technetium-tc-99m-sulfur-colloid and Gastroesophageal-Reflux

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

Topics: Diagnosis, Differential; Gastroesophageal Reflux; Humans; Lung; Radionuclide Imaging; Radiopharmaceuticals; Saliva; Technetium Tc 99m Sulfur Colloid

According to established diagnostic and therapeutic guidelines for chronic pulmonary aspiration, clinical suspicion is raised by coughing and choking with feeding, coughing during sleep, recurrent pneumonia, failure to thrive, and radiologic signs of chronic lung injury. The upper gastrointestinal series accurately defines anatomy and function, can differentiate between direct and reflux aspiration, and identifies conditions that predispose to aspiration. Gastroesophageal scintigraphy lacks anatomic detail but increases observation time, may differentiate between direct and reflux aspiration, and identifies delayed gastric emptying and gastroesophageal reflux. The lipid-laden macrophage index improves identification of aspiration, but cannot differentiate between direct and reflux aspiration. The esophageal pH probe identifies gastroesophageal reflux. Treatment options include medical therapy (thickened feedings, prone positioning, and metoclopramide) and surgical intervention (gastrostomy, fundoplication, and definitive correction of predisposing conditions). Therapy is determined by severity of illness and results of diagnostic evaluation.

Topics: Bethanechol; Bethanechol Compounds; Bronchoscopy; Child; Chronic Disease; Diet Therapy; Gastric Acidity Determination; Gastric Fundus; Gastroesophageal Reflux; Gastrostomy; Humans; Metoclopramide; Phagocytosis; Pneumonia, Aspiration; Radionuclide Imaging; 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

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

Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.

Topics: Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Diseases; Child; Common Bile Duct Diseases; Computers; Cysts; Gastroesophageal Reflux; Gastrointestinal Diseases; Humans; Infant, Newborn; Jaundice, Neonatal; Liver; Liver Diseases; Meckel Diverticulum; Postoperative Care; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Radionuclide studies have gained wide acceptance in the evaluation of infants and children with gastroesophageal reflux (GER). For correct interpretation of scan results, knowledge of inter-observer and intra-observer variability and minimum detectable reflux volume is essential. In this study, we evaluated the methodological issues underlying the visual assessment of GER and time activity curve analysis. An in vitro model of stomach and oesophagus was established to determine the minimum detectable reflux by placing various volumes and concentrations representing the diluted activity in the stomach. In the clinical part 99 patients were imaged for 1 h after oral administration of 99mTc sulfur colloid. Eleven patients were excluded from the study either due to incomplete clinical data or suboptimal image quality. Frames of 16 s each, and time-activity curves which were generated after drawing regions of interest from the oesophagus, were read three times by an experienced nuclear medicine physician and a resident in training. On the phantom study, the concentration, volume and duration were the determining factor for the visualization of reflux. In the clinical part, the overall incidence of GER in 88 patients was 69%. The mean intra- and inter-observer reproducibility (kappa values) was 0.76 and 0.7065, respectively. Agreement was slightly higher in the analysis of time-activity curves (0.767 and 0.731). Our results indicate that GER may be reproducibly analysed on scintigraphy by the same and different observers with varying levels of training. Its visualization is associated with reflux duration, volume and dilution factor of radioactivity.

Topics: Child; Child, Preschool; Female; Gastroesophageal Reflux; Humans; Infant; Male; Metabolic Clearance Rate; Models, Biological; Observer Variation; Radioisotope Dilution Technique; Radioisotopes; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

The aim of this study was to evaluate the effect of two body positions (supine and semirecumbency) on the dynamics of gastroesophageal reflux (GER) in 15 patients requiring mechanical ventilation and having a nasogastric tube in place. Samples of gastric contents, pharyngeal and bronchial secretions, and blood were obtained at baseline and every hour during a period of 5 h after nasogastric tube isotopic instillation of 37 megabecquerels of Tc99m. Radioactivity counting (RAc) was performed using a gamma counter with correction for decay. Irrespective of the body position, all patients showed at 3, 4, and 5 h after the isotope instillation a significant increase in RAc of the oropharyngeal contents (p < 0.05, each), indicating GER. Although RAc values in the pharynx were higher in supine from 1 through 4 h (p < 0.05), at the end of the study (5 h) the values did not differ between each position. Likewise, the slopes of the regression lines of sequential oropharyngeal RAc values were not different between each position (0.39 +/- 0.09 versus 0.45 +/- 0.11, respectively). In contrast, RAc values in bronchial secretions were higher at 5 h in the supine position compared with baseline (p < 0.05) and to semirecumbency (p < 0.01). These results strongly support that GER in mechanically ventilated patients with a nasogastric tube is a feature occurring irrespective of body position. Semirecumbent position does not protect completely from GER and subsequently from oropharyngeal colonization from gastric origin.

Topics: Cross Infection; Female; Gastroesophageal Reflux; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Oropharynx; Pneumonia, Aspiration; Posture; Radionuclide Imaging; Respiration, Artificial; Supine Position; Technetium Tc 99m Sulfur Colloid

Thirty-one children examined for gastroesophageal (GE) reflux were studied with both barium meal X-ray and gastroesophageal scintigraphy. The study was performed with a double-blind method. The children with negative findings at both tests were submitted to intraluminal esophageal pH probe test. Barium X-ray detected GE reflux in 17/27 patients, whereas radionuclide scintigraphy was positive in 24/27 (positivity: 63% versus 89%; p less than 0.05). Their combined use provided positive findings in 26/27 cases. Scintigraphy appeared to be a safe and reliable screening test to detect GE reflux. Moreover, scintigraphy was superior to barium X-ray study for it had higher diagnostic accuracy, it could be easily performed on young patients, and delivered smaller radiation doses.

Topics: Barium Sulfate; Child; Child, Preschool; Double-Blind Method; Esophagus; Evaluation Studies as Topic; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

The effect of metoclopramide on gastroesophageal reflux was studied in 30 infants less than 1 year of age. Gastroesophageal reflux was documented in all infants by extended pH monitoring before enrollment in the study. Patients were randomly assigned to receive metoclopramide 0.1 mg/kg or placebo four times a day, 1/2 hour before feeding for 1 week, followed by the alternate regimen for 1 week. The infants were reevaluated with extended pH monitoring and scintigraphy after 4 to 7 days of each treatment. A symptom score was derived by determining the average number of occurrences of all symptoms recorded daily by parents on a symptom checklist during pretreatment, placebo, and metoclopramide treatment periods. There was a difference between pretreatment evaluation and placebo periods with respect to daily symptom scores (p less than 0.005), reflecting a significant placebo response. However, no difference in scintigraphic study was found between placebo and metoclopramide periods. A significant difference between placebo and metoclopramide periods was noted in the percentage of time esophageal pH was less than 4.0 (p less than 0.001). However, although metoclopramide decreased the proportion of time esophageal pH was less than 4.0, pH remained less than 4.0 for more than 5% of the time in most patients. Substratification of the total group into infants younger and older than 3 months revealed that older infants had greater average daily weight gain during the metoclopramide treatment period (34.3 gm/day) than in the placebo treatment period (6.6 gm/day, p = 0.05). We conclude that metoclopramide in the dosage 0.1 mg/kg four times daily reduces reflux in infants and may be useful for infants with poor weight gain and other serious complications of gastroesophageal reflux.

