Reflux scintigraphy in gastro-esophageal reflux disease: a comparison study with 24 hour pH-impedance monitoring

Abstract

Objective

Reflux scintigraphy is often used to diagnose gastro-esophageal reflux disease (GERD). However, the efficacy of this study remains controversial. Our aim was to determine the role of reflux scintigraphy in diagnosing GERD by comparing it to 24 h combined pH-impedance study as the gold standard.

Materials and methods

Adult patients who presented for investigations of reflux symptoms were prospectively recruited into the study. All patients underwent high resolution esophageal manometry and those with major motor disorders of the esophagus were excluded. Eligible patients immediately underwent reflux scintigraphy following insertion of the pH-impedance catheter.

Results

Thirty patients were included in the study. Using a total acid exposure time (AET) of >4.2% as the reference for abnormal acid reflux, reflux scintigraphy had a sensitivity and specificity of 62.5 and 68.2%, respectively, in detecting acid reflux. When compared to AET >6%, reflux scintigraphy had a sensitivity and specificity of 66.7 and 62.5%, respectively, and a positive predictive value of 30.8% and a negative predictive value of 88.2%. There were no associations between outcomes of reflux scintigraphy and total AET (p = .46), total (acid or non-acid) reflux events (p = 0.11), proximal AET (p = .33) or the number of proximal reflux episodes (p = .75) on 24 h pH-impedance study.

Conclusions

Reflux scintigraphy has limited role in diagnosing GERD when compared to 24 h combined pH-impedance monitoring.

Keywords:

• Reflux scintigraphy
• gastro-esophageal reflux disease
• pH-impedance study
• anti-reflux surgery

Author contributions

Dr. Lisa Shim and A/Prof Meng Ngu were responsible for the design and conceptual plan of the study. Dr. Lisa Shim and Dr. Yunki Yau performed the esophageal manometry and pH studies, analyzed the data and wrote the manuscript. Dr. Robert Russo was responsible for the design of the study, performed the reflux scintigraphy, analyzed the data and assisted with writing of the manuscript. All authors have approved the final draft submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).