for Pediatric Gastroenterology, Hepatology, and Nutrition state that UGI is not useful for diagnosing GER but can help exclude or confirm anatomic abnormalities that cause symptoms similar to GER [34]. The brief duration of the UGI series results in false-negative results for GER, whereas the frequent occurrence of nonpathological reflux results in false-positive results. Thus, the UGI series is not a useful test to reliably determine the presence or absence of GER. In patients with severe or complicated GERD who will be managed with gastrostomy tube placement and Nissen fundoplication or with gastrojejunostomy tube, the UGI is useful to exclude anatomic abnormalities, such as esophageal stricture or malrotation, that would need to be addressed at the time of surgery. Radiography Abdomen There is no relevant literature to support the use of radiographs in the evaluation for GER. Nuclear Medicine Gastroesophageal Reflux Scan Reflux scintigraphy can be performed using Tc-99m sulfur colloid or Tc-99m DTPA or Tc-99m MAA mixed in a feeding. Seibert et al [35] noted reflux scintigraphy to be 79% sensitive when compared to a 24-hour pH esophageal probe as a standard. Methodology and interpretation criteria for reflux scintigraphy are not uniform from center to center [36,37]. Several studies have tried to standardize the methodology of the examination. A 1-hour scintigraphic study formatted in 60-second frames provides a quantitative representation of postprandial GER for children, particularly in the absence of rapid gastric emptying [38]. False-negative examinations can be associated with delayed gastric emptying, and in this patient group, prolongation of the study beyond 60 minutes or confirmatory pH probe evaluation may be advisable. Othman [39] proposes that placing the patient in multiple positions during the scan results in a percentage yield of a positive study that is 3-fold that of the conventional supine position technique.
Vomiting in Infants. for Pediatric Gastroenterology, Hepatology, and Nutrition state that UGI is not useful for diagnosing GER but can help exclude or confirm anatomic abnormalities that cause symptoms similar to GER [34]. The brief duration of the UGI series results in false-negative results for GER, whereas the frequent occurrence of nonpathological reflux results in false-positive results. Thus, the UGI series is not a useful test to reliably determine the presence or absence of GER. In patients with severe or complicated GERD who will be managed with gastrostomy tube placement and Nissen fundoplication or with gastrojejunostomy tube, the UGI is useful to exclude anatomic abnormalities, such as esophageal stricture or malrotation, that would need to be addressed at the time of surgery. Radiography Abdomen There is no relevant literature to support the use of radiographs in the evaluation for GER. Nuclear Medicine Gastroesophageal Reflux Scan Reflux scintigraphy can be performed using Tc-99m sulfur colloid or Tc-99m DTPA or Tc-99m MAA mixed in a feeding. Seibert et al [35] noted reflux scintigraphy to be 79% sensitive when compared to a 24-hour pH esophageal probe as a standard. Methodology and interpretation criteria for reflux scintigraphy are not uniform from center to center [36,37]. Several studies have tried to standardize the methodology of the examination. A 1-hour scintigraphic study formatted in 60-second frames provides a quantitative representation of postprandial GER for children, particularly in the absence of rapid gastric emptying [38]. False-negative examinations can be associated with delayed gastric emptying, and in this patient group, prolongation of the study beyond 60 minutes or confirmatory pH probe evaluation may be advisable. Othman [39] proposes that placing the patient in multiple positions during the scan results in a percentage yield of a positive study that is 3-fold that of the conventional supine position technique.