Scintigraphy, pH measurement, and radiography in the evaluation of gastroesophageal reflux.

Scintigraphy as a diagnostic tool has been explored in 69 patients with gastroesophageal reflux (GER) symptoms and endoscopic esophagitis. In all subjects the presence of reflux was also evaluated by radiography and intraesophageal pH measurements (standard acid reflux test). The overall sensitivity of scintigraphy (85.5%) was significantly higher than those of radiography (27.5%) and pH measurements (69.5%). Scintigraphy was performed with normal saline and with acidified orange juice as the transport medium for the isotope 99mTc. The yield of positive scintigrams was higher (22.3 to 61.1%, depending on the grade of endoscopic esophagitis) with the latter variant. Moreover, demonstration of spontaneous reflux was greatly facilitated by the acid scintigraphy. This was particularly obvious in the grade I esophagitis, in which the frequency of spontaneous reflux with the saline method was 3.4% and with the acid medium, 34.3%. Reflux (induced or spontaneous) was seen in 2 of 22 normal control subjects with the saline method and in 1 subject only with the acid method. On the basis of these findings, it is concluded that scintigraphy, especially the acid variant of the technique, is a valuable diagnostic procedure in GER disease.