Topics: Body Weight; Clinical Trials as Topic; Double-Blind Method; Gastric Emptying; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Metoclopramide; Prospective Studies; Random Allocation; 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

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

Both gastroesophageal reflux (GER) scintigraphy and radionuclide salivagram are commonly used in the detection of pulmonary aspiration in pediatric patients. This investigation is to compare the diagnostic value of these 2 imaging methods.. This retrospective study included 4186 pediatric patients (aged 1 week to 16 years; mean age, 28 months) who underwent a GER scintigraphy and/or radionuclide salivagram. Detection rate of pulmonary aspiration by the 2 imaging techniques was compared.. The detection rate for pulmonary aspiration in patients undergoing both procedures was 1.9% (5 of 266) for GER scintigraphy and 22.2% (59 of 266) for radionuclide salivagram. Fifty-six of 59 patients with proven aspiration on radionuclide salivagram demonstrated no such findings on GER scintigraphy, whereas 2 of 5 patients with proven aspiration on GER scintigraphy demonstrated no such findings on radionuclide salivagram. In patients who underwent only 1 procedure (either GER scintigraphy or salivagram), the detection rate for pulmonary aspiration was 0.4% (15 of 3551) for GER scintigraphy and 20.3% (75 of 369) for radionuclide salivagram.. Radionuclide salivagram showed a much higher detection rate for pulmonary aspiration compared with GER scintigraphy. However, this may be related to a significantly higher prevalence of antegrade versus retrograde aspiration in our study population. Our results also suggest that not all episodes of retrograde aspiration can be detected by a radionuclide salivagram, and the requested scan should be tailored to the type of suspected aspiration.

Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Radionuclide Imaging; Radiopharmaceuticals; Respiratory Aspiration; Retrospective Studies; Saliva; Technetium Tc 99m Sulfur Colloid

Evidence is increasingly convincing that lung transplantation is a risk factor of gastroesophageal reflux disease (GERD). However, it is still not known if the type of lung transplant (unilateral, bilateral, or retransplant) plays a role in the pathogenesis of GERD.. The records of 61 lung transplant patients who underwent esophageal function tests between September 2008 and May 2010, were retrospectively reviewed. These patients were divided into 3 groups based on the type of lung transplant they received: unilateral (n=25); bilateral (n=30), and retransplant (n=6). Among these groups we compared: (1) the demographic characteristics (eg, sex, age, race, and body mass index); (2) the presence of Barrett esophagus, delayed gastric emptying, and hiatal hernia; and (3) the esophageal manometric and pH-metric profile.. Distal and proximal reflux were more prevalent in patients with bilateral transplant or retransplant and less prevalent in patients after unilateral transplant, regardless of the cause of their lung disease. The prevalence of hiatal hernia, Barrett esophagus, and the manometric profile were similar in all groups of patients.. Although our data show a discrepancy in prevalence of GERD in patients with different types of lung transplantation, we cannot determine the exact cause for these findings from this study. We speculate that the extent of dissection during the transplant places the patients at risk for GERD. On the basis of the results of this study, a higher level of suspicion of GERD should be held in patients after bilateral or retransplantation.

Topics: Adult; Aged; Barium Sulfate; Barrett Esophagus; Contrast Media; Female; Gastric Emptying; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Hydrogen-Ion Concentration; Lung Transplantation; Male; Manometry; Middle Aged; Monitoring, Ambulatory; Radiography; Radiopharmaceuticals; Reoperation; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

To compare the diagnostic value of Gastro-intestinal (GI) scintiscan with 24-h pH study in detecting gastro-esophageal reflux (GER) among infantile wheezers.. Fifty-two children < 2 years of age.. All patients, irrespective of symptom underwent study to evaluate for GER.. GER studies were positive in almost 45% of cases. The agreement between positivity of these two tests is best among children between 7 and 12 months of age (κ = 0.591, p = 0.002). Overall GI scintiscan was a better test with higher sensitivity and specificity as compared to 24-h pH study when compared with the history suggestive of reflux and clinical response with anti-reflux treatment as standard (p ≤ .001).. Both GER scan and 24-h pH study are complimentary to each other, however, if both the tests are available then GI scintiscan is better as a single test for GER in these early wheezers.

Topics: Child, Preschool; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Male; Monitoring, Physiologic; Radionuclide Imaging; Radiopharmaceuticals; Respiratory Sounds; Sensitivity and Specificity; Sex Distribution; Technetium Tc 99m Sulfur Colloid

Gastro-oesophageal reflux (GOR) is a major cause of morbidity in children who undergo surgical repair for oesophageal atresia with tracheo-oesophageal fistula (OA/TOF). We performed a retrospective analysis to determine the incidence of GOR on radionuclide scintigraphy in symptomatic and asymptomatic OA/TOF patients in the first post-operative year. A total of 124 patients (74 males, 50 females), with a mean age of 3.5 months (range, 20 days to 12 months), were studied. Of these 124 patients, 67 were symptomatic and 57 were asymptomatic. On radionuclide scintigraphy, 73 patients (48 symptomatic and 25 asymptomatic) had reflux. Of the 48 symptomatic patients with scintigraphic studies positive for reflux, 79.2% (38) had proximal reflux and 20.8% (10) had distal reflux, whereas, of the 57 asymptomatic patients, 48% (12) had proximal reflux and 52% (13) had distal reflux. There was a significantly higher incidence of GOR in symptomatic children than in asymptomatic children (P<0.01). In particular, there was a significantly higher incidence of proximal GOR in symptomatic children than in asymptomatic children (P<0.001). In conclusion, the severity and incidence of GOR were significantly higher in symptomatic than asymptomatic OA/TOF patients in their first post-operative year. Scintigraphic evidence of proximal reflux correlates with the presence of symptomatic GOR.

Topics: Dilatation; Esophageal Atresia; Follow-Up Studies; Gastroesophageal Reflux; Humans; Incidence; Infant; Infant, Newborn; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Gastroesophageal reflux (GER) has long been associated with pulmonary symptoms and diseases. This retrospective analysis was undertaken to determine the prevalence of GER detected by gastroesophageal scintigraphy in children with recurrent lower respiratory tract infections but none of the typical gastroesophageal symptoms of GER.. A total of 312 children (mean age, 2.36 years; age range, 4 months to 11 years) were evaluated. All studies were performed using Tc-99m sulfur colloid (3.7 to 7.4 MBq; 100 to 200 microCi).. Of 312 children, 108 (34.6%) had GER on gastroesophageal scintigraphy. The children were separated into four groups, depending on their age. Group 1 (119 children, younger than 1 year), group 2 (131 children, ages 1 to 3 years), group 3 (36 children, ages 3 to 6 years), and group 4 (26 children, ages 6 to 12 years) showed silent GER with prevalences of 38.7%, 37.4%, 22.2%, and 19.2%, respectively. Because physiologic GER is common in children younger than 18 months, we also analyzed the prevalence of GER in children younger than 18 months and older than 18 months of age. The prevalences of GER in these groups were 41.7% and 24.6%, respectively.. A significant number of children with recurrent lower respiratory tract infection have scintigraphic evidence of GER. This high prevalence, even in children older than 18 months, cannot be ignored. Prospective studies including many patients are needed to establish the exact role of GER in these patients.

