Benchmarking of a Simple Scintigraphic Test for Gastro-oesophageal Reflux Disease That Assesses Oesophageal Disease and Its Pulmonary Complications

Abstract

Objectives:Gastro-oesophageal reflux disease (GORD) is both common and troubling with a prevalence of 20-40%. We assessed the utility of a scintigraphic reflux study to evaluate the oesophageal and extra-oesophageal manifestation of disease compared to the standard tests such as pH monitoring and manometry.Methods:Patients were recruited into a prospective database of referrals to a tertiary referral center for either resistance to maximal medical therapy or extra-oesophageal symptoms of GORD. Data included 2 channel 24-hour pH monitoring and manometry results, as well as scintigraphic reflux data with late images assessing pulmonary aspiration of refluxate.Results:Study population included 250 patients (155 F, 95 M) with an average age of 60 years. Patients were clinically classified as either GORD (n=72) or laryngopharyngeal reflux (LPR) (n=178). Pulmonary aspiration of the refluxate was detected significantly more commonly in LPR patients (58/178 compared with GORD 10/72). Strong correlations were found between the scintigraphic time-activity curves in the upper oesophagus and pharynx, and ineffective oesophageal motility and pulmonary aspiration. pH studies correlated with the scintigraphic studies but did not predict aspiration similar to other modalities when evaluated by ROC analysis.Conclusion:Scintigraphic reflux studies offer a viable alternative test for GORD and extra-oesophageal manifestations of reflux disease. Strong correlations were found between measurable scintigraphic parameters and oesophageal motility and lung aspiration of refluxate. This may provide a more confident decision analysis in patients being considered for fundoplication for troubling extra-oesophageal symptoms.

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

“…Recently, Burton et al have suggested the use of scintigraphy with Tc-99m to identify alterations in the esophageal motility and lung aspiration of refluxate [4].…”

“…The 2006 Montreal consensus defined GERD as a condition that develops when the reflux of the stomach contents causes troublesome symptoms and/or complications into the esophagus [1]. Tissue damage related to GERD range from esophagitis to Barrett's esophagus and esophageal adenocarcinoma; troublesome symptoms attributable to reflux can be esophageal (heartburn, regurgitation) or extra-esophageal (EE) [2][3][4][5]. GERD can be further classified by the presence of erosions on endoscopic examination (Erosive Reflux Disease [ERD] and Nonerosive Reflux Disease [NERD]) [5].…”

Refractory Gastro-oesophageal Reflux Disease and Laryngopharyngeal Reflux - Use the Bottom up Approach

“…Reflux scintigraphy performed with the correct protocol has been shown by our group to more accurately detect upper airway reflux and lung aspiration with good response to anti-reflux surgery in selected patients [36,37]. In LPR patients with symptoms refractory to high dose PPI therapy undergoing combined oesophageal and scintigraphy studies, a high incidence of non-acid reflux is the rule often with reduced lower oesophageal sphincter tone.…”

A transformational change in scintigraphic gastroesophageal reflux studies: A comparison with historic techniques

“…The technique implemented at Site A has been validated against the standardized current diagnostic tests for GORD (Burton et al, 2018(Burton et al, , 2020Falk et al, 2015). Findings in 25 normal volunteers have demonstrated that 32% have asymptomatic upright reflux which does not reach the pharynx/laryngopharynx.…”

“…The technique at Site A has been validated against the current standards for testing of GORD and shown good correlation with pH/impedance and manometry (Burton et al, 2018(Burton et al, , 2020Falk et al, 2015) and for the first time, allowed the direct visualization of refluxate at extraoesophageal sites with SPECT/CT imaging.…”