technetium-tc-99m-sulfur-colloid and Spasm

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 clinical and investigative features of eight patients with attacks of epigastric pain believed due to a hypertensive lower esophageal sphincter (LES) are described. Radionuclide esophageal transit studies were normal in all but one patient. Two patients had positive acid perfusion studies. Only three had an abnormal baseline esophageal manometry, but after small intravenous doses of pentagastrin all subjects experienced their presenting pain coincident with increases in LES pressure ranging from 75 to 140 mmHg. Five patients eventually required surgical myotomy of the LES, but pain relief which was immediate and complete in all proved permanent in only one. Two of the operated patients continued to experience severe attacks of pain refractory to medical therapy. The diagnosis of a hypertensive LES is best made by pentagastrin stimulation of the sphincter, but cutting the sphincter may not cure the patient.

Topics: Adolescent; Adult; Diagnosis, Differential; Esophageal Diseases; Esophagogastric Junction; Female; Humans; Male; Manometry; Pentagastrin; Radionuclide Imaging; 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

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

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