Topics: Case-Control Studies; Child; Child, Preschool; Esophagus; Female; Gastroesophageal Reflux; Humans; Infant; Male; Prevalence; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Respiratory Tract Infections; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

We investigated the incidence of gastroesophageal reflux by scintigraphy in patients with laryngopharyngeal symptoms and findings.. The study included 32 patients (14 males, 18 females; mean age 38 years; range 17 to 55 years) who presented with laryngopharyngeal complaints. All patients underwent routine ENT and head-neck examinations and rigid endoscopy of the larynx to determine laryngopharyngeal symptoms and findings. The presence of gastroesophageal reflux was sought by technetium 99m sulfur colloid scintigraphy.. The most common symptom was dysphagia (56%) followed by hoarseness (46%). Posterior laryngitis was the most common laryngeal finding (18 patients, 56%). Scintigraphy revealed gastroesophageal reflux in 21 patients (66%), 14 of whom (67%) had posterior laryngitis.. Patients with laryngopharyngeal symptoms and findings should be investigated with regard to gastroesophageal reflux. Scintigraphy may be a method of choice in this respect.

Topics: Adolescent; Adult; Female; Gastroesophageal Reflux; Humans; Laryngeal Diseases; Male; Middle Aged; Pharyngeal Diseases; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Turkey

Topics: Chronic Disease; Esophagitis; Esophagus; Female; Gastroesophageal Reflux; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Sulfur Colloid

The aim of this study was to use gastroesophageal and pulmonary scintigraphy to evaluate the prevalence of gastroesophageal reflux and airway involvement among patients with posterior laryngitis.. The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoarseness. A control population of 20 healthy volunteers (13 females, 7 males; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12-h fast, all subjects underwent gastroesophageal scintigraphy through administration of 300 mL orange juice labeled with 185 MBq 99mTc-sulfur colloid. After 18 h, planar anteroposterior thoracic images were acquired with the subjects supine.. Sixty-seven percent of patients (134/201) had scans positive for gastroesophageal reflux; of these, 30 (22%) had distal reflux and 104 (78%) had proximal reflux. In addition, the scans of 31 patients were positive for proximal reflux-associated pulmonary uptake. The frequency, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.001). The 67 patients in whom reflux was not detected had diseases or reflux-associated cofactors that could account for laryngeal symptoms. No statistically significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal reflux had significantly prolonged gastric emptying times compared with healthy volunteers.. Most patients with posterior laryngitis had detectable proximal gastroesophageal reflux. Exposure of the proximal part of the esophagus to acid, by setting the stage for microaspiration of gastric material into the larynx, remains a major cause of damage to the laryngeal mucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symptoms such as a dry cough, painful swallowing, or hoarseness may not be reliable predictors of the presence of gastroesophageal reflux or of associated airway involvement.

Topics: Case-Control Studies; Esophagus; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Laryngitis; Lung; Male; Middle Aged; Pneumonia, Aspiration; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Sulfur Colloid

Topics: Child; Gastric Emptying; Gastroesophageal Reflux; Humans; Intestine, Small; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Sulfur Colloid

The radionuclide milk scan is a valuable tool for the evaluation of gastroesophageal reflux and gastric emptying in children. There is uncertainty as to whether anterior imaging alone is sufficient for determining gastric emptying in these patients.. Twenty-five children underwent Tc-99m sulfur colloid milk scans with images acquired in the anterior and posterior projections. Calculations of the 1 hour and 2 hour percentage of gastric residual activity were performed using the anterior counts alone and the geometric mean of the anterior and posterior counts. The anterior and posterior images were visually assessed for the presence of gastroesophageal reflux.. The means of the absolute differences at 1 and 2 hours for the two methods of gastric residual calculation were 4.1% +/- 2.1% and 3.4% +/- 2.8%, respectively. There was good correlation between the two methods at 1 and 2 hours with r values of 0.991 and 0.997 respectively. Gastroesophageal reflux was more obvious in the anterior images and three small episodes were only seen on the anterior view.. Anterior images alone give reliable results for the determination of gastric emptying, and gastroesophageal reflux is more readily visualized anteriorly in the pediatric population.

Topics: Adolescent; Animals; Child; Child, Preschool; Female; Gamma Cameras; Gastric Emptying; Gastric Fundus; Gastroesophageal Reflux; Gastrointestinal Contents; Humans; Infant; Infant Food; Male; Methods; Milk; Pyloric Antrum; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Sulfur Colloid; Time Factors

Gastroesophageal reflux and gastric emptying are usually assessed simultaneously with a 1-hr procedure. After ingestion of radiolabeled formula sequential images are gathered when the infant is in the supine position. This position is adequate for gastroesophageal reflux assessment, but delays gastric emptying.. We studied 48 children, 1 wk to 2 yr of age, who presented with vomiting or failure to thrive. They received 99mTc-sulphur colloid in formula. After completing 1 hr supine imaging we obtained additional abdominal views after changing the position of the infant to right lateral for 30 min, and upright for another 30 min.. The percent of gastric emptying at 60 min in the supine position was 35% +/- 19%. After 90 min, in the right lateral decubitus, the percent gastric emptying was 60% +/- 25%. At 120 min, after an upright period, the gastric emptying was 73% +/- 20%. In the supine position 19 of 48 patients showed significant emptying (defined as > 40% emptying). This increased to 41 of 48 normal studies considering the right lateral position and to 45 of 48 normal studies considering the infant upright position.. Many patients with delayed gastric emptying show significant emptying just by changing position. We routinely complement gastric emptying studies with delayed views in the right lateral and upright position.

Topics: Child, Preschool; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Posture; Radionuclide Imaging; Stomach; Supine Position; Technetium Tc 99m Sulfur Colloid; Time Factors

In infants with recurrent vomiting, and especially bilious vomiting, the algorithmic approach is to perform conventional barium upper gastrointestinal radiography to rule out malrotation and midgut volvulus, which are surgical emergencies. However, children with protracted vomiting and failure to thrive are candidates for medical treatment. These children are often evaluated by radionuclide gastric emptying studies to assess gastric emptying. Three patients are presented in whom the radionuclide gastric emptying study revealed the presence of a malrotation anomaly which had been undetected by antecedent barium gastrointestinal radiographic studies.

Topics: Barium Sulfate; Child, Preschool; Duodenum; Failure to Thrive; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Jejunum; Male; Radionuclide Imaging; Stomach; Technetium Tc 99m Sulfur Colloid

The case of a female infant with a feeding disorder and with inadequate growth is described. In her workup, there was no evidence of an organic disorder. Barium studies of the upper GI tract showed normal anatomy and function. A radionuclide milk scan was helpful in demonstrating mild reflux and significantly delayed gastric emptying. There was a good response to therapy.

Topics: Animals; Feeding and Eating Disorders; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Infant Food; Milk; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Delayed gastric emptying of formula is observed in many infants with gastroesophageal reflux but the mechanisms responsible for this observation are not defined. Postprandial gastric motility was quantified using a perfused catheter placed into the distal stomach of five infants with gastroesophageal reflux and delayed gastric emptying of 99mTc-sulfur colloid-labeled formula. Five infants with reflux who exhibited normal emptying of formula served as the controls. Gastric motility indices were calculated for 60 min following a meal. Half the patients in each group were given metoclopramide following a 30-min recording period. In both groups, postprandial gastric motility was similar and characterized by minimal gastric contractions. Metoclopramide resulted in increased amplitude and duration of antral contractions, but no significant differences were noted between groups. The findings suggest that minimal delays in gastric emptying in infants with gastroesophageal reflux are not associated with significant alterations of postprandial gastric motility.

Topics: Bottle Feeding; Esophagus; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Infant; Metoclopramide; Monitoring, Physiologic; Radionuclide Imaging; Stomach; 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

We performed 12 simultaneous scintigraphic and pH probe studies in children being evaluated for reflux to determine the ability of scintigraphic images in comparison to pH probe data to quantify gastroesophageal reflux in children and to identify an optimal scintigraphic framing interval. We used a multiplexor to synchronize exactly the scintigraphy and pH probe and an acid meal to avoid missing postprandial episodes with the pH probe. We reformatted the studies in both 60-sec and 10-sec images to compare the two framing intervals. The 60-sec images produced better agreement between pH probe and scintigraphy than the 10-sec images for both the number of reflux episodes and the duration of reflux. Of the 64 reflux episodes detected by either method at this coarser framing interval, scintigraphy detected 80%, the pH probe detected 63% and both methods concurrently detected 42%. Of the 681 60-sec images aggregated across patients, scintigraphy detected 55% of those with intraesophageal refluxate, the pH probe detected 96% and both tests concurrently detected 51%. Within patients, the number of positive scintigraphic images in the postprandial hour correlated with the number of images with pH < 4 during the same hour (p = 0.008, and p < 0.0001 if two patients with very rapid gastric emptying are excluded), but not with the results of the 24-hr pH probe study. A 1-hr scintigraphic study formatted in 60-sec frames provides a quantitative representation of postprandial gastroesophageal reflux for children, particularly if they do not have rapid gastric emptying.

Topics: Child; Child, Preschool; Food; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

We illustrate the importance of short imaging times during gastroesophageal (GE) scintigraphy to better image GE reflux while still obtaining clinically useful gastric emptying data. While most reflux scans are comprised of 30- or 60-sec sequential images, we advocate the use of 10-sec images to maximize the signal-to-noise ratio of any radionuclide present in the esophagus. In the current case, clinically documented reflux of significant magnitude was missed during a study inadvertently performed using 60-sec frames, but subsequently detected using a 10-sec imaging protocol.

Topics: Esophagus; Gastric Emptying; Gastroesophageal Reflux; Humans; Male; Middle Aged; Radionuclide Imaging; Stomach; Technetium Tc 99m Sulfur Colloid; Time Factors

The acquisition of gastric emptying (GE) data by scintigraphy has become an important component of the evaluation of the pediatric patient for gastroesophageal reflux (GER). Delay of GE can contribute to ongoing gastric distension and hence increase propensity to reflux. Generally, only 1 h GE is determined during scintigraphy. Infants with GER have variable patterns of symptoms: some have spitting, vomiting, choking, and/or apparent life-threatening events in the immediate post-prandial period only, whereas in others symptoms persist until the time of next feeding. It is not clear whether differential rates of GE contribute towards such disparity of symptoms. We performed this prospective study to determine the correlation between GE at 1 h or 2 h, respectively, and for 2 h following a feeding in 27 infants under one year of age, who were referred for evaluation of GER. Continuous scintigraphy was performed for 2 h following a formula feeding. Gastric emptying at 1 h was calculated as percent of original dose emptied by 60 min; GE at 2 h was calculated as percent of isotope remaining in the stomach at 60 min which was emptied by 120 min. The median GE between 0 to 60 min was 36% (95% CI 26.0-42.0) and median GE of the residual formula between 60 to 120 min was 45% (95% CI 34.3-51.3). The correlation coefficient of GE, at 1 h with total GE over 2 h was 0.75 and of GE during the 2nd h with total GE over 2 h was 0.76. We conclude that routine determination of GE for 2 h continuously does not appear to offer clinically significant additional information.

Topics: Bottle Feeding; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Infant Food; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Sulfur Colloid; Time Factors

Twenty-nine infants under 1 yr of age were studied by simultaneous esophageal pH monitoring and scintigraphy for evaluation of gastroesophageal reflux (GER). Scintigraphy and pH monitoring were performed for 120 min after infants ingested their usual volume of formula. The number of reflux episodes during six 20-min intervals, as determined by both tests, were recorded. Esophageal pH monitoring was continued for 18-24 h. Sixteen of 29 patients exhibited GER by pH monitoring during the 2-h study. Gastroesophageal reflux occurred in seven of 29 during the first hour and 13 of 29 during the second hour. The mean time of first reflux episode detected by pH monitoring following the feeding was 82.4 +/- 49.3 min. In comparison, 28 of 29 patients had GER by scintigraphy during the 2 h. All 28 exhibited GER during the first hour, whereas only 22 of 29 patients exhibited GER during the second hour. The mean time of first episode of reflux by scintigraphy was 3.1 +/- 2.7 min. Forty-five percent of all reflux episodes detected by scintigraphy occurred during the first 20 min and 80% were detected during the first hour. In contrast, only 17% of reflux episodes were seen by pH monitoring during the first 20 min and 35% during the first hour; 65% of reflux episodes detected by pH monitoring were during the second hour. There was no correlation between the total number of reflux episodes detected by scintigraphy and 2-h esophageal pH monitoring during the 2-h study period (r = 0.326; p > 0.1). Overall, to detect reflux, scintigraphy was a more sensitive method than esophageal pH monitoring under the conditions of this study. Scintigraphy selectively detected reflux during the first 60 min post-prandially whereas pH monitoring was more likely to detect reflux beyond the first postprandial hour. These observations help to explain the lack of correlation between the two tests.

Topics: Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Monitoring, Physiologic; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

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

Gastric emptying measurements were performed in infants and children at 1 and 2 hours after a liquid feeding. The 1-hour measurements were predictive of only 58% of the variability in the 2-hour measurements, indicating that the 1-hour measurement was not a good predictor of the 2-hour measurement. Gastric emptying measurements in children should be continued until 2 hours after feeding unless rapid emptying is observed during the 1st hour of the study.

