title: Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease.
abstract: OBJECTIVE
  The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD).
  
  
  METHODS
  The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy.
  
  
  RESULTS
  GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (LA grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy.
  
  
  CONCLUSIONS
  GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Saitama Medical School, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asakura
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Imai
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ota
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyamae
mesh_terms: D000328:Adult; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007717:Knee; D008297:Male; D008875:Middle Aged; D011187:Posture; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013909:Thorax