Assessment of gastro-esophageal reflux disease : comparison of reflux scintigraphy with endoscopy biopsy and esophageal pH monitoring

: In a study designed to evaluate reflux scintigraphy in 79 patients with gastro-esophageal reflux disease, quantitated reflux scintigraphy was found to have predictive values of 73% in detecting reflux as judged by esophageal pH monitoring, of 63% in detecting esophagitis as judged by esophagoscopy and biopsy, and of 77% in detecting the presence of either esophagitis or reflux. However, its sensitivity was only 48, 58 and 42%, respectively. Gastro-esophageal reflux scanning has little value in the routine clinical diagnosis of mild to moderate gastroesophageal reflux disease, but none of the other tests (biopsy, endoscopic appearances of 24 hour esophageal pH monitoring) were sufficiently specific to be taken as a sole diagnostic criterion ("gold standard"). Investigation of gastro-esophageal reflux disease could probably best be limited to endoscopy (especially to detect ulceration or metaplasia and to exclude neoplasia) with 24 hour pH monitoring in addition for those patients with suspected reflux disease but negative endoscopy.