Topics: Child, Preschool; Digestive System; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Methods; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

Dumping syndrome in infancy is a rare complication following gastric surgery. We describe an 11-month-old infant affected by recurrent peptic oesophagitis who underwent a combined Nissen fundoplication and pyloroplasty. Early dumping symptoms such as irritability, pallor, sweating, abdominal distension and watery diarrhoea were observed postoperatively after bolus feeding. Gastric emptying, measured after the administration of 150 ml of regular cow milk mixed with 200 microCi (8 MBq) of technetium-99m sulfur colloid (99mTc-SC), demonstrated an early rapid and massive emptying of the isotopes into the small intestine, followed by duodenogastric reflux and a second wave of emptying and reflux at 9 min. The initial pattern of gastric emptying and duodenogastric reflux was followed by a slow emptying phase with half-emptying time of 81 min. Isotope studies should be used to investigate motility disorders caused by this type of anti-reflux operation.

Topics: Dumping Syndrome; Duodenogastric Reflux; Esophagus; Gastric Emptying; Gastric Fundus; Gastroesophageal Reflux; Glucose Tolerance Test; Humans; Infant; Male; Pylorus; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A new technique for performing quantitative gastroesophageal scintigraphy has been described. The method involves administration of radioactivity in capsule form into the stomach; the isotope is released after dissolution of the capsule. The mean time of onset of capsule breakage was 3.3 min (range 2-5 min) and complete dissolution occurred by 6.0 min (range 5-8 min). The appearance of isotope activity in the oesophagus by means of cine scintigraphy was quantified by PDP 11/34 computer (Gamma-11) in terms of percentage of gastroesophageal reflux (GER). In 15 healthy subjects, the percentage of reflux (mean +/- S.D.) in the lower, middle and upper oesophagus was found to be 1.25 +/- 0.67, 0.26 +/- 0.23 and 0.02 +/- 0.04 respectively. We have studied 52 patients using this technique, and results are encouraging.

Topics: Capsules; Gastroesophageal Reflux; Humans; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Adult; Biopsy; Diagnosis, Differential; Esophagoscopy; Esophagus; Evaluation Studies as Topic; Female; Gamma Cameras; Gastroesophageal Reflux; Gastroscopy; Humans; Male; Middle Aged; Radionuclide Imaging; Stomach; Technetium Tc 99m Sulfur Colloid

The radionuclide "salivagram" was introduced to document the aspiration of oral secretions in patients who are at risk. Approximately one-third of patients studied had positive tests. A positive study does not necessarily imply that patients are at risk for aspiration after gastroesophageal reflux. However, sequential images of the lung fields after the oral radioactivity has cleared may be a sensitive technique for detecting aspiration in infants and children following reflux.

Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Chronic Disease; Female; Gastroesophageal Reflux; Humans; Infant; Intellectual Disability; Male; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid

We studied intraesophageal pressure changes in patients with symptoms of gastroesophageal reflux and an abnormal 24-hr pH monitoring record (N = 52). Our method was simultaneous esophageal manometry and pH monitoring. We observed a three-component esophageal manometric sequence (EMS). When this sequence recurred over and over, we termed this phenomenon "cycling." We found cycling in 35% of the patients (18/52). Those with cycling had lower basal LES pressures, more acid exposure, and an increased incidence of endoscopic esophagitis. That cycling resulted from repeated reflux events and their esophageal clearance was documented by scintigraphy during simultaneous manometry and pH monitoring (N = 7 patients). Cycling was found on the routine esophageal manometry record of 25% of symptomatic patients (N = 112) with an abnormal 24-hr pH score. In conclusion, cycling represents an esophageal manometric phenomenon due to repetitive reflux events. Its recognition during esophageal manometry may denote a severe reflux diathesis.

Topics: Adult; Eating; Esophagitis; Esophagoscopy; Esophagus; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Monitoring, Physiologic; Periodicity; Posture; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.

Topics: Adult; Aged; Aged, 80 and over; Female; Gastroesophageal Reflux; Humans; Laryngeal Diseases; Male; Middle Aged; Pharyngeal Diseases; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

It is well established that liquid emptying occurs in the absence of motor activity of the stomach. In contrast, solid-phase emptying is controlled in part by antral peristalsis and is, therefore, a more precise indicator of gastric motility. We developed a semisolid, radionuclide gastric emptying test using rice cereal and technetium-99m-sulfur colloid to assess antral physiology in infants with vomiting. Computer-programmed mathematical models were used to determine the shape of a line that best fit our emptying data points. Linear, simple exponential [f = 2-(t/t1/2)], and power exponential [f = 2(t/t1/2)beta] patterns of emptying were calculated, where f is the fraction of the meal remaining in the stomach at time t, and t1/2 is the time when 50% of the meal has emptied and is a determinant of the shape of the curve. In infants with simple regurgitation (chalasia) and those with vomiting and failure to gain weight, we made statistical comparisons between gastric emptying patterns after analysis of the mean percentage of retained radionuclide at 120 min, calculated t1/2, and area under the curve. The coefficient of determination, R2, was calculated as an index of whether a curve provided goodness of fit to the data. Differences between groups of patients were statistically significant for all parameters of each mathematical model. However, higher coefficients of determination were noted in the power exponential model. The data suggest that the power exponential mathematical model provides the best analysis of the gastric emptying patterns for infants with chalasia and those with vomiting and failure to gain weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adsorption; Failure to Thrive; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Kinetics; Models, Biological; Oryza; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Vomiting

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Topics: Apnea; Child, Preschool; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

Gastro-esophageal reflux (G.E.R.) in children has been implicated in various recurring respiratory diseases. Several techniques including oesophageal pH testing and scintigraphy have been devised to detect and quantify G.E.R. Limitations have been found for each test: short duration with gamma-camera and restricted acceptability of the pH probe by children. A single isotopic probe was designed for a non-invasive screening test of G.E.R. in infants. This device was checked by comparison with oesophageal scintigraphy using a gamma camera. Only 1 discrepancy was detected in 19 reflux episodes. This method, using a relatively inexpensive detector and data acquisition module, seems to be well accepted by children, and may be associated with a pH probe for GER diagnosis.

