CASE OF THE WEEK – “AN IMPROVED RADIONUCLIDE METHOD FOR THE DIAGNOSIS OF GASTROESOPHAGEAL REFLUX IN CHILDRENS (MILK SCAN)“by Dr. Shekhar Shikare, HOD & Consultant, Nuclear Medicine & Dr. Loai Eid Consultant Pediatric Nephrologist, NMC Royal Hospital Sharjah
Gastro esophageal reflux disease (GERD) is the most common cause of children admission to the pediatric unit and affects 30% of the pediatric population.
5-month-old baby with history of failure to thrive with poor weight gain. Admitted with vomiting, dehydration, and electrolytes imbalance with underlying bilateral polycystic kidney disease.
99m Tc –COLLOID LABELLED GER (milk) SCAN
Evidence of gastro-esophageal reflux grade III (tracer uptake is seen upto upper esophageal region and appreciated at 8.5 minutes (as shown with arrow) of forty minutes dynamic study.
- Simple, quick, physiological, and more reproducible.
- Sensitivity-Reflux detected in 95% to 100% symptomatic patients. Both acid and alkaline reflux can be detected.
- Much more sensitive than fluoroscopy and endoscopy (ST-40%) and lower esophageal sphincter pressure.
- There is 90% correlation with acid pH test.
- Barium swallow is an insensitive test for detecting the presence of intermittent reflux.
- Although scintigraphy can detect small volumes of aspiration, the diagnosis cannot be excluded by a negative examination.