technetium-tc-99m-sulfur-colloid and Esophagitis--Peptic

This review critically evaluates the gastroduodenal factors that may play a clinically relevant role in the pathogenesis of reflux esophagitis. The gastroesophageal pressure gradient is of obvious importance, but the role of gastric contraction/relaxation is poorly understood. The intragastric volume, as well as the factors that influence it, could theoretically play a role in gastroesophageal reflux (GER). For example, suppression of gastric emptying and gastric motility would be expected to increase GER, and treatment with gastrokinetic agents appears to provide symptomatic improvement. However, only a fraction of patients with GER have delayed gastric emptying, and there is no correlation between either subjective epigastric fullness or esophagitis on one hand and gastric emptying on the other hand. Gastric acid and pepsin, and possibly the hypersecretion of acid, play a pivotal role in reflux esophagitis, as demonstrated by the efficacy of the treatment with histamine H2 antagonists and antacids. Other important factors in experimental esophagitis are duodenogastric reflux, the presence of bile acids in the gastric contents, as well as trypsin if the pH is alkaline. It is suggested that these important findings may lead to novel therapeutic approaches of reflux esophagitis.

Topics: Animals; Bile Acids and Salts; Duodenum; Eating; Esophagitis, Peptic; Esophagus; Gastric Acidity Determination; Gastric Emptying; Gastric Juice; Gastroesophageal Reflux; Gastrointestinal Contents; Gastrointestinal Motility; Humans; Pentetic Acid; Pepsin A; Pressure; Stomach; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

Dynamic radionuclide imaging potentially offers a convenient, noninvasive technique for detecting gastroesophageal (GE) reflux disease. Initial studies suggested a high degree of sensitivity, although subsequent reports have been less encouraging. We sought to clarify this controversy by assessing the sensitivity of GE scintigraphy in 15 patients with severe esophagitis at endoscopy and 15 health volunteers. After acid loading, scintigraphy was performed in the basal state and after maneuvers (Valsalva, abdominal compression) which provoke GE reflux. Computer analysis permitted calculation of a reflux index for each maneuver. An index greater than 4% was considered a positive test. We found that the mean reflux index for the patients was significantly greater (p less than 0.01) than the healthy volunteers; 4.55 +/- 1.75% versus 0.42 +/- 0.11%, means +/- S.E.M. Only 30% of the patients had a reflux greater than 4%. Using data from our healthy volunteers, we redefined an abnormal reflux index as greater than 1.7%, but that only improved the test sensitivity to 60% and the specificity to 100%. Scintigraphy for reflux is primarily limited by the short duration of imaging. We cannot recommend GE scintigraphy as a useful screening test for reflux.

Topics: Adult; Aged; Computers; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Thirty cases of recurrent pulmonary infection and ten control cases underwent radionuclide gastroesophagography endoscopy, histopathology and barium esophagography to evaluate the clinical efficacy of scintigraphic technique in, detection of gastroesophageal reflux. After ingesting 500 micro curie of Tc-Sulphur colloid mixed in milk, patients esophageal activity was monitored using the gamma camera for forty-five minutes continuously. By using histopathology as standard of comparison, the sensitivity and specificity of radionuclide esophagography was 78.54 and 81.25%, respectively. Because of its physiologic nature, low radiation exposure and convenience, radionuclide esophagography is recommended as a suitable screening test for detecting gastroesophageal reflux where available.

Topics: Barium Sulfate; Child; Child, Preschool; Esophagitis, Peptic; Esophagoscopy; Evaluation Studies as Topic; Female; Fluoroscopy; Gastroesophageal Reflux; Gastroscopy; Humans; Infant; Male; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

To compare reflux events detected by intraesophageal pH monitoring with that of scintigraphy, we simultaneously performed both techniques along with esophageal manometry in nine patients with severe reflux esophagitis. Two hundred eighteen reflux events were detected in the recumbent posture after a meal during a 40-min interval. Both techniques simultaneously detected only 23% of all reflux events. Scintigraphy alone detected 61% of all reflux events as opposed to 16% for pH monitoring. Of those reflux events diagnosed only by scintigraphy, more occurred while the intraesophageal pH was less than 4 (ie, during an acid-clearing interval) than while the intraesophageal pH was greater than 4 (ie, when intragastric contents were neutralized by the meal). Most reflux events occurred during periods of stable, but low LES pressure. While reflux events diagnosed by scintigraphy significantly decreased during the second of two 20-min postprandial intervals, those by pH monitoring tended to increase. That simultaneous scintigraphy and pH monitoring agreed on less than 1/3 of all reflux events not only underscores the fact that both techniques measured different physical components of the esophageal refluxate (ie, volume vs acid concentration, respectively), but also were influenced by different physiologic events such as the ingestion of a meal, gastric emptying, and esophageal acid clearance.

Topics: Adult; Aged; Eating; Esophagitis, Peptic; Female; Humans; Hydrogen-Ion Concentration; Male; Manometry; Middle Aged; Monitoring, Physiologic; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Radionuclide esophageal transit (RET) is a noninvasive method of studying esophageal function. The purpose of this study was to evaluate RET as a screening test for motility disorders in symptomatic patients. Esophageal manometry and RET were performed in 16 volunteers and in 34 patients who were referred for motility evaluation. Each RET study consisted of two swallows of labeled water with the patient in the supine position under a gamma camera. Six patients had achalasia, two had scleroderma, two had diffuse esophageal spasms, and five had a nonspecific motor disorder. In each case the RET time was prolonged (greater than 15 s). Ten patients had reflux esophagitis; two of these had both abnormal manometry results and prolonged RET times. There were nine patients with upper gastrointestinal tract symptoms but normal manometry results and the RET test was positive in two patients. There were no false-negative RET results. The agreement between the RET and manometry results in this series was 96% (48/50). This preliminary experience suggests that RET is as sensitive as manometry for identifying motility disorders.

Topics: Adult; Aged; Esophageal Achalasia; Esophageal Diseases; Esophagitis, Peptic; Female; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Muscle, Smooth; Peristalsis; Radionuclide Imaging; Reference Values; Scleroderma, Systemic; Spasm; Technetium Tc 99m Sulfur Colloid

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

Scintigraphic studies of swallowed 99m Tc-sulphur colloid mixed with a few millilitres of liquid, performed on 400 paediatric patients of all ages, allowed visualisation of foregut function and measurement of oesophageal transit time and gastric emptying proportions. This non-invasive and physiological procedure requires a standard gamma camera with computing facilities and was performed as an outpatient routine. It proved very effective for the detection of gastro-oesophageal reflux and aspiration of refluxed liquid in patients of all ages but especially in neonates. The relevance of these scintigraphic results to oesophagitis, repeated respiratory problems, cyanotic and apnoeic spells and alternative methods of investigation is described.

Topics: Apnea; Esophagitis, Peptic; Female; Gastric Emptying; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pneumonia, Aspiration; Radionuclide Imaging; Respiration Disorders; Sudden Infant Death; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid