Tc-99m-sulfur colloid gastroesophageal scintigraphy with late lung imagingto evaluate patients with posterior laryngitis

The aim of this study was to use gastroesophageal and pulmonary scintigraph y to evaluate the prevalence of gastroesophageal reflux and airway involvem ent among patients with posterior laryngitis. Methods: The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoar seness. A control population of 20 healthy volunteers (131 females, 7 males ; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12 -h fast, all subjects underwent gastroesophageal scintigraphy through admin istration of 300 mi orange juice labeled with 185 MBq Tc-99m-sulfur colloid . After 13 h, planar anteroposterior thoracic images were acquired with the subjects supine. Results: Sixty-seven percent of patients (134/201) had sc ans positive for gastroesophageal reflux; of these, 30 (22%) had distal ref lux and 104 (78%) had proximal reflux. In addition, the scans of 31 patient s were positive for proximal reflux-associated pulmonary uptake. The freque ncy, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.00 1). The 67 patients in whom reflux was not detected had diseases or reflux- associated cofactors that could account for laryngeal symptoms. No statisti cally significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal re flux had significantly prolonged gastric emptying times compared with healt hy volunteers. Conclusion: Most patients with posterior laryngitis had dete ctable proximal gastroesophageal reflux. Exposure of the proximal part of t he esophagus to acid, by setting the stage for microaspiration of gastric m aterial into the larynx, remains a major cause of damage to the laryngeal m ucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symp toms such as a dry cough, painful swallowing, or hoarseness may not be reli able predictors of the presence of gastroesophageal reflux or of associated airway involvement.