technetium-tc-99m-sulfur-colloid and Deglutition-Disorders

Topics: Connective Tissue Diseases; Defecography; Deglutition Disorders; Digestive System; Esophageal Motility Disorders; Esophagus; Food; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Isotope Labeling; Muscular Diseases; Peristalsis; Radioactive Tracers; Radionuclide Imaging; Reference Values; Technetium Tc 99m Sulfur Colloid

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

Topics: Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagus; Gallium Radioisotopes; Gastroesophageal Reflux; Humans; Muscular Dystrophies; Organotechnetium Compounds; Radionuclide Imaging; Rhenium; Sodium Pertechnetate Tc 99m; Stomach; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Healthy adults can swallow boluses of 20 ml water in a single swallow. Individuals with impaired swallowing, however, may be unable to do so, instead requiring two or more swallows; this phenomenon is called "piecemeal deglutition". The term "dysphagia limit" refers to the volume at which piecemeal deglutition occurs. The aim of our study was to investigate the potential value of scintigraphic evaluation of piecemeal deglutition and dysphagia limit in patients with dysphagia, based on correlation with the results of submental electromyography (SM-EMG) and laryngeal sensor monitoring (LS). The study population comprised 24 patients with dysphagia secondary to neurological disorders and ten normal adults, who formed a control group. In the scintigraphic evaluation, subjects underwent four separate dynamic studies using 5, 10, 15 and 20 ml of water containing 0.5 mCi technetium-99m labelled sulphur colloid, and time-activity curves (TACs) were created for each study. Static thoracic images were also recorded in order to detect airway aspiration Observation of two or more peaks on TACs within the 10-s acquisition period was considered a sign of piecemeal deglutition. If piecemeal deglutition occurred at or below 20 ml, this volume was regarded as the dysphagia limit. Piecemeal deglutition was not found in any normal subjects; by contrast, it was observed in 14 of the 24 (58%) patients on scintigraphy and in 17 (71%) patients on EMG and LS. In three patients, signs of the airway aspiration were observed on static thoracic images. Scintigraphic and electrophysiological findings were in agreement in 19 patients (79%), and the correlation between scintigraphy and the electrophysiological methods for the evaluation of dysphagia was statistically significant (r=0.57, P=0.003). The novel finding of this study is the demonstration of piecemeal deglutition and dysphagia limit on scintigraphic studies in patients with neurogenic dysphagia. Based on this finding we consider that scintigraphic evaluations of piecemeal deglutition and dysphagia limit could be of value especially in centres which do not have electrophysiological test facilities. The technique should be added to the list of standard scintigraphic methods for the evaluation of patients with oropharyngeal dysphagia.

Topics: Administration, Oral; Adult; Aged; Deglutition Disorders; Electromyography; Female; Humans; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

A valid and reliable technique to quantify the efficiency of the oral-pharyngeal phase of swallowing is needed to measure objectively the severity of dysphagia and longitudinal changes in swallowing in response to intervention. The objective of this study was to develop and validate a scintigraphic technique to quantify the efficiency of bolus clearance during the oral-pharyngeal swallow and assess its diagnostic accuracy. To accomplish this, postswallow oral and pharyngeal counts of residual for technetium-labeled 5- and 10-ml water boluses and regional transit times were measured in 3 separate healthy control groups and in a group of patients with proven oral-pharyngeal dysphagia. Repeat measures were obtained in one group of aged (> 55yr) controls to establish test-retest reliability. Scintigraphic transit measures were validated by comparison with radiographic temporal measures. Scintigraphic measures in those with proven dysphagia were compared with radiographic classification of oral vs. pharyngeal dysfunction to establish their diagnostic accuracy. We found that oral ( p = 0.04), but not pharyngeal, isotope clearance is swallowed bolus-dependently. Scintigraphic transit times do not differ from times derived radiographically. All scintigraphic measures have extremely good test-retest reliability. The mean difference between test and retest for oral residual was -1% (95% CI -3%-1%) and for pharyngeal residual it was -2% (95% CI -5%-1%). Scintigraphic transit times have very poor diagnostic accuracy for regional dysfunction. Abnormal oral and pharyngeal residuals have positive predictive values of 100% and 92%, respectively, for regional dysfunction. We conclude that oral-pharyngeal scintigraphic clearance is highly reliable, bolus volume-dependent, and has a high predictive value for regional dysfunction. It may prove useful in assessment of dysphagia severity and longitudinal change.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Deglutition Disorders; Female; Humans; Male; Oropharynx; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Aspiration can cause acute symptoms and chronic lung disease in the developing lung. However, the source of aspiration in infants is often unclear, making the choice of intervention difficult.. To quantify the source, amount and duration of lung aspiration in infants using gamma scintigraphy.. Two infants with clinical evidence of gastroesophageal reflux and oropharyngeal dysphagia swallowed formula radiolabeled with. Aspiration was greatest with swallowing, compared to instillation, peaking between 2.0% and 2.4% within 30 min and between 0.40% and 0.65% within 20 min, respectively. Radioactivity remained above zero four hours after either administration.. Quantification of the source, amount and duration of lung aspiration in infants is feasible using gamma scintigraphy. The impact of aspiration accrual on clinical care deserves further investigation.

