Abstract
Radionuclide measurement of esophageal transit has been proposed as a screening test for esophageal motor dysfunction. In this study we evaluated the radionuclide esophageal transit test in 49 consecutive patients undergoing esophageal manometry for esophageal motor disorders. Esophageal transit was assessed using a 10-ml water bolus labeled with 250 μCi technetium-99m sulfur colloid. In preliminary studies in 14 healthy controls, mean transit time was 9.6±2.1 (SD) sec. Prolonged transit (>15 sec) was observed in two of 28 swallow sequences in the control subjects. Transit times were prolonged in all patients with achalasia or diffuse esophageal spasm, and in five of seven patients with nonspecific abnormalities of peristaltic progression. The test was abnormal in only three of seven patients with high-amplitude peristalsis (nutcracker esophagus) and in none of three patients with hypertensive lower esophageal sphincter. Additionally, prolonged transit was seen in two of 18 patients with normal manometry. We conclude that the radionuclide transit test using a liquid bolus successfully identifies motor disorders characterized by defective peristaltic progression but not disorders in which peristalsis is intact. A major limiting factor appears to be the small number of swallow sequences tested. The test may not, therefore, be accurate enough to consider adopting as a sensitive and noninvasive screening test in the evaluation of patients with suspected esophageal motor disorders.
Similar content being viewed by others
References
Kazem I.: A new scintigraphic technique for the study of the esophagus. Am J Roentgenol 115:681–688, 1972
Tolin RD, Malmud LS, Reilley J, Fisher RS: Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit). Gastroenterology 76:1402–1408, 1979
Russell COH, Hill LD, Holmes ER III, Hull DA, Gannon R, Pope CE II: Radionuclide transit: A sensitive screening test for esophageal dysfunction. Gastroenterology 80:887–892, 1981
Blackwell JN, Hannan WJ, Adam RD, Heading RC: Radionuclide transit studies in the detection of oesophageal dysmotility. Gut 24:421–426, 1983
Winnan GR, Meyer CT, McCallum RW: Interpretation of the Bernstein test: A reappraisal of criteria. Ann Intern Med 96:320–322, 1982
Kantrowitz PA, Corson JG, Fleischli DJ, Skinner DB: Measurement of gastroesophageal reflux. Gastroenterology 56:666–673, 1969
Traube M, Albibi R, McCallum RW: High amplitude peristaltic contractions associated with chest pain. J Am Med Assoc 250:2655–2659, 1983
Svedberg J: The bolus transport diagram: A functional display method applied to oesophageal studies. Clin Phys Physiol Meas 3:267–272, 1982
Klein HA: Computer aided analysis of radionuclide esophageal transit studies. J Nucl Med 29:957–964, 1984
Meshkinpour H, Glick ME, Sanchez P, Tarvin J: Esophageal manometry. A benefit and cost analysis. Dig Dis Sci 27:772–775, 1981
Dodds WJ, Hogan WJ, Reid DP, Stewart ET, Arndorfer RC: A comparison between primary esophageal peristalsis following wet and dry swallows. J Appl Physiol 35:851–857, 1973
Kahrilas PJ, Dodds WJ, Hogan WJ: Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94:73–80, 1988
deCaestecker JS, Blackwell JN, Adam RD, Hannan WJ, Brown J, Heading RC: Clinical value of radionuclide oesophageal transit measurement. Gut 27:659–666, 1986
Mirghal MM, Marples M, Bancewicz J: Scintigraphic assessment of oesophageal transit motility: What does it show and how reliable is it? Gut 27:946–953, 1986
Benjamin SB, O'Donnell JK, Hancock J, Nielsen P, Castell DO: Prolonged radionuclide transit in “nutcracker esophagus.” Dig Dis Sci 28:775–779, 1983
Richter JE, Wu W, Cowan RJ, Ott D, Blackwell JN: Nutcracker esophagus. Dig Dis Sci 30:188, 1985 (letter)
Blackwell JN, Castell DO: Oesophageal chest pain: A point of view. Gut 25:1–6, 1984
Blackwell JN, Richter JE, Wu WC, Cowan RJ, Castell DO: Esophageal transit tests: Potential false positive results. Gastroenterology 84:1108, 1983 (abstract)
Mittal RK, Lange RC, Magyar L, McCallum RW: Identification and mechanism of delayed esophageal acid clearance in subjects with hiatal hernia. Gastroenterology 92:130–135, 1987
Kjellen G, Svedberg JB: Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography. Dig Dis Sci 29; 1–5, 1984
Applegate GR, Malmud LS, Rock E, Reilley JR, Fisher RS: It's a hard pill to swallow or don't take it lying down. Gastroenterology 78:1132, 1980
Fisher RS, Malmud LS, Applegate G, Rock E, Lorber SH: Effect of bolus composition on esophageal transit: Concise communication. J Nucl Med 23:878–882, 1982
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holloway, R.H., Lange, R.C., Plankey, M.W. et al. Detection of esophageal motor disorders by radionuclide transit studies. Digest Dis Sci 34, 905–912 (1989). https://doi.org/10.1007/BF01540277
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01540277