (< or = 30 seconds) or prolonged (> 30 but < or = 240 seconds). Capsules were considered entrapped when transit times were > 240 seconds. Transit times were normal in 10 of the 36 (27.8%) examinations, whereas times were prolonged in 7 (19.4%) examinations. Capsules became entrapped in the midcervical region of the esophagus during 19 (52.8%) examinations. Following termination of each examination, cats with entrapped capsules were fed a small amount (0.5 to 1 ounce) of food; this resulted in passage of the capsule to the stomach. The possibility of medication-induced esophagitis should be considered when orally administering ulcerogenic drugs to cats. It is recommended that a small volume of food be given following medications to ensure complete esophageal clearance.

Standards for non-invasive methods for gastrointestinal motility: Scintigraphy. A position statement from the Gruppo Italiano di Studio Motilità Apparato Digerente (GISMAD)

Scintigraphic techniques are well established methods to assess gastrointestinal transit patterns. The main advantages are represented by the possibility to evaluate, in a relatively non-invasive manner, the transit time of specific components of physiological meals as well as of some digestive secretions. These techniques are generally well accepted by the patients and results are largely not operator dependent. Their main limitation is the use of a radioisotope, that prevents repeated applications in all subjects and immediate exclusion of women of childbearing potential. Due to the high costs of these tests and the limited availability of Nuclear Medicine Departments, scintigraphic techniques should be reserved for well-selected patients. A review is made of the technical requirements and indications for scintigraphic tests currently available for clinical purposes (gastric emptying study, oesophageal transit time, evaluation of gastro-oesophageal reflux, intestinal and colonic transit time, evaluation of biliary motility and of duodenogastric reflux).

Evidence of Abnormal Esophageal Motility in Syndrome X by Radionuclide Esophageal Transit Test

In 30 patients with syndrome X, esophageal motility was evaluated by radionuclide esophageal transit test (RETT). Esophageal motility measurements included esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI). In comparison with 25 age- and sex-matched healthy volunteers, 66% of the patients with syndrome X had abnormal RETT findings including 50% of cases with longer MTT, 50% of cases with higher RF, and 33% of cases with higher RI. In addition, the mean values of MTT, RF, and RI in patients with syndrome X were significantly higher than those of healthy volunteers. We conclude that abnormal esophageal motility occurred in a large portion of syndrome X patients based on an simple and noninvasive RETT.