. 2020; 29(1): 7-16

Correlation of reflux scintigraphy and 24-hour impedance/ pH in a cohort of refractory symptomatic patients

Leticia Burton1, Gregory Falk2, Karl Baumgart3, James Beattie4, Scott Simpson5, Hans Van der Wall1
1CNI Molecular Imaging and university of Notre Dame, Sydney, Australia
2Sydney Heartburn Clinic and Sydney University, Sydney, Australia
3North Shore Medical Centre, Sydney, Australia
4Ryde Medical Centre, Sydney, Australia
5Sydney Adventis Hospital and Sydney University, Sydney, Australia

INTRODUCTION: The role of gastroesophageal reflux disease (GERD) in the aetiology of laryngopharyngeal reflux (LPR) is poorly understood and remains a controversial issue. 24-hour impedance monitoring has shown promise in the evaluation of LPR but is problematic in pharyngeal recording. We have shown the utility of scintigraphic studies in the detection of LPR and lung aspiration of refluxate. Correlative studies were obtained in patients with a strong history of LPR and severe GERD.
METHODS: A highly selected sequential cohort of patients with a high pre-test probability of LPR/ severe GERD who had failed maximal medical therapy were studied by 24-hour impedance/ pH, manometry and scintigraphic reflux studies.
RESULTS: The study group comprised 34 patients (15M, 19F) with a mean age of 56 years (Range: 28-80 years). The majority had LPR symptoms (mainly cough) in 31 and severe GERD in 3. Impedance bolus clearance and pH studies were abnormal in all patients in the upright and supine position. A high rate of non-acid GERD was detected by impedance monitoring. Lower oesophageal sphincter tone and ineffective oesophageal clearance was found in the majority of patients. Scintigraphic studies showed strong correlations with impedance, pH and manometric abnormalities, with 10 patients showing pulmonary aspiration.
DISCUSSION AND CONCLUSION: Scintigraphic studies appear to be a good screening test for LPR and pulmonary aspiration as there is direct visualisation of tracer at these sites. Impedance studies highlight the importance of non-acidic reflux and bolus clearance in the causation of cough and may allow the development of a risk profile for pulmonary aspiration of refluxate.

Keywords: GERD, LPR, reflux, impedance, pH, manometry, scintigraphy, pulmonary aspiration


Leticia Burton, Gregory Falk, Karl Baumgart, James Beattie, Scott Simpson, Hans Van der Wall. Correlation of reflux scintigraphy and 24-hour impedance/ pH in a cohort of refractory symptomatic patients. . 2020; 29(1): 7-16

Corresponding Author: Hans Van der Wall, Australia


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