Skip to main content
SpringerLink
Log in

Detection of esophageal motor disorders by radionuclide transit studies

A reappraisal

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kazem I.: A new scintigraphic technique for the study of the esophagus. Am J Roentgenol 115:681–688, 1972

    Google Scholar 

  2. Tolin RD, Malmud LS, Reilley J, Fisher RS: Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit). Gastroenterology 76:1402–1408, 1979

    PubMed  Google Scholar 

  3. 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

    Google Scholar 

  4. Blackwell JN, Hannan WJ, Adam RD, Heading RC: Radionuclide transit studies in the detection of oesophageal dysmotility. Gut 24:421–426, 1983

    PubMed  Google Scholar 

  5. Winnan GR, Meyer CT, McCallum RW: Interpretation of the Bernstein test: A reappraisal of criteria. Ann Intern Med 96:320–322, 1982

    PubMed  Google Scholar 

  6. Kantrowitz PA, Corson JG, Fleischli DJ, Skinner DB: Measurement of gastroesophageal reflux. Gastroenterology 56:666–673, 1969

    Google Scholar 

  7. Traube M, Albibi R, McCallum RW: High amplitude peristaltic contractions associated with chest pain. J Am Med Assoc 250:2655–2659, 1983

    Google Scholar 

  8. Svedberg J: The bolus transport diagram: A functional display method applied to oesophageal studies. Clin Phys Physiol Meas 3:267–272, 1982

    PubMed  Google Scholar 

  9. Klein HA: Computer aided analysis of radionuclide esophageal transit studies. J Nucl Med 29:957–964, 1984

    Google Scholar 

  10. Meshkinpour H, Glick ME, Sanchez P, Tarvin J: Esophageal manometry. A benefit and cost analysis. Dig Dis Sci 27:772–775, 1981

    Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. Kahrilas PJ, Dodds WJ, Hogan WJ: Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94:73–80, 1988

    Google Scholar 

  13. deCaestecker JS, Blackwell JN, Adam RD, Hannan WJ, Brown J, Heading RC: Clinical value of radionuclide oesophageal transit measurement. Gut 27:659–666, 1986

    PubMed  Google Scholar 

  14. 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

    PubMed  Google Scholar 

  15. Benjamin SB, O'Donnell JK, Hancock J, Nielsen P, Castell DO: Prolonged radionuclide transit in “nutcracker esophagus.” Dig Dis Sci 28:775–779, 1983

    PubMed  Google Scholar 

  16. Richter JE, Wu W, Cowan RJ, Ott D, Blackwell JN: Nutcracker esophagus. Dig Dis Sci 30:188, 1985 (letter)

    Google Scholar 

  17. Blackwell JN, Castell DO: Oesophageal chest pain: A point of view. Gut 25:1–6, 1984

    PubMed  Google Scholar 

  18. Blackwell JN, Richter JE, Wu WC, Cowan RJ, Castell DO: Esophageal transit tests: Potential false positive results. Gastroenterology 84:1108, 1983 (abstract)

    Google Scholar 

  19. 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

    PubMed  Google Scholar 

  20. 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

    PubMed  Google Scholar 

  21. 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

    Google Scholar 

  22. 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

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Richard H. Holloway MD

    Present address: Gastroenterology Unit, Royal Adelaide Hospital, 5000, North Terrace, Adelaide S.A., Australia

Authors and Affiliations

  1. Departments of Medicine and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut

    Richard H. Holloway MD, Robert C. Lange PhD, Michael W. Plankey CNMT & Richard W. McCallum MD

Authors
  1. Richard H. Holloway MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. Lange PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael W. Plankey CNMT
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard W. McCallum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01540277

Key words

Search

Navigation