Topics: Deglutition; Deglutition Disorders; Gastroesophageal Reflux; Humans; Infant; Intubation, Gastrointestinal; Male; Radionuclide Imaging; Radiopharmaceuticals; Respiratory Aspiration; Respiratory Aspiration of Gastric Contents; Technetium Tc 99m Sulfur Colloid

Topics: Deglutition Disorders; Humans; Male; Middle Aged; Pneumonia, Aspiration; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Technetium Tc 99m Sulfur Colloid

Topics: Deglutition Disorders; Esophagus; Humans; Mouth Neoplasms; Oropharynx; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Chronic salivary aspiration may be responsible for a significant percentage of pneumonia in the neurologically impaired child. The radionuclide salivagram (RS), a simple investigative study, can document salivary aspiration as the source of pulmonary contamination. The purpose of this study was to determine if the results of the RS would accurately identify children with severe and chronic salivary aspiration who would benefit from laryngotracheal separation (LTS). We reviewed 30 records of children with chronic aspiration pneumonitis who underwent LTS between 1988 and 1996. We recorded the number of inpatient days required for respiratory infections before and after LTS. This number was compared with the number of inpatient days for respiratory infection from children (n = 27) who underwent the RS during a ten-month period but who were never referred for LTS. Fifteen children who underwent LTS had a preoperative RS. The RS documented salivary aspiration in 11 of these children. Aspiration was effectively controlled by LTS for this group. There were three studies that failed to show either aspiration or progression of the Technetium 99m sulfur colloid (Tc 99m SC) into the esophagus This finding was felt to represent significant swallowing dysfunction and, therefore, was also considered a positive finding. There was a significant difference in the number of inpatient days for children who had a negative RS and were never referred for LTS when compared with the number of inpatient days for those children who had a positive RS and were referred for LTS. We feel that the RS is an effective tool to document salivary aspiration as the source of recurrent pneumonia. A modification of the technique and interpretation of RS is suggested.

Topics: Child; Child, Preschool; Chronic Disease; Deglutition Disorders; Fundoplication; Humans; Larynx; Pneumonia, Aspiration; Radionuclide Imaging; Retrospective Studies; Saliva; Severity of Illness Index; Technetium Tc 99m Sulfur Colloid; Trachea; Tracheotomy

To determine the patterns of esophageal motility found in patients with Chagas' disease.. Clinical, manometric, and scintigraphic data were obtained from 43 subjects with positive serological tests for Chagas' disease and nondilated esophagus and 10 patients with Chagasic megaesophagus.. Twenty (46.5%) of the seropositive subjects with nondilated esophagus were asymptomatic, and 23 (53.5%) had dysphagia, but only 12 (27.9%) had persistent dysphagia, a feature typical of Chagasic megaesophagus; only two (4.6%) had chest pain. Manometric findings within the seropositive group were: normal motility in 16 subjects, peristaltic multipeaked contractions in three, aperistalsis of the esophagus with relaxing lower esophageal sphincter in nine, and aperistalsis with nonrelaxing lower esophageal sphincter in 15 subjects. All of 10 megaesophagus patients had aperistalsis of the esophagus plus nonrelaxing lower esophageal sphincter. Scintigraphy was as sensitive as manometry in detecting esophageal dysmotility, but the erect scintigraphy was abnormal in subjects with complete aperistalsis only.. In Chagas' disease, megaesophagus appears to be a disorder at the most severe end of a spectrum encompassing classical achalasia and its milder variants. Other esophageal motility disorders are rare, but normal esophageal function is common.

Topics: Adolescent; Adult; Aged; Chagas Disease; Deglutition Disorders; Esophageal Achalasia; Esophageal Motility Disorders; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Peristalsis; Technetium Tc 99m Sulfur Colloid

Pulmonary aspiration was assessed using a scintigraphic swallowing procedure in 14 dysphagics in whom penetration of the larynx had been previously diagnosed. No patient had recent evidence of aspiration pneumonia. Imaging was performed during and following ingestion of a cupful of thin liquid admixed with between 1-2 mCi of Tc-99m sulfur colloid. Follow-up scans were obtained several hours later as needed to assess airway clearance. Five of the fourteen (36%) showed penetration distal to the trachea. Seven (50%) were indeterminate for aspiration, as isotope localized to the neck could not be clearly designated as being in either airway or foodway. Two subjects had negative studies. Of patients with subtracheal penetration, (1) fractions of the ingested material which were aspirated ranged from < 1%-25%, and (2) elimination from airways was complete or near-complete by 3 hours. The presence of an immediate or delayed cough was noted but did not correlate with subtracheal aspiration. Based on the results of scintigraphy, 8 of 9 patients on some form of liquid restriction at the time of testing were allowed to ease restrictions. Five patients without prior liquid restriction were allowed to continue to drink. We propose that scintigraphy provides important data on airway penetration and clearance that is useful in the dietary management of dysphagic patients.

Topics: Adult; Aged; Cough; Deglutition; Deglutition Disorders; Foreign Bodies; Humans; Inhalation; Larynx; Middle Aged; Mucociliary Clearance; Radionuclide Imaging; Severity of Illness Index; Technetium Tc 99m Sulfur Colloid; Trachea

Scintigraphic studies for determining aspiration associated with swallowing have ignored error due to differential gamma attenuation in the patient by the various regions of the body. This study sought to estimate the magnitude of that error, and to assess the feasibility of providing individual attenuation corrections based on clinical data.. Relative attenuation for the pharynx, thorax and abdomen were determined from physical measurements employing an anthropomorphic phantom and 45 adult human subjects. A small sealed radioactive source of 2.5 mCi of 99mTc was placed inside the phantom at various locations within the upper digestive tract and respiratory system, and relative count rates determined via static scans with a gamma camera. Similar data for human subjects was obtained from clinical swallowing testing using a bolus of 2.5 mCi of 99mTc in 10 cc of water.. The ratios representing relative counts were highly similar between the phantom and average human data. Test-retest replication of results was good for the abdominal reference and pharynx ratios--less so for the thorax. A procedure is described for estimating accuracy of percent aspiration calculation based on group data, using normalization coefficients derived for separate anatomical regions in the subglottic respiratory system.. Error in percent aspiration calculation will depend on the amount and location of aspirate. Individual subject corrections based on the type of clinical data studied should be attempted with caution.

Topics: Adult; Aged; Deglutition; Deglutition Disorders; Esophagus; Female; Humans; Inhalation; Male; Middle Aged; Models, Structural; Mouth; Pharynx; Radionuclide Imaging; Respiratory System; Technetium Tc 99m Sulfur Colloid

