Gastroesophageal reflux disease (GERD) is the most frequently encountered esophageal disorder. GERD occurs with the passage of gastric contents into the esophagus, leading to a variety of symptoms and/or complications. The disease is the most common cause of neonatal admissions to pediatric gastroenterology unit and affects about 30% of pediatric population. Complications can be divided into two groups as esophageal and extra esophageal. The major complications are vomiting, weight loss, dysphagia, abdominal or substernal pain, esophagitis and respiratory disease. Esophageal dysfunction may also cause problems which include a series of growth and developmental retardation; therefore, implementation of early diagnosis and appropriate treatment is important.
A radionuclide study using technetium-99m-labelled milk feeding is described for the detection of gastroesophageal reflux and aspiration in pediatric age group and provide a simple, physiologic and sensitive non-invasive procedure. It has been reported that radionuclide imaging has 95%-100% sensitivity and 95%-100% specificity. Both acid and alkaline reflux can be detected and allow quantitative evaluation of reflux.
Radionuclide Reflux Scintigraphy; after 4 hours of fasting, accurately 37 MBq (1mCi) 99mTc MAA / 99mTc Colloid in 25 - 50 mL of milk was ingested by the patient (Orally or through the Ryle’s tube). Then 100 -150 mL of milk was ingested to clean up residual radioactive substance remaining in the mouth and esophagus. On supine position under the Gamma Camera, thirty-minute dynamic images are acquired & presence of reflux was evaluated. Reflux levels were determined as low (grade I), medium (grade II) and high (grade III) along with numbers of reflux episodes within 30 minutes of study were also recorded.
6 days old baby, FTND, with multiple apneic spells at 6 hours of age, requiring stimulation.
99mTc-colloid labelled milk scan shows multiple episodes of tracer uptakes going up to the oral cavity region
during thirty-minutes of dynamic study, suggesting high grade III GER.
2 years old baby with history of recurrent upper respiratory tract infections and failure to thrive.
99mTc-colloid labelled milk scan shows multiple episodes of tracer uptakes going up to the oral cavity region during thirty-minutes of dynamic study, suggesting significant high-grade GER
11 weeks baby with history of vomiting after feed and chocking episodes and cyanosis.
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region in the
initial part during thirty-minutes of dynamic study, suggesting high grade III GER.
11 weeks baby with history of vomiting after feed and chocking episodes and cyanosis.
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region in the initial part during thirty-minutes of dynamic study, suggesting high grade III GER.
7 days old baby with history of recurrent vomiting and cyanosis post feed.
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region, twice during thirty-minutes dynamic study, suggesting grade III GER.
6 weeks old baby with history of recurrent vomiting
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region, appreciated at 24th minutes during thirty-minute dynamic study, suggesting grade III GER.
Milk scan is Simple, quick and more reproducible. Sensitivity-Reflux detected in 95 to 100% symptomatic patients.vMuch more sensitive than fluoroscopy and endoscopy (ST-40%) and lower esophageal sphincter pressure. There is 90% correlation with acid pH test.Barium swallow is an insensitive test for detecting the presence of intermittent reflux. Although scintigraphy can detect small volumes of aspiration, the diagnosis cannot be excluded by a negative examination
Case 1:
99mTc-colloid labelled milk scan shows multiple episodes of tracer uptakes going up to the oral cavity region during thirty Minutes of dynamic study, suggesting high grade III GER.
Case 2:
99mTc-colloid labelled milk scan shows multiple episodes of tracer uptakes going up to the oral cavity region during thirty minutes of dynamic study, suggesting significant high grade III GER.
Case 3:
99mTc-colloid labelled milk scan shows tracer uptake visualization uptakes up to upper end of esophageal region in the initial part during thirty minutes of dymaic study, suggesting High grade III GER.
Case 4:
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region, twice during thirty minutes of dynamic study, suggesting grade III GER.
Case 5:
99mTc-colloid labelled milk scan shows tracer uptake visualization up to upper end of esophageal region, appreciated at 24th minutes during thirty minutes of dynamic study suggesting grade III GER.