Reflux Scintigraphy (also known as Gastroesophageal Reflux Testing) is bulk billed, non-invasive, simple and available at CitiScan Radiology.
Gastroesophageal reflux disease (GORD) is a common condition which may be asymptomatic and progress to laryngopharyngeal reflux (LPR) and lung aspiration of refluxate. Contamination of reflux throughout the head and neck can be the cause of ear and sinusitis infections, sore throat and difficulty swallowing. Reflux can also irritate the airways and be aspirated into the lungs causing chronic cough, recurring chest infections, bronchitis or pneumonia.
GORD can be difficult to diagnose in patients who have a chronic cough (lasting over two months) but no heartburn symptoms. This is because common conditions such as postnasal drip and asthma are even more likely to cause a chronic cough.
Patients may not be displaying classic symptoms of GORD (heartburn & regurgitation) but may present with atypical upper respiratory tract symptoms such as chronic cough, dysphonia, sore throat and globus. There may be no symptoms of GORD in patients presenting with chronic cough. A high clinical index of suspicion is necessary to associate these symptoms with GORD.
Historically, GORD has been diagnosed using pH monitoring, fluoroscopy or endoscopy.
pH monitoring is performed off therapy. Standard test preparation is to cease anti-reflux therapy for the 3 days prior to the test. This causes a rebound acid effect, and the stomach produces more acid. Although this test is 50-80% sensitive & 77–100% specific in the presence of heartburn & regurgitation, it is limited to oesophageal disease only, particularly the lower oesophagus. This test is expensive, invasive, and may be poorly tolerated by patients.
Endoscopy is effective as an anatomical diagnostic tool, but has a poor sensitivity for GORD (less than 30%) and is limited to detecting reflux disease that is severe enough to damage the oesophagus.
Fluoroscopy or Barium Swallow is insensitive and has a high radiation burden and only demonstrates oesophageal disease.
Reflux Scintigraphy provides an effective, bulk billed, non-invasive screening tool for oesophageal disease, LPR and lung aspiration, detecting contamination throughout the maxillary sinuses, throat, middle ears, laryngopharynx, airways and lungs. Scintigraphy is 90% sensitive, detecting both acid and non-acid reflux and is well-tolerated by patients.
Reflux Scintigraphy is performed over three hours in two stages:
Test preparation is simple - involving a 4 hour fast, with all medications, including Gaviscon and PPIs, to be taken prior to the fasting period.
Upon arrival to clinic, the Nuclear Medicine technician gives the patient 20mL of an over the counter liquid anti-acid (GastroGel, Gaviscon, or equivilent) followed by 50mL of water with a small dose of Technetium, and another 50mL of water to flush and clear the mouth of the tracer. Dynamic images are taken from the mouth to the stomach in the upright and supine position with the gamma camera.
This is then analysed with special software to indicate the frequency and amplitude of reflux for the upper oesophagus and pharynx/ laryngopharynx. Liquid gastric emptying is also calculated.
Following a 90-minute break, a study of the head, neck and chest will be performed to detect any aspiration of refluxate into the head and neck structures (including the laryngopharynx) and lungs.
Results will be sent via secure electronic transmission to the referring health professional within 72 hours.
If you think you may benefit from a Gastroesophageal Reflux Test, ask your doctor for a referral to CitiScan Radiology. If you are a Medicare card holder, you will be bulk billed for this test.
To learn more about what the test entails, click here.