Figure 7. Flowchart outlining the evaluation of uninvestigated dyspepsia.

Frequently Asked Questions (FAQs)

Are Nuclear Medicine techniques used in diagnosing gastroesophageal reflux disease (GERD)?

Nuclear Medicine has a definite clinical role in the evaluation of infants with excessive spitting up or possible pulmonary aspiration (discussed in Chapter 17). Its place in adult GERD is more questionable. Radionuclide testing attempts to demonstrate abnormal entry of stomach contents into the esophagus. The test is performed after a six to eight hour fast. Medications known to affect function of the LES, such as caffeine, alcohol and smoking, are avoided prior to testing. Orange juice 150 ml containing 99mTc-sulfur colloid is ingested in the erect position to completely clear the esophagus, after which the patient is positioned supine under the gamma camera. Dynamic images are obtained at 30 seconds per frame. Some centers perform provocative maneuvers to increase intra-abdominal pressure, such as having the patient perform a Valsalva maneuver or the application of an abdominal binder (slowly inflated to a maximum of 100 mm Hg).

A clinical diagnosis of GERD can be made if the predominant symptom is regurgitation or an epigastric burning sensation that radiates towards the throat. If there are other complaints, the diagnostic accuracy lessens. In those patients without "alarm symptoms" such as dysphagia, anemia, weight loss or bleeding, it is rea

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