technetium-tc-99m-disofenin and Duodenal-Ulcer

Alkaline reflux gastritis is a clinical syndrome that results from a mucosal injury by duodenal contents. In this study, the amount of duodenogastric reflux was assessed in patients who previously underwent proximal gastric vagotomy (PGV group; n = 11) and PGV plus duodenoplasty (PGV+D group; n = 10) as a treatment for duodenal ulcer. The control group (A) consisted of 11 healthy volunteers without endoscopic abnormalities. A quantitative index of duodenogastric reflux was obtained in each case by determining the percentage of the injected dose of 99mTechnetium-DISIDA that was recovered by continuous aspiration of gastric juice in fasting subjects. In the PGV group, the percentage of administered 99mTechnetium-DISIDA recovered from the stomach (median: 0.69%; range: 0.09%-3.61%) did not differ significantly (P > 0.05) from that of the PGV+D group (median: 0.49%; range: 0.09%-3.91%) and from that of the A group (median: 1.47%; range: 0.22%-3.01%). The results show that proximal gastric vagotomy plus duodenoplasty did not increase duodenogastric reflux.

Topics: Duodenal Ulcer; Duodenogastric Reflux; Duodenum; Female; Humans; Imino Acids; Male; Organotechnetium Compounds; Reference Values; Reoperation; Technetium Tc 99m Disofenin; Vagotomy, Proximal Gastric

Complete reflux of duodenal contents into the stomach with persistent retention on hepatobiliary scintigraphy or radionuclide gastrointestinal bleeding studies is a relatively rare occurrence. Two cases of complete duodenogastric reflux are reported: one case in a patient with a perforated duodenal diverticulum and the other in a patient with an inflamed, bleeding duodenal ulcer. The finding of complete duodenogastric reflux and persistent retention in the stomach should instigate a thorough evaluation for significant duodenal pathology.

Topics: Adult; Aged; Diverticulum; Duodenal Diseases; Duodenal Ulcer; Duodenogastric Reflux; Erythrocytes; Female; Humans; Imino Acids; Intestinal Perforation; Male; Organometallic Compounds; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

The amount of enterogastric biliary reflux was assessed in patients who previously underwent Henley operation (n = 8) or Roux-en-Y biliary diversion (n = 7) using the radiopharmaceutical 99mTechnetium-DISIDA. Two other groups were investigated: a control group consisting of patients with unoperated duodenal ulcer (n = 10) and a group of patients who underwent Billroth II gastrectomy (n = 7). The length of the interposed segment of jejunum ranged from 20 to 30 cm (median of 22.5 cm) in the Henley patients, and from 30 to 60 cm (median of 40 cm) in the Roux-en-Y group. In Henley patients, the percentage of administered 99mTechnetium-DISIDA that was recovered from the stomach (median of 0.92%) was lower (p less than 0.01) than that obtained for Billroth II patients (median of 32.28%) and did not differ (p greater than 0.10) from that of the Roux-en-Y (median of 0.36%) and duodenal ulcer groups (median of 2.53%). These results indicate that Henley operation is as effective as Roux-en-Y diversion in promoting the reduction of the amount of enterogastric biliary reflux that follows Billroth II distal gastrectomy.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Bile Reflux; Biliary Tract Diseases; Duodenal Ulcer; Duodenum; Evaluation Studies as Topic; Female; Gastrectomy; Gastrointestinal Contents; Humans; Imino Acids; Jejunum; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

There are several methods for detection of bile in the stomach, but none has proven satisfactory. It appears that the scintigraphic study with quantitation of duodenal-gastric reflux after corrections for the overlap of the stomach by the liver and bowel is more reliable, noninvasive, and physiologic. Fifty-four patients were divided into groups according to their clinical presentation; seven asymptomatic volunteers, 20 patients with duodenal-gastric reflux gastropathy (DRG), 16 patients with recurrent ulcers of the duodenal bulb (RUD), and 11 patients with Moynihan's disease. Each of the 47 dyspeptic patients underwent an endoscopic examination and a scintigraphic study with [99mTc]disofenin for detection and quantitation of duodenal-gastric reflux. Endoscopy revealed the presence of bile in the stomach of 16 out of 20 DRG and four out of 16 RUD, while ten out of 11 patients with Moynihan's disease had clear gastric juice. Most of the DRG cases (15 out of 20) and half of the RUD (eight out of 16) presented reflux greater than 1.5%, while of the 11 Moynhihan, ten presented reflux less than 1.5% and all the asymptomatic volunteer subjects less than 1%. This quantitation method allowed us to perceive clearly the low % of reflux in the "normal asymptomatic" subjects compared with the DRG-type of dyspeptic patients. Among the dyspeptic, the distinction seems more evident between the DRG type and the Moynihan type. Occasionally, the scintigraphic method permits identification of patients with slower gallbladder evacuation (eight out of 47 dyspeptic in our study), adding valuable information for the diagnostic approach to dyspeptic patients.

Topics: Adult; Aged; Duodenal Ulcer; Duodenogastric Reflux; Dyspepsia; Female; Gastroscopy; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Recurrence; Syndrome; Technetium Tc 99m Disofenin

A 66-year-old woman with known gallstones and peptic ulcer disease presented with acute epigastric pain. Cholescintigraphy revealed nonvisualization of the gallbladder with subhepatic and perihepatic accumulation of tracer. An upper gastrointestinal examination with water-soluble contrast revealed a perforated duodenal ulcer, with leakage confirmed at laparotomy. The gallbladder was intact.

Topics: Aged; Biliary Fistula; Cholelithiasis; Diagnosis, Differential; Duodenal Ulcer; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Imino Acids; Organometallic Compounds; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium Tc 99m Disofenin

Cholescintigraphy with technetium Tc 99m DISIDA has proven to be a useful method for evaluating perforations of the hepatobiliary system. We have reported the first documented case of anterior duodenal ulcer perforation diagnosed by hepatobiliary scintigraphy.

Topics: Duodenal Ulcer; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Adult; Biliary Tract; Duodenal Ulcer; Humans; Imino Acids; Male; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Cholescintigraphy with Tc-99m iminodiacetic acid (IDA) agents has proved to be a convenient, non-invasive method for evaluating patients with suspected cholecystitis. (1,2) We recently examined two patients who were being evaluated for abdominal pain. The etiology of the two abnormal cholescintigrams was later proven to be due to nonhepatobiliary pathology.

Topics: Abdomen; Adult; Ampulla of Vater; Biliary Tract; Common Bile Duct Diseases; Duodenal Ulcer; Humans; Imino Acids; Male; Middle Aged; Morphine; Pain; Radionuclide Imaging; Spasm; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin