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[Dysphagia] Pulmonary Aspiration Shown by Scintigraphy inGastroesophageal Reflux-Related Respiratory Disease
I think there's a prevalent assumption that if no reflux shows on standard examination, then it doesn't exist while nothing could be further from the truth. I have spent many hours trying to persuade parents and SLPs that many (perhaps most) children with chronic respiratory problemsare refluxing even though they've been told they're not.
"Buckie,Marcia" <mbuckie at dmc.org> wrote: My question is: why isn't scintigraphy used more often?
I think it would really help distinguish the patients who aspirate
chronically (more than normal saliva) and clear it later on via
coughing, and those who it does settle in the lungs and contribute to
the development of consolidations.
Is it an expense issue?
I had posted about my premature infant son earlier this year, who had a
scintigram to evaluate for reflux, and it was relatively simple from our
(patient/family standpoint.)
Marcia
-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Phyllis M. Palmer
Sent: Friday, November 10, 2006 21:46
To: Irene Campbell-Taylor
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Pulmonary Aspiration Shown by Scintigraphy
inGastroesophageal Reflux-Related Respiratory Disease
Thanks Irene for the literature summary. I will post this on the
dysphagia
news section of http://www.dysphagia.com.
__________________________________________________________
Phyllis M. Palmer, Ph.D. Speech Language Pathologist
University Of New Mexico
www.dysphagia.com
__________________________________________________________
On Fri, 10 Nov 2006, Irene Campbell-Taylor wrote:
> Published today but known for years:
>
> Pulmonary Aspiration Shown by Scintigraphy in Gastroesophageal
Reflux-Related Respiratory Disease Chest. 2006;130:1520-1526
> Alberto M. Ravelli, MD; M. Beatrice Panarotto, MD; Lucio Verdoni, MD;
Valeria Consolati, MD and Stefania Bolognini, MS
> Objectives: Gastroesophageal reflux (GER) may underlie respiratory
manifestations via vagally mediated airway hyperresponsiveness or
microaspiration, and intraesophageal pH monitoring is generally used to
identify GER in patients with such manifestations. We aimed to establish
the frequency of retrograde pulmonary aspiration in patients with
unexplained respiratory manifestations.
> Methods: Fifty-one patients with refractory respiratory symptoms
(cough, n = 18; pneumonia, n = 14; apnea, n = 8; asthma, n = 7; and
laryngitis, n = 4) were prospectively evaluated. They underwent 24-h
intraesophageal pH monitoring and gastroesophageal 99Tc scintigraphy
with lung scan 18 to 20 h after the test meal.
> Results: Thirteen of 51 patients (25.5%) had abnormal intraesophageal
pH study results (mean reflux index, 11.3%; range, 6.5 to 50%); and in
25 of 51 patients (49%), overnight scintigraphy showed pulmonary
aspiration. Nineteen of these 25 patients had entirely normal pH study
results, whereas 6 of 13 patients with abnormal pH study results had
aspiration. Pulmonary aspiration was demonstrated in all patients with
apnea and 61.5% of patients with recurrent pneumonia. Nine of 25
patients (36%) with aspiration had histologic evidence of esophagitis,
whereas histologic esophagitis was present in 5 of 13 patients (38.4%)
with pathologic GER as shown by intraesophageal pH monitoring.
> Conclusions: Pulmonary aspiration as demonstrated by overnight
scintigraphy is common in children with unexplained and refractory
respiratory manifestations, suggesting that GER could be the underlying
cause of these manifestations. Since only a few children with chronic or
recurrent respiratory symptoms have a pathologic gastroesophageal acid
reflux, a normal intraesophageal pH study result does not rule out GER
in these children.
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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