Sager Sait, Halac Metin, Selcuk Nalan, Dogan Ismail, Kabasakal Levent, Onsel Cetin, Uslu Ilhami
Department of Nuclear Medicine, Istanbul University, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey.
Nucl Med Commun. 2010 Dec;31(12):1059-62. doi: 10.1097/MNM.0b013e32833e85b2.
There are conflicting reports for the relationship of reflux and the gastric emptying rate. In addition, the acquisition period is not well defined for the gastroesophageal reflux studies. The aim of our study was to evaluate the temporal distribution of the reflux episodes and to evaluate whether the gastric emptying rate changed with the gastroesophageal reflux time or amount.
We used radionuclide scintigraphy to evaluate 211 pediatric patients (0-10 years of age). Scintigraphic studies were performed by acquiring 15 s images for 1 h in a supine position after ingesting milk containing 0.5 mCi (18.5 MBq) Tc-99m colloid. Reflux episodes were calculated every 10 min for each patient who had reflux. The gastric emptying rate was measured by drawing an region of interest over the gastric activity.
Gastric reflux was observed in 104 patients (49.28%). The number of reflux episodes was higher in the first and second 10 min (33.7 and 29.1% respectively). The lowest reflux episode was observed in the last 10 min (between 50 and 60 min) (2.6%) suggesting that the reflux episode was decreasing by the gastric emptying. Within the first 30 min, reflux was observed in 98 of 104 patients (94.23%). The gastric emptying rate was calculated to be 73 min in patients with a higher incidence of reflux and 62 min in patients who had delayed and lower incidence of reflux episodes. In 104 patients, the average gastric emptying rate was 71.60 min. There were no significant differences in the gastric emptying rates between patients who had reflux episodes beginning in the first 30 min of the study and those who had reflux episodes in the last 30 min of the study (P>0.05).
This study has suggested that the number of reflux episodes were not related with the gastric emptying rate. However, reflux could be observed in a higher frequency before gastric emptying, which also suggested that a 30-min period may be sufficient when reflux is shown early. In negative cases, a 60-min acquisition time is recommended for the diagnosis of gastroesophageal reflux.
关于反流与胃排空率的关系存在相互矛盾的报道。此外，胃食管反流研究的采集时间界定并不明确。我们研究的目的是评估反流发作的时间分布，并评估胃排空率是否随胃食管反流时间或反流量而变化。
我们使用放射性核素闪烁扫描术对211例儿科患者（0至10岁）进行评估。闪烁扫描研究是在摄入含有0.5毫居里（18.5兆贝可）锝-99m胶体的牛奶后，让患者仰卧位采集1小时的15秒图像来进行的。对每例有反流的患者每10分钟计算一次反流发作次数。通过在胃活动区域绘制感兴趣区来测量胃排空率。
104例患者（49.28%）观察到胃反流。在最初的10分钟和第二个10分钟内反流发作次数较多（分别为33.7%和29.1%）。在最后10分钟（50至60分钟之间）观察到的反流发作次数最少（2.6%），这表明反流发作次数因胃排空而减少。在最初30分钟内，104例患者中有98例（94.23%）观察到反流。反流发生率较高的患者胃排空率计算为73分钟，反流发作延迟且发生率较低的患者胃排空率为62分钟。104例患者的平均胃排空率为71.60分钟。在研究开始的前30分钟出现反流发作的患者与在研究最后30分钟出现反流发作的患者之间，胃排空率无显著差异（P>0.05）。
本研究表明反流发作次数与胃排空率无关。然而，在胃排空之前反流的发生频率可能更高，这也表明当早期出现反流时，30分钟的观察期可能就足够了。在阴性病例中，建议采用60分钟的采集时间来诊断胃食管反流。
