Gastroesophageal reflux studies using milk in infants and children--the need for multiple views

The aim of this study was to assess the value of multiple acquisitions in detecting position-related gastroesophageal reflux (GER). We retrospectively reviewed milk scans of 105 patients with suspected GER and possible lung complications. After 2 h of fasting, 11.4 MBq Tc-99m-sulfur colloid was given to the patient orally along with formula or milk (infants). Without sedation in most patients, serial images (30 s each for 15 frames=8 min) were acquired in the supine, prone, right-side down, and left-side down positions. If reflux was detected in one position, before proceeding to the next position the patient was given water or milk to clear the esophagus.The study was considered positive if the activity reappeared in the esophagus. Anterior and posterior chest images were obtained after a delay of 2-4 h to detect any pulmonary aspiration. A total of 59 patients (56.2%) tested negatively for GER in all four positions and also showed a negative delayed scan for pulmonary aspiration. In contrast, 46 patients tested positively for GER in variable positions (prone=4, supine=6, left-side down=3, right-side down=12, and in more than one position=21, of which six included the supine position). The percentage yield of a positive GER position-related technique was three-fold that of conventional single supine position. These results may aid a better understanding of the pathophysiology of the disease and the design of preventive and therapeutic measures.