Topics: Adolescent; Child; Child, Preschool; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

We have examined the use of radionuclide milk scanning to detect aspiration and have compared the clinical features of patients with demonstrated aspiration with those of patients in whom aspiration was not demonstrated. One hundred twenty children underwent radionuclide milk scanning for three different clinical indications, namely, respiratory tract symptoms (n = 56), gastroesophageal (GO) reflux (n = 20), and near-miss sudden infant death syndrome (SIDS) (n = 44). Ninety-eight (82%) of the 120 patients had a GO reflux demonstrated on the radionuclide milk scan. The incidence of aspiration was high in the respiratory (23%) and near-miss SIDS groups (20%) but low in the GO reflux group (5%). Only four of the 19 patients with an aspiration-positive scan had an aspiration-positive barium swallow film. The clinical symptoms and signs of those patients with aspiration-positive results were not significantly different from those of patients in whom aspiration was not demonstrated. We conclude that radionuclide milk scanning is more sensitive than barium swallow roentgenography in detecting aspiration; however, the clinical significance of such aspiration is undetermined. In view of the high incidence of GO reflux demonstrated in the absence of aspiration by the use of radionuclide milk scanning, the sole finding of GO reflux in a child with respiratory tract symptoms should not be taken as presumptive evidence that aspiration is contributing to those symptoms.

Topics: Adolescent; Animals; Barium Sulfate; Child; Child, Preschool; Contrast Media; Deglutition; Gastroesophageal Reflux; Humans; Infant; Infant Food; Milk; Pneumonia, Aspiration; Radiography; Radionuclide Imaging; Sudden Infant Death; Technetium Tc 99m Sulfur Colloid

To determine if hiatus hernia (HH) contributes to the delayed clearance of acid from the esophagus in patients with gastroesophageal reflux (GER), we performed simultaneous esophageal pH recordings and radionuclide studies in three study populations: 12 GER patients with HH, 5 GER patients with no HH, and 8 subjects with HH but no GER symptoms. Acid clearance was measured at 5 cm. above the manometrically located lower esophageal sphincter (LES) after injecting a 15-ml. bolus of 0.1 N HCl at 15 cm. above the LES. The acid was labeled with 200 mu Ci of 99mTc-sulfur colloid. Acid clearance was also measured at 10 cm. above the LES after injection of a 15-ml. bolus of 0.1 N HCl at 20 cm. above the LES. Acid clearance at 5 cm. above the LES was faster in GER patients with no HH compared to GER patients with HH and asymptomatic HH subjects. Acid clearance was faster at 10 cm. than 5 cm. above the LES in all HH and non-HH subjects studied. In non-HH subjects, each swallow resulted in an increase in pH (a monophasic pH response) at 5 and 10 cm. above the LES. In symptomatic as well as asymptomatic HH subjects, swallows resulted in an initial fall followed by a rise in pH at 5 cm. above the LES (a biphasic pH response). Radionuclide studies showed reflux of the isotope-labeled acid into the esophagus followed by clearance (a biphasic response) accompanying swallows in 15 of the 20 HH subjects. Swallow-induced reflux was not detected by radionuclide scanning in non-HH subjects. Based on these observations, we conclude that during acid clearance a small amount of acid is trapped in the HH sac and refluxes into the esophagus during subsequent swallows when there is relaxation of the LES, and these repeated episodes of acid reflux from the HH account for the delayed acid clearance observed in GER patients with HH.

Topics: Adult; Aged; Deglutition; Esophagogastric Junction; Esophagus; Female; Gastroesophageal Reflux; Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Peristalsis; Technetium Tc 99m Sulfur Colloid

The dosimetry associated with orally administered [99mTc]sulfur colloid for the diagnosis of gastroesophageal reflux has not been adequately described for the pediatric populations. Standard MIRD methodology was performed for the following: newborn, 1, 5, 10, and 15 yr old, and adult standard man. The critical organ for all pediatric groups was the lower large intestine with absorbed dose of 0.927, 0.380, 0.194, 0.120 and 0.0721 rad/100 microCi, respectively. For the adult the critical organ was the upper large intestine with an absorbed dose of 0.0518 rad/100 microCi. These data should be considered when administering [99mTc]sulfur colloid orally in a pediatric population.

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Gastroesophageal Reflux; Humans; Infant, Newborn; Radiation Dosage; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Newborn children, fitted with tracheal prosthesis for mechanical ventilation, may present chronic pulmonary complications due to the repetition of silent aspirations following gastroesophageal reflux. We evaluated, in a newborn intensive care population, the frequency of such aspirations and the relationship between the different parameters and pathologies. This particular group of sick neonates cannot be moved, and as the hospital for the newborn is far from the Nuclear Medicine district, the patients cannot be scanned. We used a simple technique: the injection of a solution of 99Tcm-sulphur colloid in their gastric tube, and the measurement of the tracheal aspiration tubes' radioactivity. Thirty one children were tested; thirteen children (42%) had radioactive tracheal tubes. The study of the relationship between several parameters and our results, shows that the examination was generally positive when the maximal insufflation pressure value was low. Our results prove that silent aspirations are very frequent in such a population and that it will be perhaps useful to prevent them in a systematic way in order to save the neonates from developing pulmonary lesions.

Topics: Female; Gastroesophageal Reflux; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intubation, Intratracheal; Male; Pneumonia, Aspiration; Radionuclide Imaging; Respiration, Artificial; Technetium Tc 99m Sulfur Colloid

In appropriate cases, information from a dynamic series of nuclear images may be condensed into a single image with one spatial and one temporal dimension. A useful elaboration of the method consists of the masking out of undesired spatial regions. The versatility of such condensed dynamic images is illustrated by examples derived from gastroesophageal and pulmonary studies. Advantages of the method include obviating the need to examine and comprehend multiple images as well as enabling economical archiving of image data. Its diagnostic potential is particularly evident in esophageal transit and infant gastroesophageal reflux studies.

Topics: Adult; Aged; Esophagus; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant, Newborn; Male; Middle Aged; Peristalsis; Pulmonary Gas Exchange; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Xenon Radioisotopes

Topics: Adult; Aged; Child, Preschool; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Infant; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Sclerotherapy in oesophageal variceal bleeding and portal hypertension is a standardized method. Gastro-oesophageal reflux-scintigraphy was performed in 18 from 90 patients. Augmented reflux of gastric acid and signs of insufficiency could not be shown. Our results indicate that a general treatment for avoiding a relapse of variceal bleeding by reflux is not necessary.

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Radionuclide Imaging; Sclerosing Solutions; Technetium Tc 99m Sulfur Colloid

Gastroesophageal reflux (GER) is a common cause of repeated emesis, failure to thrive, repeated pulmonary infection, and asthma in infants and children. During a 14-year period 270 children underwent gastroesophageal fundoplication for symptomatic reflux. The 24-hour esophageal pH monitoring is the most accurate test available to verify the presence of GER and is also helpful in evaluating the results of fundoplication. Transabdominal fundoplication may be performed with a low risk of complications. The most frequent complication requiring reoperation is paraesophageal hiatus hernia (6/270 patients), which should be repaired in almost all instances when symptoms develop. Closure of the crura posterior to the esophagus greatly reduces the incidence of this problem. Esophageal motility disorders occur in more than 35% of patients with symptomatic reflux and militate against performing a tight antireflux operation. Approximately 50% of patients with symptomatic reflux have associated gastric motility disorders. Radionuclide studies with 99mTC sulfur colloid in semisolid feedings have determined the magnitude of gastric retention after a feeding and have been helpful in identifying children who require a pyloroplasty with or without fundoplication. Pyloroplasty is performed simultaneously with fundoplication in approximately 10% of patients with symptomatic reflux when the lower esophageal sphincter pressure is low and the esophageal pH monitor shows reflux. The excellent clinical results achieved by fundoplication with or without pyloroplasty and the low morbidity and mortality rates indicate that these procedures should be used early in the management of infants and children who suffer symptomatic GER.

