Scintigraphy, Ph Measurement, and Radiography in the Evaluation of Gastroesophageal Reflux

Abstract

Scintigraphy as a diagnostic tool has been explored in 69 patients with gastroesophageal reflux (GER) symptoms and endoscopic esophagitis. In all subjects the presence of reflux was also evaluated by radiography and intraesophageal pH measurements (standard acid reflux test). The overall sensitivity of scintigraphy (85.5%) was significantly higher than those of radiography (27.5%) and pH measurements (69.5%). Scintigraphy was performed with normal saline and with acidified orange juice as the transport medium for the isotope 99mTc. The yield of positive scintigrams was higher (22.3 to 61.1%, depending on the grade of endoscopic esophagitis) with the latter variant. Moreover, demonstration of spontaneous reflux was greatly facilitated by the acid scintigraphy. This was particularly obvious in the grade I esophagitis, in which the frequency of spontaneous reflux with the saline method was 3.4% and with the acid medium, 34.3%. Reflux (induced or spontaneous) was seen in 2 of 22 normal control subjects with the saline method and in 1 subject only with the acid method. On the basis of these findings, it is concluded that scintigraphy, especially the acid variant of the technique, is a valuable diagnostic procedure in GER disease.

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

“…In 1984, Cargill in France found that scintigraphy could be used to evaluate the reflux of food in the development of pulmonary disorders 11 . 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 .…”

Esophageal smooth muscle reactivity is impaired in chronic reflux esophagitis by both receptor- and nonreceptor-mediated mechanisms

“…Disturbances in this series of events can result in various clinical symptoms and pathologic changes in the esophagus. Important esophageal motor function changes have been reported based on the pH monitoring and manometric, radiological, and scintigraphic studies in such patients [10][11][12][13]. For example, decreased peristaltic activity, increased nonpropulsive waves, irregular esophageal contractions, and diminished esophageal peristalsis were observed during GER episodes in previous studies [14,15].…”

Búsqueda de un sistema de priorización de la esófago-gastro-duodenoscopia en pacientes con síntomas de enfermedad por reflujo gastroesofágico y en otras situaciones clínicas

“…Hasta un 50 % de la población sana puede presentar hernia de hiato [83], por lo que su diagnóstico no implica padecer ERGE. Por otra parte, la mitad de los enfermos con ERGE sintomática no tienen hernia de hiato [84]. De esta forma, se asume que es una condición facilitadora pero no imprescindible ni necesaria en la ERGE [85].…”