title: Classification schema of symptomatic enterogastric reflux utilizing sincalide augmentation on hepatobiliary scintigraphy.
abstract: Enterogastric reflux (EGR) is the reflux of duodenal contents into the stomach. Hepatobiliary scintigraphy provides physiologic assessment of the biliary system and was used to test the hypothesis that presence and timing of EGR may be associated with infusion of sincalide, a surrogate of endogenous cholecystokinin.
  
  
  METHODS
  One hundred fifty-seven hepatobiliary scintigraphy studies were retrospectively reviewed. Data included EGR incidence on initial reports, incidence after masked second reads, and time of EGR onset in relation to sincalide infusion. EGR cases were then classified according to onset on pre-, post-, or both presincalide and postsincalide imaging.
  
  
  RESULTS
  Time of EGR onset at 19-24 minutes after start of a 15-min sincalide infusion differed significantly from normal (p<0.0001). EGR was initially reported in 14 of 157 cases (8.9%) but found in 38 of 157 cases on masked second reads (24.2%), corresponding to a 15.3% discrepancy rate.
  
  
  CONCLUSIONS
  The temporal association of EGR onset with sincalide infusion may identify patients with EGR mimicking chronic cholecystitis or biliary dyskinesia. A novel classification schema was therefore developed as a framework for future research, utilizing EGR onset in relation to pre-, post-, or both presincalide and postsincalide imaging as a hypothetical biomarker of clinically significant EGR.
authors.affiliation: Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and philliphkuo@gmail.com.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Covington
authors.affiliation: Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krupinski
authors.affiliation: Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Avery
authors.affiliation: Department of Medical Imaging, Medicine and Biomedical Engineering, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D004383:Duodenogastric Reflux / Q000000981:diagnostic imaging*; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012844:Sincalide; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D012844:Sincalide
keywords: HIDA scan; bile reflux; enterogastric reflux; hepatobiliary scintigraphy; sincalide