Topics: Adolescent; Child; Child, Preschool; Esophagus; Female; Follow-Up Studies; Gastric Emptying; Gastric Fundus; Gastroesophageal Reflux; Gastrostomy; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Intubation, Gastrointestinal; Male; Postoperative Complications; Pressure; Pylorus; Technetium Tc 99m Sulfur Colloid

Esophageal transit time as measured by radionuclide scintigraphy using a swallowed technetium sulfur colloid bolus was measured in obese patients with gastroesophageal reflux, lean patients with reflux, and lean volunteers without reflux. The esophageal transit time was significantly prolonged in the obese group compared with both lean groups (p less than 0.001). Esophageal manometric measurement also confirmed that obese patients have an elevated gastroesophageal pressure gradient, presumably caused by increased intraabdominal pressure resulting from the mechanical burden of excess fat. The esophageal transit time is significantly related to the gastroesophageal pressure gradient. This finding, coupled with those in previous manometric investigations showing that esophageal muscle has a decreased maximum velocity with increasing afterload, explains in part why obese patients have delayed esophageal transit time. Therapy for reflux in obese patients should be aimed at improving esophageal transit.

Topics: Adult; Aged; Esophagus; Gastroesophageal Reflux; Humans; Manometry; Middle Aged; Obesity; Peristalsis; Pressure; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

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

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. We compared results of 24-hour pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) in 26 symptomatic patients to determine which of the components of acid clearance is better correlated with gastroesophageal acid reflux (GER). Seven of eight patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in nine of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, is the predominant component of abnormal acid clearance in patients with GER. RIS is superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition.

Topics: Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Manometry; Methods; Pressure; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Fifteen patients with intractable reflux or its complications were sequentially studied after the placement of the Angelchik antireflux prosthesis. In all, 16 devices were inserted. Parameters were measured before and 3, 12, 24, and 36 months after prosthesis placement and included symptom scoring, esophageal manometry with Tuttle test, endoscopy, suction biopsy, barium swallow, and gastroesophageal scintigraphy. In addition, a subset of patients underwent stimulation/inhibition of the lower esophageal sphincter (LES) with pentagastrin, metoclopramide, edrophonium, and atropine. At a mean time of 16 months postsurgery, 10 of 16 (63%) patients were reflux-free and there was significant improvement in endoscopic, biopsy, and symptom scoring. Post-insertion, there were statistically significant increments in LES pressure with intravenous boluses of pentagastrin, metoclopramide, and edrophonium, and a significant decrease with atropine. Two patients who developed prosthesis herniation into the chest required removal because of ongoing reflux and dysphagia. An additional patient had prosthesis disruption and migration, which also required removal. Four patients with previously failed antireflux procedures had five prostheses placed. All continued to reflux postoperatively. No patient who was initially reflux-free subsequently developed reflux, despite a tendency for LES pressure to decline with time. Although this procedure proved effective for up to 36 months in patients who had had no previous antireflux procedure, the displacement rate (3/16 = 19%), reoperation rate (3/16 = 19%), and the progressive decline in LES pressure over time should make one cautious about its routine use in the surgical treatment of reflux esophagitis.

Topics: Endoscopy; Esophagogastric Junction; Esophagus; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Manometry; Postoperative Complications; Pressure; Prospective Studies; Prostheses and Implants; Radionuclide Imaging; Reoperation; 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

Topics: Adult; Child; Deglutition; Esophageal Diseases; Esophagus; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Infant; Mathematics; Pressure; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

For detailed examination of the esophageal transit of a swallowed radioactive liquid bolus, three computer-based techniques have been developed: (a) analysis of time-activity curves with decomposition into rapid and residual components, yielding the mean transit time for the former and the residual fraction for the latter; (b) reduction of dynamic image sequences to single condensed images, facilitating subjective assessment; and (c) tracking of the centroid of radioactivity, permitting quantification of retrograde motion. Studies were performed on 12 normal subjects and on six patients with motility disorders. Elevated residual fractions were observed in all the patients, and an abnormal degree of retrograde motion in two. Two normal and two abnormal studies exemplify the variety of patterns observed in condensed images.

Topics: Adult; Computers; Deglutition; Esophageal Achalasia; Esophageal Diseases; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Male; Mathematics; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

A method for combining scintigraphic studies of esophageal transit and gastroesophageal (GE) reflux is presented. Thirty-two patients with symptoms of GE reflux were studied. The severity of their symptoms was compared to nuclear medicine studies and esophageal mucosal biopsy. Fifteen healthy volunteers were studied as a control group for scintigraphy. The sensitivity of reflux scintigraphy to detect GE reflux as determined by esophageal histology was 70% and its specificity 87%. No relationship was observed between the magnitude of symptoms and the volume of GE reflux. A higher incidence of esophageal transit abnormalities was observed in those patients with histologic features of GE reflux than in those with normal histology. The combination of esophageal reflux and transit scintigraphy provides a way of studying some of the esophageal motor abnormalities associated with GE reflux. For clinical purposes GE reflux scintigraphy seems unsuitable as a single screening test.

Topics: Adolescent; Adult; Biopsy; Esophagoscopy; Esophagus; Evaluation Studies as Topic; Female; Gastroesophageal Reflux; Heartburn; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Child; Child, Preschool; Female; Gastroesophageal Reflux; Humans; Infant; Male; Radionuclide Imaging; Recurrence; Respiratory Tract Diseases; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Child; Child, Preschool; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Methods; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Electrodes; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Monitoring, Physiologic; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

One hundred twenty-six pediatric patients (0-16 yr of age) with clinically suspected gastroesophageal reflux (GER) were evaluated using radionuclide scintigraphy. Although 46 of the patients (38.3%) had abnormal studies exhibiting evidence of GER, there were no significant differences in gastric emptying between patients with and without GER. At 60 min after ingestion, the 76 patients less than 2 yr old had a mean residual of 54%, whereas those over 2 yr of age had a value of 29% (P less than 0.0001). Gastric emptying values may be age-related.

Topics: Adolescent; Aging; Child; Child, Preschool; Colloids; Esophagus; Fasting; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Radionuclide Imaging; Stomach; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The best established technique for diagnosing gastroesophageal reflux in children is the 24 hr esophageal pH probe test. No simultaneous comparison of this technique with radionuclide scans has been reported. Therefore, simultaneous 1 hr pH monitoring and gastroesophageal scintigraphy were performed in 49 infants and children with suspected gastroesophageal reflux. Forty-seven of these patients also were later monitored by the 24 hr pH probe test. Upper gastrointestinal series were performed on all patients. All patients with a positive 1 hr pH monitoring also had positive simultaneous scintigraphy. All patients with positive scintigraphy and pH probe monitoring also had a positive upper gastrointestinal series for reflux. The sensitivity of gastroesophageal scintigraphy, when compared to the 24 hr probe as a standard, was 79%; its specificity was 93%. The sensitivity of the upper gastrointestinal series was 86%, when compared to the 24 hr pH probe test. However, it specificity was only 21%.

