The Burden of Gastroesophageal Reflux Disease on the Cost of Managing Chronic Diseases in Australia. The Need for a New Diagnostic and Management Paradigm - Abstract
Introduction: Chronic disease poses a major problem for the Australian healthcare system as the leading cost-burden and cause of death. Gastroesophageal reflux disease (GORD) typifies the problems with a growing prevalence and cost. We hypothesise that a new scintigraphic test could streamline and speed up the diagnosis, especially in extraoesophageal disease which is universally problematic.
Materials & methods: Data was collected from 2 groups of patients. Patients undergoing fundoplication for severe GORD (n=30) and those with atypical symptoms (n=30) were studied by scintigraphy and 24-hour oesophageal pH, impedance and manometry in an outpatient setting.
Results: Mean age of cohort was 55.8 years with 40 females and 20 males. Body mass index was a mean of 28.3. DeMeester score was normal in 12/60 with atypical symptoms and abnormal in the rest. Good correlation was shown between scintigraphy and impedance, manometry and distal pH readings. Pulmonary aspiration was shown in 25/60 (15 with atypical symptoms) and LPR in 20/30. Several impedance, manometric and scintigraphic finding were good predictors of lung aspiration of refluxate.
Conclusion: Scintigraphy provides a good tool for screening patients with typical and atypical symptoms of GORD. It is well correlated with the standard methods for the diagnosis and provides visual evidence of LPR and lung aspiration, especially in atypical disease