Gastro-oesophageal and bile reflux - simultaneous quantitative assessment with gastric and gallbladder emptying evaluation: clinical applicability of a new computerized gammagraphic method

Abstract

Summary

The aim of this study was to develop a new computerized gammagraphic method to evaluate gastro-oesophageal (GER), bileo-oesophageal (BER) and bileogastric reflux (BGR) simultaneously with gastric and gallbladder emptying: a long duration (60 min) and a dual energy detection (113Inm-sulphur colloid and 99Tcm-HIDA) test of the different refluxes during slow gastric emptying of an enteric feeding liquid meal. Forty patients with oesophagitis and 18 normal volunteers were evaluated. Good reproducibility of all the quantified parameters was found with γ Spearman between 0.75 (P < 0.05) and 1.0 (P < 0.001). Patients with oesophagitis have a tendency for slower gastric emptying patterns (gastric emptying T1/2BT1/2 P < 0.05). The calculated specificity for gallbladder emptying parameters was 77.8% for the gallbladder T1/2, BTl/2) and 94.4% for gallbladder residue at 60 min (BR60)- The calculated accuracy for the GER index was 90%. The predictability for positive values was 95%, owing to a 90% sensitivity and 89% specificity. The predictability for negative values was 80%. The mean GER index in oesophagitis was greater than in controls (P < 0.001). The calculated specificity for BGR was 94.4% and reflux was detected in 12 out of 40 patients. The calculated specificity for BER was 83.3% for a ‘+’ index and 94.4% for a ‘++’ BER index. In 14 patients a positive BER index has been determined (‘+’ in three and ‘++’ in 11 cases). A general overview of the results obtained with this new method supports its conception as an integrative approach to upper digestive tract functions and its suitability for the surgical evaluation of patients with oesophageal and gastric functional pathology.