title: Enterogastric reflux mimicking gallbladder disease: detection, quantitation and potential significance.
abstract: OBJECTIVE
  Visualization of enterogastric reflux (EGR) may be present during hepatobiliary imaging. Reflux of bile may damage the gastric mucosa, altering its function, and cause such symptoms as epigastric pain, heartburn, nausea, intermittent vomiting and abdominal fullness. These symptoms also are associated with gallbladder disease. The aim of this study was to quantitate the EGR index (EGRI) and to determine if a difference exists in normal and abnormal responses using standard cholecystokinin (CCK)-augmented hepatobiliary imaging.
  
  
  METHODS
  This study used 129 patients. LAO dynamic data on a 128 x 128 matrix at a rate of 1 frame/min were obtained. After the gallbladder ejection fraction (GBEF) was determined, the EGRI (%) was calculated by relating the counts in the gastric ROI to the counts in the hepatobiliary ROI at a specified time. The results were compared with the patient's final clinical diagnosis.
  
  
  RESULTS
  Normal responders (GBEF > or = 35%) had a higher EGRI than abnormal responders with a P = 0.001 EGR observed in 75 patients (58.1%). Significant reflux (EGRI > or = 14.2% at 15 min) was observed in 29 additional patients (22.5%). Patients with EGRI > or = 24.5% showed a strong association with the pathophysiologic syndrome of gastritis, alkaline reflux, gastric ulcer and gastro esophageal reflux disease. There was no EGR observed in the remaining 25 patients (19.4%).
  
  
  CONCLUSIONS
  This simple addition to the CCK-augmented hepatobiliary imaging may both detect and quantitate abnormal EGR as the cause of the patient's symptoms in the presence of a normal GBEF result, and/or those patients with risk factors for gastritis.
authors.affiliation: Department of Nuclear Medicine, St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Arroyo
authors.forename: J B
authors.initials: JB
authors.lastname: Burns
authors.forename: W A
authors.initials: WA
authors.lastname: Huyghe
authors.forename: A E
authors.initials: AE
authors.lastname: Dollman
authors.forename: Y P
authors.initials: YP
authors.lastname: Patel
mesh_terms: D000814:Aniline Compounds; D001655:Bile Reflux / Q000000981:diagnostic imaging*; D001659:Biliary Tract / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004383:Duodenogastric Reflux / Q000000981:diagnostic imaging*; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D005765:Gastrointestinal Agents; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012844:Sincalide
chemical_list: D000814:Aniline Compounds; D005765:Gastrointestinal Agents; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D012844:Sincalide; D005998:Glycine