[Dysphagia] Pulmonary Aspiration Shown by ScintigraphyinGastroesophageal Reflux-Related Respiratory Disease

[mbuckie at dmc.org (Buckie,Marcia)]

I don't know that your post is really directly related to what I posted about scintigraphy. I wasn't necessarily talking about aspiration of reflux, but aspiration during p.o. intake ( I know your professional viewpoint on that, so we don't need to revisit it.)
 
What I was saying is scintigraphy as a mode of assessment didn't appear to be that complicated from my standpoint as a the parent of the patient, so I wondered if it was cost that was a deterrant.
 
However, If a child is going to be placed on a medication for reflux,(which my son was briefly)  I would think it would be best practice to employ  the dx tools one has on hand, including scintigraphy and clinical assessment to gain a comprehensive picture. 
 
I know there is no gold standard instrumental assessment for reflux, not even 24 h ph monitoring.
 
marcia
 
Marcia

	-----Original Message----- 
	From: dysphagia-bounces at b9.com on behalf of Irene Campbell-Taylor 
	Sent: Wed 11/15/2006 2:11 PM 
	To: Buckie,Marcia; Phyllis M. Palmer 
	Cc: dysphagia at b9.com 
	Subject: Re: [Dysphagia] Pulmonary Aspiration Shown by ScintigraphyinGastroesophageal Reflux-Related Respiratory Disease
	
	

	I think there's a prevalent assumption that if no reflux shows on standard examination, then it doesn't exist while nothing could be further from the truth. I have spent many hours trying to persuade parents and SLPs that many (perhaps most) children with chronic respiratory problemsare refluxing even though they've been told they're not.
	
	"Buckie,Marcia" <mbuckie at dmc.org> wrote:  My question is: why isn't scintigraphy used more often?
	I think it would really help distinguish the patients who aspirate
	chronically (more than normal saliva) and clear it later on via
	coughing, and those who it does settle in the lungs and contribute to
	the development of consolidations.
	Is it an expense issue?
	I had posted about my premature infant son earlier this year, who had a
	scintigram to evaluate for reflux, and it was relatively simple from our
	(patient/family standpoint.)
	Marcia
	
	
	
	-----Original Message-----
	From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
	Behalf Of Phyllis M. Palmer
	Sent: Friday, November 10, 2006 21:46
	To: Irene Campbell-Taylor
	Cc: dysphagia at b9.com
	Subject: Re: [Dysphagia] Pulmonary Aspiration Shown by Scintigraphy
	inGastroesophageal Reflux-Related Respiratory Disease
	
	Thanks Irene for the literature summary. I will post this on the
	dysphagia
	news section of http://www.dysphagia.com.
	
	__________________________________________________________
	Phyllis M. Palmer, Ph.D. Speech Language Pathologist
	University Of New Mexico
	
	www.dysphagia.com
	__________________________________________________________
	
	On Fri, 10 Nov 2006, Irene Campbell-Taylor wrote:
	
	> Published today but known for years:
	>
	> Pulmonary Aspiration Shown by Scintigraphy in Gastroesophageal
	Reflux-Related Respiratory Disease Chest. 2006;130:1520-1526
	> Alberto M. Ravelli, MD; M. Beatrice Panarotto, MD; Lucio Verdoni, MD;
	Valeria Consolati, MD and Stefania Bolognini, MS
	> Objectives: Gastroesophageal reflux (GER) may underlie respiratory
	manifestations via vagally mediated airway hyperresponsiveness or
	microaspiration, and intraesophageal pH monitoring is generally used to
	identify GER in patients with such manifestations. We aimed to establish
	the frequency of retrograde pulmonary aspiration in patients with
	unexplained respiratory manifestations.
	> Methods: Fifty-one patients with refractory respiratory symptoms
	(cough, n = 18; pneumonia, n = 14; apnea, n = 8; asthma, n = 7; and
	laryngitis, n = 4) were prospectively evaluated. They underwent 24-h
	intraesophageal pH monitoring and gastroesophageal 99Tc scintigraphy
	with lung scan 18 to 20 h after the test meal.
	> Results: Thirteen of 51 patients (25.5%) had abnormal intraesophageal
	pH study results (mean reflux index, 11.3%; range, 6.5 to 50%); and in
	25 of 51 patients (49%), overnight scintigraphy showed pulmonary
	aspiration. Nineteen of these 25 patients had entirely normal pH study
	results, whereas 6 of 13 patients with abnormal pH study results had
	aspiration. Pulmonary aspiration was demonstrated in all patients with
	apnea and 61.5% of patients with recurrent pneumonia. Nine of 25
	patients (36%) with aspiration had histologic evidence of esophagitis,
	whereas histologic esophagitis was present in 5 of 13 patients (38.4%)
	with pathologic GER as shown by intraesophageal pH monitoring.
	> Conclusions: Pulmonary aspiration as demonstrated by overnight
	scintigraphy is common in children with unexplained and refractory
	respiratory manifestations, suggesting that GER could be the underlying
	cause of these manifestations. Since only a few children with chronic or
	recurrent respiratory symptoms have a pathologic gastroesophageal acid
	reflux, a normal intraesophageal pH study result does not rule out GER
	in these children.
	>
	>
	>
	>
	> Dr I Campbell-Taylor
	> Clinical Neuroscientist
	> Exclusive Distributor:
	> www.interactivetherapy.com
	> _______________________________________________
	> Dysphagia mailing list
	> Dysphagia at b9.com
	> http://lists.b9.com/mailman/listinfo/dysphagia
	>
	_______________________________________________
	Dysphagia mailing list
	Dysphagia at b9.com
	http://lists.b9.com/mailman/listinfo/dysphagia
	
	
	
	Dr I Campbell-Taylor
	Clinical Neuroscientist
	Exclusive Distributor:
	www.interactivetherapy.com
	_______________________________________________
	Dysphagia mailing list
	Dysphagia at b9.com
	http://lists.b9.com/mailman/listinfo/dysphagia