A better understanding of scintigraphic findings may lead to a wider acceptance of esophageal transit studies. The purpose of this study, therefore, was to correlate standard manometric parameters with the quantitative and qualitative characteristics of liquid and semi-solid bolus transport. Twenty-nine patients were simultaneously investigated with esophageal scintigraphy and manometry. Single-swallow and sum-image data of six consecutive swallows were analyzed. No significant relationship between transit time and the velocity of the peristaltic wave could be identified, which suggests that factors other than peristaltic velocity (e.g., pharyngeal pump) essentially modulate esophageal transit. There was also no linear correlation between esophageal emptying and peristaltic amplitudes. Emptying was normal in patients with amplitudes greater than 30 mmHg and reduced in those with amplitudes less than 30 mmHg. This suggests that a threshold pressure greater than 30 mmHg is necessary to propel a test bolus adequately. Patterns in condensed images have been shown to specifically reflect the events in corresponding manometric recordings. Normal and different pathologic types of peristalsis presented analogous findings in both modalities. Thus, an analysis of the relationship between bolus transport and contraction parameters in simultaneous studies increases understanding of quantitative and qualitative scintigraphic results.

Topics: Adult; Aged; Connective Tissue Diseases; Deglutition; Deglutition Disorders; Diabetes Mellitus, Type 1; Esophagus; Female; Gastroesophageal Reflux; Germany; Humans; Male; Manometry; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals. Attempts were made to measure the percentage of ingested material aspirated and the clearance rate from the airways. Eight patients (73%) failed to show definite evidence of aspiration on scintigrams. It is hypothesized that the lack of scintigraphic detection in previously proven aspirators was due either to interval improvement of the dysphagia or to difficult-to-detect laryngotracheal aspiration. Isotopic imaging during swallowing appears to have little utility; however, after ingestion, the technique can demonstrate more distal penetration not detected on videofluoroscopy. More studies are suggested to better define the sensitivity and specificity of scintigraphy in aspiration detection and to determine whether these techniques have prognostic value that could alter patient management.

Topics: Aged; Deglutition; Deglutition Disorders; Female; Humans; Male; Middle Aged; Nervous System Diseases; Pilot Projects; Pneumonia, Aspiration; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Scintigraphic studies of the oropharyngeal transit of a liquid bolus were performed in 15 healthy controls, 12 patients with symptoms of oral-pharyngeal dysphagia, and 13 patients with neuromuscular disease, who did not have dysphagia. Gamma camera imaging of the head, neck, and upper thorax was undertaken, in the lateral projection, during the swallowing of the radiolabeled bolus of water. Inspection of summed images permitted the selection of regions of interest (ROI) to represent the mouth, pharynx, and upper esophagus. Transit times between each ROI were calculated and compared. Significant prolongation of bolus transit time between the mouth and esophagus was present in both patients with and without dysphagia (0.59 +/- 0.38 sec and 0.33 +/- 0.7 sec; mean +/- SD, respectively) compared with controls (0.26 +/- 0.04 sec P less than 0.001, P less than 0.01, respectively, Mann-Whitney U test). Repeat studies in 25 individuals indicated that the transit measurements were more reproducible between swallows in normal subjects than in patients with symptoms. Deglutitive scintigraphy provides a noninvasive technique for the quantitative study of swallowing and its disorders.

Topics: Adult; Aged; Deglutition; Deglutition Disorders; Female; Gastrointestinal Transit; Humans; Male; Middle Aged; Neuromuscular Diseases; Oropharynx; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Sulfur Colloid

Fifteen patients with oculopharyngeal muscular dystrophy underwent cricopharyngeal myotomy for palliation of dysphagia. The aim of this work was to assess the effectiveness of this operation by using a radionuclide pharyngeal emptying study as a new quantitative method in addition to clinical and manometric evaluation. Radionuclide study was performed with the patient in both the upright and the supine positions after ingestion of 15 ml of water labeled with sulfur colloid 99mTc. Computerized data were acquired at 0.5 second intervals for 15 minutes and a pharyngeal time-activity curve was generated. Four quantitative parameters were evaluated: the time for pharyngeal clearance of 25%, 50%, and 75% of the ingested radioactive water and the pharyngeal stasis at 15 minutes. Manometric studies were also performed before and after cricopharyngeal myotomy. The pharyngeal clearance of 25%, 50%, and 75% of the water and pharyngeal stasis at 15 minutes were all improved by cricopharyngeal myotomy, decreasing from 1.2 to 0.9 second (p less than 0.04), 4.2 to 2 seconds (p less than 0.005), 15 to 7 seconds (p less than 0.02), and 10.3% to 6% (p less than 0.01), respectively. Both pharyngoesophageal and tracheobronchial symptoms were also significantly improved by cricopharyngeal myotomy. Manometric evaluation showed a decrease of the upper esophageal sphincter closing pressure from 60.1 mm Hg before to 28.2 mm Hg after the operation (p less than 0.001), and the resting pressure decreased from 34.4 to 15.7 mm Hg (p less than 0.0005). Cricopharyngeal myotomy significantly improves both symptoms and pharyngeal emptying in patients with oculopharyngeal muscular dystrophy.

