Gastrointestinal reflux scanning is a nuclear study performed to assist in diagnosing esophageal reflux in clients complaining of heartburn and regurgitation. This disorder is common in the adult population, but it also occurs in infants and children, causing significant complications such as esophagitis, stricture, aspiration pneumonia, and failure to thrive.45 Lung scanning can be performed if aspiration of gastric contents into the lungs is suspected. The study can be combined with the gastric emptying study because reflux is known to be associated with a delay in emptying. The radionuclide 99mTc as technetium Tc 99m sulfur colloid is mixed with orange juice or other acidic fluid and administered orally. Scanning is performed over the gastroesophageal area and later over the lungs, if aspiration is suspected. This study is more sensitive for this condition than is endoscopy, fluoroscopy, or manometry to measure esophageal sphincter pressure.
Esophageal motility studies are performed to diagnose achalasia and esophageal spasms. The technetium Tc 99m sulfur colloid is mixed with water and administered to the client, followed by scanning. A significant reduction in esophageal activity indicates the presence of abnormalities. This test is more sensitive than esophageal manometry in clients with complaints of dysphagia.46
Nursing Care Before the Procedure
Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").
- Instruct the client to restrict food or ingest a meal before the study, depending on the policy of the nuclear medicine department.
- Inform the client of the scanning schedule and explain that the study takes 30 minutes.
- History should include information about gastrointestinal status and complaints resulting from an abnormality.
The client is given the radiopharmaceutical in 300 mL of orange juice and is then placed in an upright position for scanning. The client is requested to remain still, and imaging is performed in 10 to 15 minutes over the esophageal area. Imaging is also performed in other positions to determine whether reflux occurs in a specific position. After this initial imaging, an abdominal compression binder is applied to sequentially lower esophageal sphincter pressure 5 mm Hg at a time. Images are recorded on the computer at each pressure level, and the reflux is calculated for each pressure level. Esophageal motility or transient time can be determined by the presence of radionuclide in the esophagus. If an infant is scanned, the radiopharmaceutical is administered in the formula or instilled via a gastrointestinal tube, and imaging is performed at intervals for 1 hour.
If an aspiration scan is performed, the radiopharmaceutical is given to the client in the evening meal before the study. The client remains in the supine position until morning, and scanning is performed over the lungs to note uptake of the radionuclide, indicating aspiration.
Nursing Care After the Procedure
Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").
