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Introduction ⬇

A gastroesophageal reflux scan, also known as gastroesophageal reflux scintigraphy, is an NMI test performed using acidified orange juice labeled with 99mTc sulfur colloid (99mTc-SC) to evaluate esophageal disorders such as esophageal regurgitation and to identify the cause of persistent nausea and vomiting. For infants, the study is used to distinguish between vomiting and reflux (for those with more severe symptoms). A certain amount of reflux occurs naturally in infants. If timely diagnosis and treatment of gastrointestinal (GI) reflux do not occur, additional complications may result, such as recurrent respiratory infections, apnea, or sudden infant death syndrome.

After oral administration of the radioisotope 99mTc-SC, the patient is immediately imaged to verify that the dose is in the stomach. Images are acquired again in 2 hours. A computer analysis is used to calculate the percentage of reflux into the esophagus for each image.

Procedure ⬆ ⬇

  1. Have the patient ingest the radionuclide agent in orange juice or in scrambled eggs. For infants, perform the test at the normal infant feeding time to determine esophageal transit. Have the infant drink 99mTc-labeled sulfur colloid mixed with milk. Give a portion of the milk containing the radioisotope and burp the infant before the remainder is given. Give some unlabeled milk to clear the esophagus of the radioactive material. If a nasogastric tube is required for radiopharmaceutical administration, remove it before the imaging occurs to avoid a false-positive result.

  2. Obtain images beginning 15 minutes after ingestion. Images may be obtained in standing or supine positions for adults. Infants will be placed in the supine position for imaging. There may be additional imaging performed 2 hours after ingestion to identify residual latent reflux.

  3. Remember that a computer analysis generates a time–activity curve to calculate the reflux.

  4. See Chapter 1 guidelines for safe, effective, informed intratest care.

Procedural Alert

Patients who have esophageal motor disorders, hiatal hernias, or swallowing difficulties should have a nasogastric tube inserted for administration of the radioactive material and then removed prior to the scan

Clinical Implications ⬆ ⬇

More than 40% reflux is abnormal. The percentage of reflux is used to evaluate patients before and after surgery for gastroesophageal reflux.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, benefits, and risks of the scan. See standard NMI pretest precautions.

  2. Tell the patient that imaging may be performed with the patient in a supine position or standing.

  3. Ensure that the patient is fasting for the appropriate amount of time before the examination.

  4. Monitor oral intake of the orange juice or scrambled eggs containing 99mTc-SC.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Remove nasogastric tube, if placed for administering the radiopharmaceutical.

  2. Refer to standard NMI posttest precautions.

  3. Review test results; report and record findings. Modify the nursing care plan as needed.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

  1. Previous upper GI x-ray procedures may interfere with this test.

  2. Previous gastric banding (bariatric procedure for morbid obesity) may interfere with esophageal motility and gastroesophageal reflux.

Reference Values ⬆

Normal

<40% gastric reflux across the esophageal sphincter