Differences between scintigraphic reflux studies in gastrointestinal reflux disease and laryngopharyngeal reflux disease and correlation with symptoms.

OBJECTIVES: Gastro-oesophageal reflux disease (GERD) is poorly defined at best. Symptoms can be variable, ranging from none to heartburn, regurgitation and chest pain. When the reflux extends to the oropharynx [laryngopharyngeal reflux (LPR)], the symptoms can be protean and include cough and sore throat. We present the scintigraphic findings in two broad groups classified by symptoms as either GERD or LPR.

PATIENTS AND METHODS: Patients with an established diagnosis of GERD or LPR by standard methods (95%) or high clinical pretest probability (5%) were scanned in the upright and supine position after swallowing (99m)Tc-DTPA. A delayed image was obtained at 2 h to evaluate the possibility of lung aspiration.

RESULTS: Studies were obtained in 285 patients (168 females, 117 males), with a mean age of 54 years. Of these, 80 had typical symptoms of GERD and 205 had LPR. The group with GERD had pharyngeal contamination in 49 and 14% showed pulmonary aspiration. The group with LPR had pharyngeal contamination in 65 and 23% had lung aspiration. Pharyngeal contamination was more common in the supine than in the upright position (P=0000). Lung aspiration was correlated with upper oesophageal activity.

CONCLUSION: Scintigraphic reflux studies are a good screening test for GERD and LPR as they can detect oropharyngeal reflux and lung aspiration in an unsuspected proportion of patients in both groups. The oropharynx and lung are sites that are out of reach of the current standards of investigation such as pH studies, manometry and impedance monitoring.