Findings from a novel scintigraphic gastroesophageal reflux study in asymptomatic volunteers

Gastroesophageal reflux disease (GERD) is a common and growing problem in most western countries. It may present with the typical symptoms of heartburn and regurgitation or with the effects of extra-esophageal disease. We have developed and validated a scintigraphic test that evaluates reflux at both sites in patients at high risk of laryngopharyngeal reflux and lung aspiration. We hypothesized that the test may be able to separate physiologic reflux from pathological reflux and examined this possibility in normal asymptomatic volunteers. Asymptomatic volunteers were screened with the Belafsky reflux symptom index (RSI) and entered into the trial if scores were less than 13. ^99mTc Phytate was ingested orally and dynamic studies from the pharynx to the stomach were obtained while upright and supine. A delayed study of the thorax was also obtained for lung aspiration of refluxate. Studies were semi-quantitated graphically as time-activity curves. A total of 25 volunteers were studied (13 M, 12 F) with a mean age of 57.5 yr (Range 40-85 yr). None gave a history of heartburn or regurgitation. Mean RSI was 4.1 (range 0-10). Testing showed upright gastroesophageal reflux to the mid-upper esophagus without pharyngeal contamination in 32%. None of the subjects showed supine reflux or lung aspiration. This result corresponds well with intraluminal impedance/pH monitoring in normal volunteers. The scintigraphic reflux test gives similar results to standard intraluminal impedance/pH studies in normal volunteers. A significant proportion of asymptomatic volunteers demonstrate upright reflux only.