Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3619-3627
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3619
Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease: A definitive diagnostic test?
Gregory L Falk, John Beattie, Alvin Ing, SE Falk, Michael Magee, Leticia Burton, Hans Van der Wall
Gregory L Falk, Sydney Heartburn Clinic, Gastroenterology, Concord Hospital, Sydney, NSW 2138, Australia
Gregory L Falk, University of Sydney, Sydney, NSW 2006, Australia
Gregory L Falk, Macquarie University, Sydney, NSW 2109, Australia
John Beattie, Ryde Medical Centre, Sydney, NSW 2112, Australia
Alvin Ing, Department of Respiratory Medicine, Concord Hospital, Sydney, NSW 2138, Australia
Alvin Ing, the University of Sydney, Sydney, NSW 2006, Australia
SE Falk, Sydney Heartburn Clinic, Gastroenterology, Sydney, NSW 2070, Australia
Michael Magee, Leticia Burton, Hans Van der Wall, Concord Nuclear Imaging Clinic, Sydney, NSW 2138, Australia
Author contributions: Falk GL originated the study, conducted the pH and manometry studies and contributed to the manuscript; Beattie J and Ing A contributed patients to the study, formulated the hypothesis and were involved in manuscript preparation; Falk SE collated the data and entered it into the spreadsheet and interviewed patients; Magee M, Burton L and Van der Wall H designed the scintigraphic study, interpreted the data and helped with statistical analysis and manuscript preparation.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hans Van der Wall, MBBS, PhD, FRACP, Concord Nuclear Imaging Clinic, 4 Hospital Road, Concord West, Sydney, NSW 2138, Australia.
Telephone: +61-2-97361040 Fax: +61-2-97362095
Received: May 2, 2014
Peer-review started: May 2, 2014
First decision: May 29, 2014
Revised: July 28, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: March 28, 2015

AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication (LF) for chronic laryngopharyngeal reflux symptoms.

METHODS: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional pH and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after surgery.

RESULTS: Thirty four patients (20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour pH and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study (50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29% (5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive value of 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable side-effect profile.

CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.

Keywords: Laryngopharyngeal reflux, pH studies, Oesophageal manometry, Gastroesophageal reflux disease, Lung aspiration, Scintigraphy, Cough

Core tip: Scintigraphic studies offer a good screening tool for patients with gastroesophageal reflux disease (GERD) who are suspected of laryngopharyngeal reflux (LPR) and lung aspiration. Such studies can predict the response to fundoplication. Although the application for this study was in a highly selected group who underwent fundoplication for LPR, the results have been equally valid in over 700 unselected patients with suspected GERD. The technique however requires careful attention to detail for acquisition parameters, particularly with the volume of liquid into which the tracer is introduced.