Benchmarking of a simple scintigraphic test for GORD that assesses oesophageal disease and its pulmonary complications

INTRODUCTION: 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 centre 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 was 250 patients (155F, 95M) with an average age of 60 years. Patients were clinically classified as either GORD (n=72) or laryngopharyngeal reflux (LPR) (n=178). Lung aspiration was found 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 (IOM) and pulmonary aspiration. pH studies were correlated with the scintigraphic studies but did not predict aspiration as well as the other modalities when evaluated by receiver operating characteristic analysis (ROC)
DISCUSSION AND 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.