About
Gastroesophageal reflux disease (GORD) is a common condition. Silent reflux affects approximately 40 to 50% of patients who have GORD. It is referred to as ‘silent reflux’ because it does not present with the classical symptoms of reflux, being heartburn, lump in the throat and regurgitation. Symptoms of silent reflux range from chronic cough, recurrent sore throats, loss of voice, persistent throat clearing, chest pain, choking, wheezing and shortness of breath.
For the first time, these disease processes can be visualised at the level of the oesophagus and in the head and neck structures as well as in the lungs by our patented scintigraphic reflux test.
Please note: We do not advocate this test for simple reflux which presents with heartburn and regurgitation as this can be managed clinically without testing.
Diagnosing Gastroesophageal Reflux Disease
GORD can be difficult to diagnose in patients who have a chronic cough (lasting over two months) but no heartburn symptoms. This is because common conditions such as postnasal drip and asthma are even more likely to cause a chronic cough.
Often our patients aren’t displaying classic symptoms of GORD (heartburn & regurgitation) but present with atypical upper respiratory tract symptoms such as chronic cough, dysphonia, sore throat and globus. There may be no symptoms of GORD in patients presenting with chronic cough or recurrent chest infections.
The Gastroesophageal Reflux Test provides an effective, bulk billed, non-invasive screening tool for GORD, LPR and lung aspiration. This is the first test available that is able to identify and determine the extent of reflux contamination throughout the maxillary sinuses, throat, middle ears, laryngopharynx and detect irritation to the airways and aspiration of reflux into the lungs.
How does the Gastroesophageal Reflux Test compare to other diagnostic tests for reflux?
Historically, GORD has been diagnosed using pH monitoring, fluoroscopy or endoscopy.
pH monitoring is performed off therapy. Standard test preparation is to cease anti-reflux therapy for the 3 days prior to the test. This causes a rebound acid effect, and the stomach produces more acid. Although this test is 50-80% sensitive & 77–100% specific in the presence of heartburn & regurgitation, it is limited to oesophageal disease only, particularly the lower oesophagus. This test is expensive, invasive, and may be poorly tolerated by patients.
Endoscopy is effective as an anatomical diagnostic tool, but has a poor sensitivity for GORD (less than 30%) and is limited to detecting reflux disease that is severe enough to damage the oesophagus.
Fluoroscopy or Barium Swallow is insensitive and has a high radiation burden and only demonstrates oesophageal disease.
The Gastroesophageal Reflux Test provides an effective, bulk billed, non-invasive screening tool for oesophageal disease, LPR and lung aspiration, detecting contamination throughout the maxillary sinuses, throat, middle ears, laryngopharynx, airways and lungs. This test is 90% sensitive, detecting both acid and non-acid reflux and is well-tolerated by patients.
The Gastroesophageal Reflux Test Process
The Gastroesophageal Reflux Test is performed over three hours in two stages:
Test preparation is simple – involving a 4 hour fast, with all medications, including PPIs to be taken prior to the fasting period.
Upon arrival to clinic, the Nuclear Medicine technician gives the patient 20ml of an over the counter liquid anti-acid (GastroGel, Gaviscon, or equivilent) followed by 150mL of water with a small dose of Technetium, and another 150mL of water to flush and clear the mouth of the tracer. Dynamic images are taken from the mouth to the stomach in the upright and supine position with the gamma camera.
These images are analysed with special software to indicate the frequency and amplitude of reflux for the upper oesophagus and pharynx/ laryngopharynx. Liquid gastric emptying is also calculated.
Following a 90-minute break, a study of the head, neck and chest will be performed to detect any aspiration of refluxate into the head and neck structures (including the laryngopharynx) and lungs.
