Scintigraphy in the detection of gastro-oesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring

Abstract:

Background:

Caustic injury of the oesophagus not only causes luminal narrowing but is also responsible for longitudinal contraction, resulting in gastro-oesophageal reflux (GOR), which leads to failure of conventional therapy. Therefore, the development of GOR should be investigated periodically to direct appropriate management of these patients.

Purpose:

To determine the ability of scintigraphy to detect GOR in children with caustic oesophageal strictures in comparison with barium study and 24-h pH monitoring.

Materials and methods:

Seventeen children with caustic oesophageal injury underwent scintigraphy, an upper GI barium study and 24-h pH monitoring within the same week. Five patients were also investigated post-operatively for the assessment of surgical outcome after antireflux surgery.

Results:

On the whole, there was good correlation (r = 0.78, P < 0.00 l) between scintigraphy and 24-h oesophageal pH monitoring. Scintigraphy detected all but one (9/10) refluxing patients and also correctly identified all (7/7) non-refluxing patients. Barium studies demonstrated 6 out of 10 refluxing patients. There were no false-positive barium studies in non-refluxing patients. Post-operative studies demonstrated no evidence of GOR in surgically treated patients.

Conclusions:

Our results indicate that, by comparison with barium studies, scintigraphy is useful in the detection of GOR in cases with caustic oesophageal strictures and may be used as a screening modality for those under clinical follow-up.