Gastroesophageal Reflux Scintigraphy Research Articles

Does the Capsule Method Increase the Accuracy of the Detection of Ger by Scintigraphy Technique?

The scintigraphy technique is the most sensitive test for the detection of gastroesophageal reflux disease (GERD). Scintigraphy techniques employ two methods: the liquid method and the capsule method. In this prospective study, we are trying to find out the efficiency of the capsule method for gastroesophageal reflux scintigraphy over the liquid method and to determine the ease of execution of the technique and the interpretation of the results. A total of 65 symptomatic patients (age range: 7-71 years; mean age: 35.2 years) were included in the study. They were divided into two groups: group A, which included 18 patients who underwent the liquid method and Group B, which included 47 patients who underwent the capsule method. The average administered dose of 99mTc-labeled sulfur colloid was 11.1-18.5 MBq. The results showed that 45 (69.12%) of the 65 patients tested positive for GERD. Furthermore, 15 were positive in the liquid method and 30 in the capsule method. Grade III reflux was seen in 66.67% of patients, and 33.33% of patients with Grade II and I reflux were diagnosed using both methods. Thus, in conclusion, we can say that both liquid and capsule methods are equally sensitive for the detection of low as well as high refluxate volumes.

Infantlarda ve Çocuklarda Gastroözefagial Reflü Hastalığının Gastoözefagial Reflü Sintigrafisi ile Değerlendirilmesi

AbstractAim: Our goal was to evaluate the gastric emptying time in either reflux positive and negative children; and also the first reflux time, the number of reflux episodes in scintigraphy, reflux index (RI), and gastric emptying half time for liquids in infants and in children who were referred to our department for gastroesophageal reflux scintigraphy (GERS) with suspicion of gastroesophageal reflux disease (GERD).Material and Methods: Dynamic GERS images were first evaluated visually and then regions of interests (ROI) were drawn on esophagus, stomach and background. Time-activity curves were generated and obtained values were statistically evaluated.Results: Among 208 patients 38.5 % of the patients were reflux positive (80/208). There was a positive correlation between degree of reflux and gastric emptying half‐time (p<0.001, r= 0.274) and there was a negative correlation between the degree of reflux and the gastric emptying percentages (p<0.001, r= -0.259). There were no significant differences between first reflux time and the reflux grades of patients and also there were no significant differences between RI and reflux grades of patients (p>0.05). Conclusion: Our results show, in all groups, patients with high number of reflux episodes have longer gastric emptying half‐time with lower gastric emptying percentages. However, between groups, no significant difference was found in terms of gastric emptying percentage or gastric emptying half‐time. Consequently, independently of age groups, quantitative analysis of GERS should include both the visual analysis of the reflux and also the quantification of gastric emptying half time, gastric emptying percentage which may contribute diagnosis.

Scintigraphic evaluation of esophageal motility and gastroesophageal reflux in patients presenting with upper respiratory tract symptoms

Purpose of Study:The purpose is to evaluate the findings and utility of esophageal transit scintigraphy (ETS) and gastroesophageal reflux scintigraphy (GES) in patients presenting with upper respiratory tract (URT) symptoms suspected to be due to gastroesophageal reflux (GER) disease.Materials and Methods:Thirty patients aged between 19 and 60 years underwent nasopharyngolaryngoscopy (NPL), ETS, and GES. Correlation between GER, esophageal motility, and NPL was evaluated. Inclusion criteria include patients with recurrent URT symptoms such as chronic dry cough/hoarseness of voice and itching/foreign body sensation in throat. Those with typical gastrointestinal (GI) symptoms of GER, URT symptoms relieved by antibiotics, surgical intervention in abdomen, cardiac/hepatobiliary diseases, etc. were excluded from the study.Results:Significant correlation was found between GER and NPL in 28/30 patients. More the grade of reflux, more severe was the NPL findings. Two patients with Grade II reflux had normal NPL suggesting structural inflammatory changes due to acidic pH of refluxate which have not yet manifested or symptoms could be due to nonacid refluxate. Incidence of esophageal motility disorder was statistically significant in patients with GER disease (GERD). Patients who had symptoms, but no demonstrable GER showed delayed ET in supine position suggesting the presence of esophageal motility disorder even before GERD.Conclusion:GES demonstrated GER in patients presenting with URT symptoms without typical GI symptoms. ETS showed coexistence of esophageal motility disorder in most patients presenting with URT symptoms even without an associated reflux disease. We hypothesize that primary abnormal esophageal motility leads to delayed esophageal clearance and consequently to URT symptoms. Addition of ETS to GES is easily feasible with no significant additional cost, time, or radiation burden.