Topics: Aged; Deglutition; Deglutition Disorders; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Muscles; Muscular Dystrophies; Peristalsis; Pharyngeal Muscles; Pharynx; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Esophageal function was prospectively studied in 50 consecutive insulin-requiring diabetes mellitus patients. The patients were stratified in three groups: A) 18 without peripheral neuropathy (PN); B) 20 with PN but no autonomic neuropathy; C) 12 with PN and autonomic neuropathy. Twelve patients (four B, eight C) had gastrointestinal symptoms including six with dysphagia. Radionuclide esophageal emptying was abnormal in 55, 70, and 83% of patients in groups A, B, and C, respectively. Eleven of the 12 (92%) symptomatic and 23 of the 38 (60%) asymptomatic diabetes mellitus patients had abnormal emptying. Five of six patients with dysphagia had abnormal emptying. Esophageal manometry was also performed in 15 patients. Twelve patients had abnormal manometry. These included nutcracker esophagus in two, achalasia in one, and increased percentage of multipeaked and simultaneous contractions in nine. There were no significant correlations between radionuclide esophageal emptying, manometric changes and symptoms. Gastrointestinal symptoms were more common in the presence of autonomic neuropathy. Delayed esophageal emptying was more profound in the presence of PN, but abnormal esophageal emptying was present in patients with neuropathy as commonly as patients without. Furthermore, the presence of diabetic retinopathy, duration or control of diabetics, and fasting blood sugar did not influence the frequency of abnormal esophageal emptying. Our data indicate that esophageal dysfunction is common in male diabetics even in the absence of clinical PN and retinopathy, suggesting that diabetic gastroenteropathy can occur in the absence of significant diabetic complications. Commonly observed abnormal esophageal manometry in diabetics is not necessarily accompanied by significant functional disturbances or symptoms.

Topics: Autonomic Nervous System Diseases; Deglutition Disorders; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Esophagus; Humans; Male; Manometry; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Sixty patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal cineradiography. Fifty-two patients (87%) had abnormal RT with prolonged transit time and 28 (47%) had stagnation of radionuclide. RT was positively correlated to duration of disease (p less than 0.01). A positive correlation between transit time and the presence of dysphagia was observed. Reduced esophageal motility evaluated by cineradiography was observed in 44 patients (73%). In patients with moderate-severe esophageal dysfunction there was a positive association between prolonged RT and hypomotility at the radiological examination (p = 0.001). RT is a safe and non-invasive method which is more sensitive than cineradiography and might be used as a screening test to evaluate esophageal involvement in patients with PSS.

Topics: Adult; Aged; Cineradiography; Deglutition Disorders; Esophagus; Female; Gastrointestinal Motility; Humans; Male; Manometry; Middle Aged; Radionuclide Imaging; Scleroderma, Systemic; Technetium Tc 99m Sulfur Colloid

"Nutcracker" esophagus is a syndrome consisting of chest pain and/or dysphagia with elevation of the mean distal esophageal contractile pressure amplitude (MDA) (greater than 120 mm Hg). Its existence as a disorder of esophageal function and the proper manometric diagnostic criteria have been debated. A correlative study of radionuclide esophageal scintigraphy (RES) and manometry was performed in 31 patients with this manometric diagnosis. RES results were abnormal in 13 of 16 (81%) patients with an MDA above 150 mm Hg, and in only three of 15 (20%) patients with an MDA below this level. There was a significant difference in RES parameters (mean transit time and percentage emptying) between these two groups. Repeat manometric and RES studies showed considerable variability, but only RES showed a significant correlation between baseline and repeat studies. RES confirms a functional disorder in a subgroup of patients with the manometric diagnosis of nutcracker esophagus and supports a change in the manometric criteria for diagnosis of this disorder to an MDA above 150 mm Hg.

