P0142 PP GASTROESOPHAGEAL SCINTIGRAPHY WITH OVERNIGHT SCAN IN GASTROESOPHAGEAL REFLUX DISEASE WITH RESPIRATORY SYMPTOMS:

Introduction: Gastroesophageal reflux commonly occurs in infants and small children where it carries a benign prognosis in most cases. An adequate diagnostic work-up is required when reflux results in persistent and severe symptoms, however, in which case the term gastroesophageal reflux disease (GERD) should be used. In a significant proportion of patients GERD may present with respiratory symptoms – such as nocturnal cough, wheezing, asthma, aspiration pneumonia and apneic spells–which may result from tracheal or bronchial micro-aspiration of refluxed material. In these patients 24-hour intraesophageal pH monitoring is commonly used to detect and quantify reflux and thereby diagnose or rule out GERD. We wanted to verify if gastroesophageal scintigraphy followed by overnight scan (GEOS) on the lung fields is more reliable than 24-hour intraesophageal pH study for the diagnosis of GERD in patients with respiratory symptoms. Methods: Twenty-seven children (18 boys and 9 girls) aged 1 month-11.5 years who had respiratory symptoms possibly related to GERD were studied according to clinical indications. Eighteen/27 also had gastrointestinal symptoms (regurgitation, vomiting, heartburn, abdominal pain). GEOS was carried out for 2 hours following a standard liquid (milk) or solid (egg sandwich) caloric meal, depending on the patient’s age, labelled with Tc99 and was completed with a scan on the lung fields the following morning, 18–20 hours after the radiolabelled meal, in order to identify possible overnight aspiration. The diagnosis of GERD was made when one or more parameters of pH monitoring (reflux index, n. of refluxes, n. of refluxes >5 min, duration of longest reflux >20 min) were abnormal compared to published reference values and/or GEOS showed pulmonary microaspiration. Results: GERD was diagnosed in 17/27 patients (63%). Fourteen of these 17 (82%) had evidence of pulmonary aspiration on the overnight scan, whereas 11/17 (65%) had an entirely normal pH study (see table).Table 1Conclusion: In patients with respiratory symptoms a normal pH study does not rule out GERD as a possible cause of such symptoms, even if they are related to aspiration. Aspiration–more likely nocturnal – is present in a high proportion (more than 50%) of these patients and can be the only evidence relating respiratory symptoms with GERD. Therefore, GEOS is an essential diagnostic investigation in patients with respiratory symptoms possibly related to GERD.