Scintigraphic Methods to Evaluate Alterations of Gastric and Esophageal Functions in Female Obesity

Objective: Altered gastrointestinal function has frequently been observed in obese patients. The aim of this study was to investigate the frequency of gastro-esophageal reflux (GER) and to determine the alterations of gastric emptying and esophageal transit by scintigraphic methods in obese patients.Methods: Scintigraphic studies of 50 obese female non-diabetic patients who had not received any treatment for weight control were retrospectively reviewed. Mean Body Mass Index (BMI) was 34.96±3.04 kg/m2 (range:32-39 kg/m2). All subjects were submitted to scintigraphic evaluation of esophageal transit, gastro-esophageal reflux, gastric emptying and presence of Helicobacter pylori infection. The data of obese patients were compared with those of sex-age matched 30 non-obese cases who were selected from our clinical archive.Results: In obese group, seventeen (34%) patients were found to be GER positive scintigraphically; mean gastric emptying time (t½) was 59.18±30.8 min and the mean esophageal transit time was 8.9±7.2 s. Frequency of positive GER scintigraphy and the mean value of esophageal transit time were significantly higher in obese patients than non-obese control subjects. Gastric emptying time and esophageal transit time values were significantly longer in GER positive obese patients than GER negative ones. There was no statistically significant difference in the frequency of positive C14 urea breath test between obese and non-obese subjects and there were also no statistically significant correlations between BMI, GER, esophageal transit time and gastric emptying time.Conclusion: In our study, 42 of the 50 obese patients had esophago-gastric motility alterations. The significance of these alterations in obesity is not fully understood, but it is believed that these changes could be because of potential contributing factors in the development or maintenance of obesity or changes in eating habits.Conflict of interest:None declared.

Tube Feeding Increases the Gastric-Emptying Rate Determined by Gastroesophageal Scintigraphy

The aim of this study was to determine whether tube feeding affects the rate of gastric emptying determined by gastroesophageal reflux scintigraphy in pediatric patients. Gastroesophageal reflux scintigraphy studies of 700 pediatric patients aged 1 week to 16 years were retrospectively analyzed. From these, 350 subjects received their study meal via a feeding tube, and 350 subjects received their meal as oral feeding. Gastric-emptying rate at 60 minutes was calculated, and the results compared. Stratification analysis for age, sex, and type and volume of administered meal was also performed. The average rate of the gastric emptying was higher in the tube feeding compared with oral feeding group (52.9% ± 17.9% vs 44.2% ± 15.1% gastric emptying at 1 hour, P < 0.01). The prevalence of fast gastric emptying, defined as greater than 50% emptying at 60 minutes, was also higher in the tube feeding group, being registered in 59.7% (209/350 cases) versus only 31.4% (110/350 cases) in the oral feeding group, P < 0.01. The difference persisted following stratification analysis for sex, age, and type and volume of ingested meal. Our findings show that tube feeding increases the rate of gastric emptying determined by gastroesophageal reflux scintigraphy in pediatric patients. The effect proved independent on such factors as sex, age, and type or volume of ingested meal.

Scintigraphic scoring system for grading severity of gastro-esophageal reflux on 99mTc sulfur colloid gastro-esophageal reflux scintigraphy: A prospective study of 39 cases with pre and post treatment assessment

Aim:The study aimed at developing a scoring system for scintigraphic grading of gastro-esophageal reflux (GER), on gastro-esophageal reflux scintigraphy (GERS) and comparison of clinical and scintigraphic scores, pre- and post-treatment.Materials and Methods:A total of 39 cases with clinically symptomatic GER underwent 99mTc sulfur colloid GERS; scores were assigned based on the clinical and scintigraphic parameters. Post domperidone GERS was performed after completion of treatment. Follow up GERS was performed and clinical and scintigraphic parameters were compared with baseline parameters.Results:Paired t-test on pre and post domperidone treatment clinical scores showed that the decline in post-treatment scores was highly significant, with P value < 0.001. The scintigraphic scoring system had a sensitivity of 93.9% in assessing treatment response to domperidone, specificity of 83.3% i.e., 83.3% of children with no decline in scintigraphic scores show no clinical response to Domperidone. The scintigraphic scoring system had a positive predictive value of 96.9% and a negative predictive value of 71.4%.Conclusion:GERS with its quantitative parameters is a good investigation for assessing the severity of reflux and also for following children post-treatment.

Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain

Myocardial perfusion imaging (MPI) with technetium-99m sestamibi (Tc-99m MIBI) is considered a diagnostic technique that is widely used for the investigation of suspected coronary artery disease. Incidental inspection of an extracardiac activity is indirect, but important marker, which can identify a potentially treatable non-coronary cause for chest pain that may mimic cardiac symptoms. Here, we present an illustrative case in which significant enterogastroesophageal reflux of Tc-99m MIBI occurred during the cardiac imaging following prompt hepatobiliary clearance. Because, there was normal myocardial perfusion on MPI, presence of gastroesophageal reflux (GER) on GER scintigraphy and detection of mild inflammation with pathologically confirmed hyperplastic polyp by endoscopy, in view of the above findings we concluded that the probable cause of chest pain was reflux.

Evaluation of the relationship between dental erosion and scintigraphically detected gastroesophageal reflux in patients with cerebral palsy

To evaluate the relationship between dental erosion (DE) and scintigraphically detected gastroesophageal reflux disease (GERD) in patients with cerebral palsy (CP). Materials and methods: Included in the study were 21 CP patients with dental erosion and a control group consisting of 16 CP patients without dental erosion (total of 37 children; 19 male, 18 female; mean age: 12.1 ± 2.8 years). The severity of DE was scored and all patients underwent gastroesophageal reflux scintigraphy. Results: The prevalence of GERD in patients with DE (78.9%) was found to be significantly higher than that in patients without DE (21.1%). The number of teeth affected by erosion was significantly higher in GERD+ patients than in GERD- patients within the DE group [median (quarters): GERD+, 14 (12-20); GERD-, 4 (4-4)]. In patients with DE, a significant correlation between the severity of erosion and the presence of GERD was observed [median (quarters): GERD+, 2 (1-3); GERD-, 1 (1-1)] and there was a statistically significant difference between the distribution of interference ratios in multisurface and 1- or 2-surface affected teeth (X^2 = 41.827, df = 1, P < 0.001). Conclusion: The current study has shown that there is a strong correlation between DE and GERD in children with CP.

Gastroesophageal reflux scintigraphy: interpretation methods and inter-reader agreement

Scintigraphic imaging is a useful screening tool for patients with suspected gastroesophageal reflux. New scintigraphic interpretation methods have recently been introduced. This study was undertaken to evaluate the efficiency of various scintigraphic interpretation methods in the detection of gastroesophageal reflux and to measure their influence on inter-reader agreement. Scintigraphic images of 49 children with suspected gastroesophageal reflux were interpreted by three different methods: visual interpretation, time activity curves, and condensed images. The readings were performed by three specialists and a resident. The discordant results were resolved by a consensus reading done together by all interpreters based on the three different methods. The gastroesophageal refluxes were grouped according to their number, location and intensity. Gastroesophageal reflux scintigraphy revealed 22 patients with negative results and 27 with positive results. The sensitivity, positive predictive value and specificity for each of the three specialists vs. the resident were 96%, 96% and 81% vs. 96%; 93%, 90% and 96% vs. 81%; and 90%, 86%, and 95% vs. 73%, respectively. The mean inter-observer reproducibility (κ value) was 0.910 for visual interpretation, 0.652 for time activity curves and 0.789 for condensed images. Twenty-seven percent of the results were discordant and most of these refluxes were of low grade (92%), low intensity (77%) and localization in the distal esophagus (54%). Gastroesophageal scintigraphy is a useful tool for detecting patients with suspected reflux, and visual interpretation is better than the other two methods in terms of accuracy and inter-observer reproducibility.

Does gastroesophageal reflux scintigraphy correlate with clinical findings in children with chronic cough?

Gastroesophageal reflux (GER), a common problem during childhood, leads to chronic troublesome symptoms including chronic respiratory symptoms. Therefore, timely diagnostic work-up for GER is essential in children when GER is suspected. In this study, we aimed to establish whether scintigraphic parameters have clinical importance in investigating the reflux in children. A total of 72 children older than 7 years with chronic cough of unknown etiology were enrolled for this study. The scintigraphic procedure was performed by using technetium-99m tin colloid (37-74 MBq). Cough and GER scores were used for children who were positive for GER both before and after GER treatment. Of 72 children, 65 children with a mean age of 10.3+/-2.3 (7-19) years had GER on gastroesophageal scintigraphy. Median reflux episode number was 7 (1-14). There was a significantly positive correlation between reflux episode number and cough (r = 0.446, P<0.001) and GER score (r = 0.432, P<0.001). The significant decrease was observed in cough (from 3.5+/-1.9 to 1.6+/-1.3) and GER scores (from 4.1+/-2.5 to 1.3+/-1.1) with GER treatment (P<0.001 for each). Scintigraphy should be used for the detection of GER in children who present with chronic cough. Increasing episode number in gastroesophageal scintigraphy might be a predictor for reflux-related symptom severity.

Análise da utilidade da pesquisa de aspiração pulmonar no exame de cintilografia para a avaliação de refluxo gastroesofágico

To evaluate the benefit of routine pulmonary imaging with a five hour delay in gastroesophageal reflux scintigraphy (GERS) to detect pulmonary aspiration. 755 cases were analyzed (400 men, 355 women) within a wide range of age (1 month up to 94 years, mean of 5.2 years). Presence of reflux, its frequency, severity, and esophageal extension were investigated. Delayed pulmonary images assessed the presence of radioactivity in the lungs. 307 cases of gastroesophageal reflux were identified, 84 of which with just one episode, 51 with 2 episodes, 45 with 3, 37 with 4, 18 with 5, and 72 with more than 5. Concerning severity of these 307 cases 22 had no evaluation, 179 were mild, 69 intermediate, and 37 severe. Degree of esophageal extension was not recorded for 6 cases; in 46 cases reflux covered the lower third of the esophagus, in 83 cases it reached the central third, in 161 the upper third, and in 11 cases it extended to the mouth. Delayed pulmonary images were available in 753 cases and none showed signs of lung aspiration. Delayed pulmonary images were negative in all cases regardless of the patients' age or severity of the disease. This is suggestive that either lung aspiration is rare in GERS procedures or delayed pulmonary imaging has a sensitivity that is too low to permit detection.

Relationship Between Gastric Emptying and Gastroesophageal Reflux in Infants and Children

The aim of our study was to evaluate the relationship between gastric emptying and gastroesophageal reflux (GER) in infants and children. One hundred eight patients (pts) between 3 months and 5 years of age (77 boys, 31 girls) with clinical suspicion of GER disease were included in the study. Patients were divided into 2 groups according to the age range: group A, 0-2 years (57 pts), and group B, 2-5 (51 pts) years. Each group was divided into 2 subgroups according to the scintigraphic study as GER-positive and -negative. Cow's milk with Tc-99m sulfur colloid as radiotracer was used. Gastric emptying was expressed as the half emptying time (T1/2). The detection of activity in the esophagus at any time during scintigraphy was considered an indicator of GER episodes. Reflux episodes were graded as grade 1 if activity was detected on one or 2 frames and grade 2 if activity was detected on more than 2 frames. Forty of the 108 patients (37%) had GER findings on scintigraphy. The comparison of gastric emptying time between positive GER scintigraphy and negative GER scintigraphy groups was not statistically significant in any age group. No association was found between age and rate of gastric emptying time. Although the comparison of T1/2 between grade 1 patients and the GER-negative group was not statistically significant, grade 2 patients showed significant differences and had prolonged gastric emptying times. Mild statistical correlation between the number of reflux episodes and gastric emptying half time was found. As a conclusion, the relation between gastroesophageal reflux and delayed gastric emptying cannot be ignored. Our results support delayed gastric emptying to be a pathogenetic factor in gastroesophageal reflux in infants and children.

Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease

The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD). The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy. GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (LA grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy. GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients.

Results of the gastroesophageal reflux assessment in wheezy children.

Gastroesophageal reflux (GER) is implicated in the pathogenesis of respiratory symptoms in childhood. It should be taken into account especially in the differential diagnosis of children presenting with wheezing. Although, oesophageal pH monitorization has been reported to be the best technique in the evaluation of GER, radionuclide studies have also been shown to be very sensitive recently. In this study, 82 children presenting with recurrent wheezing (n = 74) and/or vomiting (n = 28) (mean age 17.4 months; range 3-48 months) were evaluated. GER scintigraphy was performed to determine the frequency of GER. GER was determined in 18 of the 82 cases (21.9%). The GER was found in 21.1% of children with recurrent wheezing and in 16.6% of children suffering from recurrent vomiting. GER scintigraphy should be kept in mind in the evaluation of children with the complaint of recurrent wheezing since it is a noninvasive and easily applicable method.

Recent advances in pediatric nuclear medicine

This review is devoted to some controversial topics in the field of pediatric nuclear medicine. In most cases, drug sedation can be avoided and the nuclear medicine procedure can be successfully achieved simply by taking the emotional life of the child into account. Factors such as past negative experiences (painful procedures, hospitalizations), unfamiliar environment (frightening examination room), physical aggressions related to the nuclear medicine procedure (intravenous injections, cystography), and the feeling of loss of parents' protection all contribute to the child's anxiety. People in charge of pediatric procedures should be adequately trained to be aware of these factors and to create the best environmental conditions to avoid unnecessarily frightening the child. Methods for measuring renal clearance in children are numerous. It is my aim to review the different methods proposed in the literature, including the nonradioisotopic methods, the reference radioisotopic methods, the various simplified algorithms using blood samples, and the gamma-camera methods. Gastroesophageal reflux scintigraphy is a well-established procedure for the detection of gastro-esophageal reflux in children. However, despite the numerous advantages of this technique, it has not gained wide acceptance in the field of pediatric gastroenterology. This review focuses mainly on the comparison between scintigraphy and pH metry. Finally, the applications of 99m technetium-hexamethylpropylenamine brain single photon emission computer tomography in the field of pediatric neurology are still under development; this part of the review is an attempt to summarize the real contribution of this technique.

Evaluation of Reflux Episodes During Simultaneous Esophageal pH Monitoring and Gastroesophageal Reflux Scintigraphy in Children

SummaryGastroesophageal pH monitoring and reflux scintigraphy were simultaneously performed in 65 children, who were being investigated for suspected gastroesophageal reflux disease. The aim of the study was to compare, peak per peak, the information provided by the two techniques during a 1‐h simultaneous‐recording period. During this period, 123 reflux episodes were recorded with both techniques, but only six occurred simultaneously. Significantly more reflux episodes were recorded on scintigraphy (n = 88; p &lt; 0.05), particularly during the first half‐hour period (n = 62), if compared with the number of pH drops greater than 1 unit, even at pH levels higher than 4 (n = 41; p &lt; 0.05). It is concluded that the two techniques explore differently the reflux phenomenon.

Gastroesophageal reflux scintigraphy with radioactive capsules ? a new technique for detection and quantitation of reflux

A new technique for performing quantitative gastroesophageal scintigraphy has been described. The method involves administration of radioactivity in capsule form into the stomach; the isotope is released after dissolution of the capsule. The mean time of onset of capsule breakage was 3.3 min (range 2-5 min) and complete dissolution occurred by 6.0 min (range 5-8 min). The appearance of isotope activity in the oesophagus by means of cine scintigraphy was quantified by PDP 11/34 computer (Gamma-11) in terms of percentage of gastroesophageal reflux (GER). In 15 healthy subjects, the percentage of reflux (mean +/- S.D.) in the lower, middle and upper oesophagus was found to be 1.25 +/- 0.67, 0.26 +/- 0.23 and 0.02 +/- 0.04 respectively. We have studied 52 patients using this technique, and results are encouraging.

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

On the following paper by H.D. Fawcett, C.K. Hayden, J.C. Adams and L.E. Swischuk: How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

On the following paper by H.D. Fawcett, C.K. Hayden, J.C. Adams and L.E. Swischuk: How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?