Gastroesophageal Reflux Disease: Scintigraphic, Endoscopic, and Histologic Considerations

Abstract

Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes and in 43.7% patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently (p less than 0.05) in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis (p = 0.07). Fifteen of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation.

Correlation of Findings on Direct Laryngoscopy and Bronchoscopy With Presence of Extraesophageal Reflux Disease

“… 10 Combining tests can improve sensitivity. 11 For this reason, we chose to define the presence of GERD with positive results in any one of these four tests.…”

Patterns of food and acid reflux in patients with low‐grade oesophagitis—the role of an anti‐reflux agent

“…Later studies demonstrated that the use of acidified food increased the correlation between food and acid reflux, leading to the conclusion that gamma scintigraphy was detecting the reflux of neutral materials which could not be detected by pH monitoring 12 , . 13 By 1986, largely due to the work of Kaul and co‐workers, scintigraphic reflux could be detected in 92% and 79% of the patients with and without histologic evidence of oesophagitis 14 . By 1990, the lack of correlation between pH monitoring and reflux of radiolabelled gastric contents as measured by scintigraphy became accepted as accurate findings and the conclusion was drawn that extended pH monitoring and scintigraphy measured different pathophysiologic phenomena and they detected reflux under different conditions 3 , .…”

Impact of 24‐h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: Defining the gold standard

“…Each modality has advantages and limitations and there is no absolute gold standard for the diagnosis of GERD. Endoscopy has a sensitivity of only 30–50% in patients who present with typical heartburn 2–5 . This is because the majority of patients who present with classical symptoms of GERD may not have visible changes of esophagitis.…”