Enterogastric reflux: A hidden culprit in cases of suspected cholecystitis?

Objectives Enterogastric reflux (EGR) is the reflux of bile and other digestive fluids from the duodenum into the stomach. EGR exerts harmful effects on gastric mucosa, facilitates H. pylori colonization, and acts synergistically with H. pylori to cause gastritis and intestinal metaplasia. Options for diagnosing EGR include hepatobiliary scintigraphy (HIDA) scans or endoscopy. The proper treatment of EGR includes medications or surgery. The incidence of EGR as a finding on routine HIDA scans is unknown. We completed a retrospective review to determine the incidence of reported EGR on HIDA scans at our institution.

Methods A retrospective review of the reports of 93 consecutive HIDA studies performed on adults over 6 months was completed. Data included the presence of EGR as a reported finding, patient age and gender, mCi of injected radiotracer, and gallbladder ejection fraction (GBEF) if performed. GBEF was performed using a 15 min infusion of sincalide followed by an additional 15 min of imaging. Anterior planar imaging was presented as 5 min frames.

Results EGR was a reported incidental finding in 11% of reports (10 of 93 cases). GBEF was assessed in 68 cases, 24 of which were abnormal (EF <35%). Five of the EGR cases occurred during or following sincalide infusion. The other 5 cases occurred without or prior to sincalide at an average of 49 minutes after injection of radiotracer. EGR demonstrated no statistically significant relationship with patient age (p=.97), gender (p=.65), mCi of injected activity (p=.39), nor GBEF (p=.92).

Conclusions EGR is a frequent incidental finding on HIDA scans and may have important implications for patients with suspected cholecystitis. Detecting EGR may reveal the true etiology of pain in patients with normal GBEF on HIDA scans. For patients with abnormal GBEF, EGR may be important since cholecystectomy is a risk factor for development of clinically significant EGR and therefore may worsen pre-existing EGR. Thus, nuclear medicine physicians should routinely and carefully evaluate for EGR on HIDA scans.