Topics: Chest Pain; Deglutition Disorders; Esophageal Diseases; Esophagus; Humans; Manometry; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Gastric and esophageal emptying were assessed using scintigraphic techniques in 13 patients with polymyositis or dermatomyositis and in 13 normal volunteers. Esophageal emptying was significantly delayed in patients, with 8 of 13 patients being outside the normal range. Gastric emptying was also markedly slower in patients than in controls, with 8 patients being outside the normal range for solid emptying and 8 patients beyond the normal range for liquid emptying. The 5 patients with dysphagia all had delayed esophageal emptying, but both gastric and esophageal emptying were delayed in some asymptomatic patients. There was a significant correlation between esophageal emptying and both solid and liquid gastric emptying in the patients. Both gastric and esophageal emptying correlated with the severity of the peripheral (skeletal) muscle weakness. These results indicate that profoundly delayed gastric and esophageal emptying are common in polymyositis and dermatomyositis, implying frequent malfunction of the smooth muscle of the upper gastrointestinal tract in this disease.

Topics: Adolescent; Adult; Aged; Deglutition Disorders; Dermatomyositis; Esophagus; Female; Gastric Emptying; Humans; Indium; Male; Middle Aged; Muscle, Smooth; Myositis; Pentetic Acid; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases.

Topics: Barium Sulfate; Deglutition Disorders; Endoscopy; Esophageal Diseases; Esophagus; Fiber Optic Technology; Heartburn; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Manometry; Medical History Taking; Pain; Peristalsis; Technetium Tc 99m Sulfur Colloid; Thorax

Topics: Deglutition Disorders; Esophageal Achalasia; Esophagus; Gastroesophageal Reflux; Humans; Posture; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

The authors present their experience with the radionuclide esophagogram. Cases illustrating achalasia, diffuse esophageal spasm, nutcracker esophagus, oculopharyngeal muscular dystrophy, reflux esophagitis, gastroesophageal reflux, Barrett's esophagus, hiatal hernias, pharyngoesophageal diverticulum, and malignant tumors of the esophagus are included. The radionuclide esophagogram proved to be a useful procedure in the diagnosis and follow-up of many esophageal diseases.

Topics: Adenocarcinoma; Adult; Aged; Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Reference Values; Spasm; Stomach Neoplasms; Technetium Tc 99m Sulfur Colloid

The past decade has witnessed an exponential growth of knowledge about upper gastrointestinal motility. The elucidation of the clinical problems is based on remarkable morphophysiologic, clinical, diagnostic, and pharmacotherapeutic advances. New approaches rely on a more sensitive application of manometric evaluation which has allowed identification of more subtle abnormalities of motility, as well as appreciation of the role of scintigraphic studies to measure transit through the esophagus, combined with the standard use of the cine-esophagogram modified to assess a solid bolus. New techniques to evaluate gastric motility include myoelectric gastrography and administration of isotope-labeled meals. These advances have been enhanced by the advent of prokinetic therapeutic agents, such as metoclopramide and domperidone. Evaluation of intestinal motility involves the use of intraluminal pressure sensing catheters, as well as methods to measure transit times. The standard hydrogen breath test as a noninvasive study of small intestinal transit time has been supplemented by an isotope-labeled liquid meal. Identification of clinical states with delayed and rapid small bowel transit times will have therapeutic implications in the future.

Topics: Breath Tests; Cineradiography; Deglutition Disorders; Esophageal Diseases; Esophagus; Gastric Emptying; Gastrointestinal Motility; Humans; Hydrogen; Intestine, Small; Manometry; Radionuclide Imaging; Spasm; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

Topics: Deglutition Disorders; Esophagogastric Junction; Female; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Male; Manometry; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid