Gastroesophageal Reflux Scan

Patients suffering from gastroesophageal reflux often consider it just heartburn and try to alleviate the symptoms with anti-acid medication or a change in diet. Reflux is caused by a weakening of the lower oesophageal sphincter allowing stomach acid to flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

Chronic reflux symptoms include:

  • Heartburn usually after eating, which might be worse at night
  • Chest pain
  • Difficulty swallowing and a soar throat
  • Regurgitation of food or sour liquid
  • Sensation of a lump in your throat
  • Chronic cough
  • Laryngitis
  • New or worsening asthma
  • Disrupted sleep due to reflux into the mouth/nose

Chronic reflux can cause long lasting damage to the oesophagus. Long lasting conditions include:

  • Oesophageal stricture.  Damage to the lower esophagus from stomach acid causes scar tissue to form.
  • Oesophageal ulcer. Stomach acid can wear away tissue in the esophagus, causing an open sore to form.
  • Precancerous changes to the esophagus.  Damage from acid can cause changes in the tissue lining the lower oesophagus increasing the chance to developing cancer.

Chronic simple heartburn can cause you serious harm. Nuclear medicine offers a sensitive imaging procedures known as a reflux study to asses the severity of the reflux. Using a gamma camera to detect gamma radiation over time the reflux scan offers a unique imaging ability in real time. This procedure uses very low levels of radiation. To compare the radiation dose, our most frequent type of scan is the bone scan that uses 800MBq of radioactive Tc99m-HDP; the reflux study uses 35MBq of Tc-Colloid given in a cup of water.
The radiation burden to the patient in this scintigraphic procedure is much less when compared to the fluoroscopic barium swallow.

Besides ascertaining the presence of reflux, there is a need to understand the real time dynamics of reflux severity in different positions; upright and prone. Reflux can sometimes be linked to the position of the patient . For this reason our protocol includes a upright dynamic scan and a prone dynamic scan. The dynamic images are analysed and time activity curves are generated at different segments of the oesophagus. The dynamic acquisitions can also be viewed as video clip to visualize movement of activity. There is also a single static scan acquired 2 hours after the initial oral dose to capture any residual latent reflux into the mouth, oesophagus or aspiration into the lungs.

The imaging protocol is from a patient’s perspective easy and well tolerated.  The oral dose has no side effects and has no flavor or odder. The patient is encouraged throughout the procedure not to suppress any of their symptoms. They are encouraged to cough, clear their throat, burp, swallow or hiccup to simulate their symptoms at home and to capture esophageal reflux during these symptomatic fits.

The reflux scan is a highly useful procedure to determine positional oesophageal reflux, severity of the reflux, and aspiration. It is a imaging procedure that has been enhanced in terms of sensitivity and procedural ease due to advances in gamma camera technology and computer software analysis. This procedure is available daily at MMI on our research grade nuclear medicine cameras.

Reflux Scan Negative:
Oesophagus is segmented into 3 sections by different colored square regions. There is no activity in the distal (blue square), middle (yellow square) or superior (red square) sections of the esophagus. Time activity curves are flat lined and overlapping each other.
Reflux Scan Positive:
Oesophagus is segmented into 3 sections by different colored square regions.
There is a spike of activity in the distal (blue square). Activity is not seen in the middle (yellow square) or superior (red square) sections of the oesophagus. Time activity curves indicate a sudden increase in activity in the distal segment of the esophagus (blue line) at 3.5 minutes post oral dose. All 3 time activity curves are separated in the graph and color coded to match the square regions.

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