Topics: Child; Digestive System; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Monitoring, Physiologic; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

The time-activity curve of gastric emptying of milk was evaluated in 49 infants and children who were also being evaluated for gastrointestinal reflux. After oral ingestion of technetium-99m sulfur colloid in a milk formula, the normal 1 hr time-activity curve and normal values for percentage of gastric emptying in 1 hr were determined. Normal gastric emptying in infants was 48% (+/- 16%) and in children 51% (+/- 7%). Unusual emptying patterns were observed when an overlying duodenum was present, making accurate estimation of gastric emptying difficult. Three children with gastric outlet obstruction showed similar delayed plateau emptying patterns.

Topics: Child; Duodenum; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Radionuclide Imaging; Reference Values; Stomach; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods.

Topics: Adolescent; Child; Child, Preschool; Esophagitis; Esophagus; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

During a 2 year period, 83 patients with gastric motility problems were evaluated using radionuclide imaging. The patients presented with epigastric distress, postprandial fullness, pain, nausea, vomiting, and diarrhea; signs and symptoms suggestive of either gastroparesis or gastric outlet obstruction. Upper gastrointestinal series or endoscopy, or both, demonstrated no mechanical obstruction. After oral administration of a 300 g meal labeled with 600 muCi of technetium-99m sulfur colloid, a gastric emptying study consisting of serial images and data acquisition was performed. Of the patients studied, 52 had had peptic ulcer surgery, 17 were suspected of having gastroesophageal reflux, 8 were diabetic and suspected of having visceral enteropathy, and 6 had a history of irritable bowel syndrome. The normal mean gastric half emptying time was 77 +/- 16 minutes. Of the patients who had had gastric surgery, 90.4 percent had abnormal emptying: 69.2 percent had delayed gastric emptying and 21.2 percent had rapid gastric emptying time; 9.6 percent had normal emptying time. Of the gastroesophageal reflux group, all but two had normal gastric emptying time; 65 percent demonstrated gastroesophageal reflux within 15 minutes. Two of the patients with irritable bowel syndrome had prolonged emptying; the rest had normal emptying. All diabetic patients with gastroparesis had prolonged gastric emptying time, and all responded favorably to metoclopramide. Of the patients who previously had peptic ulcer surgery and had prolonged emptying time, 72 percent also responded favorably to metoclopramide. We conclude that radionuclide gastric imaging is a useful diagnostic test for the measurement of gastric emptying in patients with a variety of gastrointestinal motility disorders and may be helpful in assessing medical therapy and selecting those who may be candidates for surgery.

Topics: Food; Gastric Emptying; Gastroesophageal Reflux; Humans; Postgastrectomy Syndromes; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Animals; Child; Child, Preschool; Deglutition; Esophagus; Female; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Male; Milk; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Four patients' positions were tested in search of increased sensitivity of gastroesophageal scintiscanning for the detection of reflux in children: supine, prone, left lateral, and 30 degrees right posterior oblique. The sensitivity was highest when the child was placed in supine position. A 60-min recording period increased the sensitivity of the technique, and is thus preferred to a shorter recording time.

Topics: Child; Child, Preschool; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Posture; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Aged; Asthma; Gastroesophageal Reflux; Humans; Lung; Male; Radionuclide Imaging; Sleep; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Adult; Aged; Esophageal Diseases; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

Topics: Administration, Oral; Alginates; Antacids; Atropine; Bethanechol Compounds; Diagnosis, Computer-Assisted; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Injections, Subcutaneous; Posture; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

There were 125 children with a strong clinical suspicion of gastroesophageal reflux and/or aspiration evaluated with gastroesophageal scintigrams. We found this examination to be more sensitive than the standard barium radiography and highly specific in detecting aspiration of gastric contents. This procedure is simple, safe and more physiologic than other available examinations. However, since gastroesophageal scintigraphy does not delineate anatomic changes as well as barium studies, structural abnormalities of the esophagus and stomach should be evaluated with barium esophagrams and upper GI series.

Topics: Child; Child, Preschool; Colloids; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Methods; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

One hundred two patients referred to our Esophageal Function Laboratory without endoscopic evidence of esophagitis were divided into two groups on the basis of the presence of a hiatal hernia on endoscopic examination. Fifty-three patients had a hiatal hernia and 49 did not. Both groups and 30 normal volunteer subjects had esophageal manometry and 24 hour esophageal pH monitoring. The incompetency of the cardia in patients with a hiatal hernia was dependent upon loss of components responsible for the antireflux mechanism, mainly a decrease in distal esophageal sphincter pressure and a decrease in the length of the sphincter exposed to the positive-pressure environment of the abdomen. These deficiencies were not related to the presence of a hiatal hernia and were similar to those of patients with an incompetent cardia without a hiatal hernia. Patients with a hiatal hernia and an incompetent cardia had significantly more esophageal exposure to refluxed acid than without a hiatal hernia. On the basis of the number of reflux episodes that lasted 5 minutes or longer and radioisotope transit studies, this increased acid exposure was due to both a loss of competency of the cardia and poor esophageal clearance secondary to the presence of a hiatal hernia. Reduction of the hernia and anchoring the distal esophagus into the abdomen not only may improve the antireflux mechanism, but corrects the clearance abnormality as well. The presence of a hiatal hernia has a detrimental effect on the clearance function of the body of the esophagus and may aggravate the effects of gastroesophageal reflux due to an incompetent cardia.

Topics: Adolescent; Adult; Aged; Cardia; Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Gastrointestinal Motility; Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Hydrogen-Ion Concentration; Manometry; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

99mTc colloid scintigraphy is a sensitive technique for the detection of gastro-oesophageal reflux, compared to X-ray studies. A quantification index of reflux is used and can be of value when there is concern about the significance of a positive result. Continuous monitoring during one hour increases by 25% the detection of reflux in comparison with a 30 min test. In our series, no case of lung aspiration was recognized using this technique. The scintiscanning index cannot predict the existence of an associated oesophagitis.

Topics: Barium; Computers; Esophagoscopy; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

This study compares the results of radionuclide gastroesophagography performed by the compression and computer-assisted noncompression techniques. The overall accuracy of the compression and noncompression methods was 71% and 84%, respectively. The use of computer processing significantly enhances the ability to detect minor degrees of reflux and may explain the better results obtained with the noncompression method. Other advantages of the noncompression technique include its technical ease and uniformity and the acquisition of more physiologic data for comparison with results of the acid reflux test.

Topics: Child, Preschool; Computers; Gastroesophageal Reflux; Humans; Infant; Pressure; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid