Skip to main content
SpringerLink
Log in

Gastroesophageal Reflux, Gastric Emptying, Esophageal Transit, and Pulmonary Aspiration

  • Chapter
  • First Online:
Pediatric Nuclear Medicine and Molecular Imaging

Abstract

Gastrointestinal diseases are common in children. The clinical diagnosis is often challenging due to significant overlap of signs and symptoms among different conditions. Radiological studies are useful in detecting pathological conditions due to congenital or acquired structural malformations in organs. Pathological conditions in the gastrointestinal tract, however, often result from organ dysfunction (e.g., motility disorders) without significant morphological changes. These conditions are best evaluated with scintigraphic techniques. Nuclear medicine studies of the GI tract are sensitive, noninvasive, and physiologic techniques that can show functional pathologies in different parts of the GI tract. They require minimum patient cooperation, are well tolerated, and entail a low radiation burden. They can also be quantified for more objective evaluation, for better intersubject comparison, and for monitoring response to therapy with serial imaging. This chapter presents a detailed description of nuclear medicine studies in the evaluation of gastroesophageal reflux, gastric emptying, esophageal transit, and pulmonary aspiration in children. Reference is made to the underlying pathophysiology, clinical presentations, diagnostic evaluation, and therapy. The role of nuclear medicine studies in comparison to alternative imaging and non-imaging diagnostic techniques is emphasized.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cezard JP. Managing gastro-oesophageal reflux disease in children. Digestion. 2004;69 Suppl 1:3–8.

    CAS  PubMed  Google Scholar 

  2. Werlin SL, Dodds WJ, Hogan WJ, et al. Mechanisms of gastroesophageal reflux in children. J Pediatr. 1980;97:244–2499.

    CAS  PubMed  Google Scholar 

  3. Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology. 1997;113:399–408.

    CAS  PubMed  Google Scholar 

  4. Omari TI, Barnett CP, Benninga MA, et al. Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut. 2002;51:475–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Holloway R, Hongo M, Berger K, McCallum R. Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology. 1985;89:779–84.

    CAS  PubMed  Google Scholar 

  6. Velasco N, Hill L, Gannan R, Pope C. Gastric emptying and gastroesophageal reflux. Am J Surg. 1982;144:58–62.

    CAS  PubMed  Google Scholar 

  7. Fink SM, Barwick KW, DeLuca V, Sanders FJ, Kandathil M, McCallum RW. The association of histologic gastritis with gastroesophageal reflux and delayed gastric emptying. J Clin Gastroenterol. 1984;6:301–9.

    CAS  PubMed  Google Scholar 

  8. Buckles DC, Sarosiek I, McMillin C, McCallum RW. Delayed gastric emptying in gastroesophageal reflux disease: reassessment with new methods and symptomatic correlations. Am J Med Sci. 2004;327:1–4.

    PubMed  Google Scholar 

  9. Hillemeier AC, Lange R, McCallum R, Seashore J, Grybosky J. Delayed gastric emptying in infants with gastroesophageal reflux. J Pediatr. 1981;98:190–3.

    CAS  PubMed  Google Scholar 

  10. Hillemeier AC, Grill BB, McCallum R, Grybosky J. Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy. Gastroenterology. 1983;84:742–6.

    Google Scholar 

  11. Cucchiara S, Salvia G, Borrelli O, et al. Gastric electrical dysrhythmias and delayed gastric emptying in gastroesophageal reflux disease. Am J Gastroenterol. 1997;92:1077–8.

    Google Scholar 

  12. Rosen PR, Treves S. The relationship of gastroesophageal reflux and gastric emptying in infants and children: concise communication. J Nucl Med. 1984;25:571–4.

    CAS  PubMed  Google Scholar 

  13. Jolley SG, Leonard JC, Tunell WP. Gastric emptying in children with gastroesophageal reflux. An estimate of effective gastric emptying. J Pediatr Surg. 1987;22:923–6.

    CAS  PubMed  Google Scholar 

  14. Di Lorenzo C, Piepsz A, Ham H, Cadranel S. Gastric emptying with gastroesophageal reflux. Arch Dis Child. 1987;2:449–53.

    Google Scholar 

  15. Salvia G, De Vizia B, Manguso F, et al. Effect of intragastric volume and osmolality on mechanisms of gastroesophageal reflux in children with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:1725–32.

    CAS  PubMed  Google Scholar 

  16. Cameron AJ, Lagergren J, Henriksson C, Nyren O, Locke GR, Pedersen NL. Gastroesophageal reflux disease in monozygotic and dizygotic twins. Gastroenterology. 2002;122:55–9.

    PubMed  Google Scholar 

  17. Orenstein SR, Shalaby TM, Barmada MM, Whitcomb DC. Genetics of gastroesophageal reflux disease: a review. J Pediatr Gastroenterol Nutr. 2002;34:506–10.

    PubMed  Google Scholar 

  18. Shepherd RW, Wren J, Evans S, Lander M, Ong TH. Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases. Clin Pediatr (Phila). 1987;26:55–60.

    CAS  Google Scholar 

  19. Treem WR, Davis PM, Hyams JS. Gastroesophageal reflux in the older child: presentation, response to treatment and long-term follow-up. Clin Pediatr (Phila). 1991;30:435–40.

    CAS  Google Scholar 

  20. Vandenplas Y. Hiatal hernia and gastroesophageal reflux. In: Buts JP, Sokal EM, editors. Management of digestive and liver disorders in infants and children, Elsevier science, vol. 9. 1993. p. 103–16.

    Google Scholar 

  21. Morigeri C, Bhattacharya A, Mukhopadhyay K, Narang A, Mittal BR. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants. Eur J Nucl Med Mol Imaging. 2008;35:1659–65.

    CAS  PubMed  Google Scholar 

  22. Nelson SP, Chen EH, Syniar GM, et al. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 1997;151:569–72.

    CAS  PubMed  Google Scholar 

  23. Werlin SL, D’Souza BJ, Hogan WJ, et al. Sandifer syndrome: an unappreciated clinical entity. Dev Med Child Neurol. 1980;22:374–8.

    CAS  PubMed  Google Scholar 

  24. Gorrotxategi P, Reguilon MJ, Arana J, et al. Gastroesophageal reflux in association with the Sandifer syndrome. Eur J Pediatr Surg. 1995;5:203–5.

    CAS  PubMed  Google Scholar 

  25. Hassall E. Barrett’s esophagus: new definitions and approaches in children. J Pediatr Gastroenterol Nutr. 1993;16:345–64.

    CAS  PubMed  Google Scholar 

  26. Ranjitkar S, Smales RJ, Kaidonis JA. Oral manifestations of gastroesophageal reflux disease. J Gastroenterol Hepatol. 2012;27:21–7.

    CAS  PubMed  Google Scholar 

  27. Harding SM. Recent clinical investigations examining the association of asthma and gastroesophageal reflux. Am J Med. 2003;18:39S–44.

    Google Scholar 

  28. Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for the evaluation and treatment of gastroesophageal reflux in infants and children. Recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32 suppl 2:S1–31.

    PubMed  Google Scholar 

  29. Streets CG, DeMeester TR. Ambulatory 24-hour esophageal pH monitoring: why, when, and what to do. J Clin Gastroenterol. 2003;37:14–22.

    PubMed  Google Scholar 

  30. Thomson M. The pediatric esophagus comes of age. J Pediatr Gastroenterol Nutr. 2002;34 suppl 1:S40–5.

    PubMed  Google Scholar 

  31. Mitchell DJ, McClure BG, Tubman TRJ. Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants. Arch Dis Child. 2001;84:273–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  32. Wenzl TG. Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance. Am J Med. 2003;18(115 Suppl 3A):161S–5.

    Google Scholar 

  33. Mousa HM, Rosen R, Woodley FW, et al. Esophageal impedance monitoring for gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2011;52:129–39.

    PubMed Central  PubMed  Google Scholar 

  34. Wenzl TG, Silny J, Schenke S, et al. Gastroesophageal reflux and respiratory phenomena in infants: status of the intraluminal impedance technique. J Pediatr Gastroenterol Nutr. 1999;28:423–8.

    CAS  PubMed  Google Scholar 

  35. Riccabona M, Maurer U, Lackner H, Uray E, Ring E. The role of sonography in the evaluation of gastro-oesophageal reflux-correlation to pH-metry. Eur J Pediatr. 1992;151:655–7.

    CAS  PubMed  Google Scholar 

  36. Fornari F, Wagner R. Update on endoscopic diagnosis, management and surveillance strategies of esophageal diseases. World J Gastrointest Endosc. 2012;4:117–22.

    PubMed Central  PubMed  Google Scholar 

  37. Biller JA, Winter HS, Grand RJ, et al. Are endoscopic changes predictive of histologic esophagitis in children? J Pediatr. 1983;103:215–8.

    CAS  PubMed  Google Scholar 

  38. Heyman S, Kirkpatrick JA, Winter HS, Treves S. An improved radionuclide method for the diagnosis of gastroesophageal reflux and aspiration in children (milk scan). Radiology. 1979;131:479–82.

    CAS  PubMed  Google Scholar 

  39. Gelfand MJ, Parisi MT, Treves ST. Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. Pediatric Nuclear Medicine Dose Reduction Workgroup. J Nucl Med. 2011;52:318–22.

    PubMed  Google Scholar 

  40. Reyhan M, Yapar AF, Aydin M, Sukan A. Gastroesophageal scintigraphy in children: a comparison of posterior and anterior imaging. Ann Nucl Med. 2005;19:17–21.

    PubMed  Google Scholar 

  41. Piepsz A, Georges B, Rodesch P, Cadranel S. Gastroesophageal scintiscanning in children. J Nucl Med. 1982;23:631–2.

    CAS  PubMed  Google Scholar 

  42. Othman S. Gastroesophageal reflux studies using milk in infants and children-the need for multiple views. Nucl Med Commun. 2011;32:967–71.

    PubMed  Google Scholar 

  43. Piepsz A, Georges B, Perlmutter N, Rodesch P, Cadranel S. Gastro-oesophageal scintiscanning in children. Pediatr Radiol. 1981;11:71–4.

    CAS  PubMed  Google Scholar 

  44. Braga FJ, De Miranda JR, Arbex MA, et al. A physiological manoeuvre to improve the positivity of the gastro-oesophageal reflux scintigraphic test. Nucl Med Commun. 2001;22:521–4.

    CAS  PubMed  Google Scholar 

  45. Castronovo FP. Gastroesophageal scintigraphy in a pediatric population: dosimetry. J Nucl Med. 1986;27:1212–4.

    PubMed  Google Scholar 

  46. Fisher RS, Malmud LS, Roberts GS, Lobis IF. Gastroesophageal (GE) scintiscanning to detect and quantitate GE reflux. Gastroenterology. 1976;70:301–8.

    CAS  PubMed  Google Scholar 

  47. Devos PG, Forget P, DeRoo M, Eggermont E. Scintigraphic evaluation of gastrointestinal reflux (GER). J Nucl Med. 1979;20:636 (abstract).

    Google Scholar 

  48. Mariani G, Boni G, Barreca M, et al. Radionuclide gastroesophageal motor studies. J Nucl Med. 2004;45:1004–28.

    PubMed  Google Scholar 

  49. Arasu TS, Wyllie R, Fitzgerald JF, et al. Gastroesophageal reflux in infants and children: comparative accuracy of diagnostic methods. J Pediatr. 1980;96:798–803.

    CAS  PubMed  Google Scholar 

  50. Blumhagen JD, Rudd TG, Christie DL. Gastroesophageal reflux in children: radionuclide gastroesophagography. AJR Am J Roentgenol. 1980;135:1001–4.

    CAS  PubMed  Google Scholar 

  51. Seibert JJ, Byrne WJ, Euler AR, Latture T, Leach M, Campbell M. Gastroesophageal reflux–the acid test: scintigraphy or the pH probe? Am J Roentgenol. 1983;140:1087–90.

    CAS  Google Scholar 

  52. Laudizi L, Zaniol P, Venuta A, Pantusa M, Sturloni N, Laudizi Z. Gastroesophageal reflux in children. A combined radiologic and scintigraphic study. Radiol Med. 1990;79:381–3.

    CAS  PubMed  Google Scholar 

  53. Kashyap R, Sharma R, Madan N, Sachdev G, Chopra MK, Chopra K. Evaluation of radionuclide gastroesophagography as a suitable screening test for detection of gastroesophageal reflux. Indian Pediatr. 1993;30:625–8.

    CAS  PubMed  Google Scholar 

  54. Patwari AK, Bajaj P, Kashyp R, et al. Diagnostic modalities for gastroesophageal reflux. Indian J Pediatr. 2002;69:133–6.

    CAS  PubMed  Google Scholar 

  55. Ozcan Z, Ozcan C, Erinc R, Dirlik A, Mutaf O. Scintigraphy in the detection of gastro-oesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring. Pediatr Radiol. 2001;31:737–41.

    CAS  PubMed  Google Scholar 

  56. Tolia V, Kuhns L, Kauffman RE. Comparison of simultaneous esophageal pH monitoring and scintigraphy in infants with gastroesophageal reflux. Am J Gastroenterol. 1993;88:661–4.

    CAS  PubMed  Google Scholar 

  57. Vandenplas Y, Derde MP, Piepsz A. Evaluation of reflux episodes during simultaneous esophageal pH monitoring and gastroesophageal reflux scintigraphy in children. J Pediatr Gastroenterol Nutr. 1992;14:256–60.

    CAS  PubMed  Google Scholar 

  58. Tolia V, Calhoun JA, Kuhns LR, Kauffman RE. Lack of correlation between extended pH monitoring and scintigraphy in the evaluation of infants with gastroesophageal reflux. J Lab Clin Med. 1990;115:559–63.

    CAS  PubMed  Google Scholar 

  59. Orenstein SR, Klein HA, Rosenthal MS. Scintigraphy versus pH probe for quantification of pediatric gastroesophageal reflux: a study using concurrent multiplexed data and acid feedings. J Nucl Med. 1993;34:1228–34.

    CAS  PubMed  Google Scholar 

  60. Jona JZ, Sty JR, Glicklich M. Simplified radioisotope technique for assessing gastroesophageal reflux in children. J Pediatr Surg. 1981;16:114–7.

    CAS  PubMed  Google Scholar 

  61. Craig WR, Hanlon-Dearman A, Sinclair C, Taback SP, Moffatt M. Withdrawn: Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev. 2010;12, CD003502.

    Google Scholar 

  62. Illueca M, Wernersson B, Henderson C, Lundborg PJ. Maintenance treatment with proton pump inhibitors for reflux esophagitis in pediatric patients: a systematic literature analysis. J Pediatr Gastroenterol Nutr. 2010;51:733–40.

    CAS  PubMed  Google Scholar 

  63. Maclennan S, Augood C, Cash-Gibson L, Logan S, Gilbert RE. Cisapride treatment for gastro-oesophageal reflux in children. Cochrane Database Syst Rev. 2010;14, CD002300.

    Google Scholar 

  64. Siddiqui MR, Abdulaal Y, Nisar A, Ali H, Hasan F. A meta-analysis of outcomes after open and laparoscopic Nissen’s fundoplication for gastro-oesophageal reflux disease in children. Pediatr Surg Int. 2011;27:359–66.

    PubMed  Google Scholar 

  65. DiLorenzo C, Mertz H, Alvarez S, Mori C, Mayer E, Hyman PE. Gastric receptive relaxation is absent in newborn infants. Gastroenterology. 1993;104:A498 (abstract).

    Google Scholar 

  66. Huisinga JD. Physiology and pathophysiology of interstitial cells of Cajal: from bench to bedside. II. Gastric motility lessons from mutant mice on slow waves and innervation. Am J Physiol. 2001;281:G1129–34.

    Google Scholar 

  67. Heyman S. Gastric emptying in children. J Nucl Med. 1998;39:865–9.

    CAS  PubMed  Google Scholar 

  68. Siegel M, Lebenthal E, Topper W, Krantz B, Li PK. Gastric emptying in prematures of isocaloric feedings with differing osmolalities. Pediatr Res. 1982;16:141–7.

    CAS  PubMed  Google Scholar 

  69. Christian PE, Moore JG, Brown F, et al. Effect of caloric content and meal size in gastric emptying. J Nucl Med. 1982;23(suppl):P20 [abstract].

    Google Scholar 

  70. Maes BD, Ghoos YF, Geypens BJ, Hiele MI, Rutgeerts PJ. Relation between gastric emptying rate and energy intake in children compared with adults. Gut. 1995;36:183–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  71. Cavell B. Gastric emptying in infants fed human milk or infant formula. Acta Paediatr Scand. 1981;70:639–41.

    CAS  PubMed  Google Scholar 

  72. Billeaud C, Guillet J, Sandler B. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr. 1990;44:577–83.

    CAS  PubMed  Google Scholar 

  73. Hunt JN, Knox MT. A relation between the chain length of fatty acids and the slowing of gastric emptying. J Physiol. 1968;194:327–36.

    CAS  PubMed Central  PubMed  Google Scholar 

  74. Cooke AR, Moulang J. Control of gastric emptying by amino acids. Gastroenterology. 1972;62:528–32.

    CAS  PubMed  Google Scholar 

  75. Di Lorenzo C, Piepsz A, Ham H, Cadranel S. Gastric emptying with gastro-oesophageal reflux. Arch Dis Child. 1987;62:449–53.

    PubMed Central  PubMed  Google Scholar 

  76. Waseem S, Islam S, Kahn G, Moshiree B, Talley NJ. Spectrum of gastroparesis in children. J Pediatr Gastroenterol Nutr. 2012;55(2):166–72.

    PubMed  Google Scholar 

  77. Demirbilek S, Karaman A, Gürünlüoğlu K, Akin M, Taş E, Aksoy RT, et al. Delayed gastric emptying in gastroesophageal reflux disease: the role of malrotation. Pediatr Surg Int. 2005;21:423–7.

    PubMed  Google Scholar 

  78. Friesen CA, Lin Z, Hyman PE, Andre L, Welchert E, Schurman JV, et al. Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity. J Pediatr Gastroenterol Nutr. 2006;42:265–9.

    PubMed  Google Scholar 

  79. Vandenplas Y, Hauser B, Salvatore S. Current pharmacological treatment of gastroparesis. Expert Opin Pharmacother. 2004;5:2251–4.

    CAS  PubMed  Google Scholar 

  80. Islam S, Vick LR, Runnels MJ, Gosche JR, Abell T. Gastric electrical stimulation for children with intractable nausea and gastroparesis. J Pediatr Surg. 2008;43:437–42.

    PubMed  Google Scholar 

  81. Koch KL. Diagnosis and treatment of neuromuscular disorders of the stomach. Curr Gastroenterol Rep. 2003;5:323–30.

    PubMed  Google Scholar 

  82. Rostas 3rd JW, Mai TT, Richards WO. Gastric motility physiology and surgical intervention. Surg Clin North Am. 2011;91:983–99.

    PubMed  Google Scholar 

  83. Portincasa P, Colecchia A, Di Ciaula A, et al. Standards for diagnosis of gastrointestinal motility disorders. Section: ultrasonography. A position statement from the Gruppo Italiano di Studio Motilita` Apparato Digerente (GISMAD). Dig Liver Dis. 2000;32:160–72.

    CAS  PubMed  Google Scholar 

  84. Bolondi L, Bortolotti M, Santi V, Caletti T, Gaiani S, Labo G. Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985;89:752–9.

    CAS  PubMed  Google Scholar 

  85. Berstad A, Hausken T, Gilja OH, Hveem K, Nesje LB, Odegaard S. Ultrasonography of the human stomach. Scand J Gastroenterol. 1996;220:75–82.

    CAS  Google Scholar 

  86. Benini L, Sembenini C, Heading RC, et al. Simultaneous measurement of gastric emptying of a solid meal by ultrasound and by scintigraphy. Am J Gastroenterol. 1999;94:2861–5.

    CAS  PubMed  Google Scholar 

  87. Cucchiara S, Minella R, Iorio R, et al. Real-time ultrasound reveals gastric motor abnormalities in children investigated for dyspeptic symptoms. J Pediatr Gastroenterol Nutr. 1995;21:446–53.

    CAS  PubMed  Google Scholar 

  88. Kock KL. Electrogastrography. In: Schuster M, Crowell MD, Koch KL, editors. Schuster atlas of gastrointestinal motility in health and disease. Hamilton: BC Decker; 2002. p. 185–201.

    Google Scholar 

  89. Ghoos YF, Maes BD, Geypens BJ, et al. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology. 1993;104:1640–7.

    CAS  PubMed  Google Scholar 

  90. Kim DY, Camilleri M. Stable isotope breath test and gastric emptying. In: Schuster M, Crowell MD, Koch KL, editors. Schuster atlas of gastrointestinal motility in health and disease. Hamilton: Decker, Inc; 2002. p. 203–18.

    Google Scholar 

  91. Braden B, Peterknecht A, Piepho T, et al. Measuring gastric emptying of semisolids in children using the 13C-acetate breath test: a validation study. Dig Liver Dis. 2004;36:260–4.

    CAS  PubMed  Google Scholar 

  92. de Zwart IM, de Roos A. MRI for the evaluation of gastric physiology. Eur Radiol. 2010;20:2609–16.

    PubMed Central  PubMed  Google Scholar 

  93. Fraser R, Horowitz M, Maddox A, Harding PE, Chatterton BE, Dent J. Hyperglycaemia slows gastric emptying in type 1 diabetes mellitus. Diabetologia. 1990;30:675–80.

    Google Scholar 

  94. Gelfand MJ, Wagner GG. Gastric emptying in infants and children: limited utility of 1-hour measurement. Radiology. 1991;178:379–81.

    CAS  PubMed  Google Scholar 

  95. Heyman S. Radionuclide transit studies. In: Hyman PE, DiLorenzo CD, editors. Pediatric gastrointestinal motility disorders. 1st ed. New York: Academy Professional Information Services; 1994. p. 291–304.

    Google Scholar 

  96. Villanueva-Meyer J, Swischuk LE, Cesani F, Ali SA, Briscoe E. Pediatric gastric emptying: value of right lateral and upright positioning. J Nucl Med. 1996;37:1356–8.

    CAS  PubMed  Google Scholar 

  97. Heyman S, Reich H. Gastric emptying of milk feedings in infants and young children: anterior vs conjugate counting [abstract]. J Nucl Med. 1995;36(suppl):259P.

    Google Scholar 

  98. Drubach LA, Kourmouzi V, Cao X, Zurakowski D, Fahey FH. Gastric Emptying in Children: What is the Best Acquisition Method? J Pediatr Gastroenterol Nutr. 2012;55(2):191–3.

    PubMed  Google Scholar 

  99. Halkar KR, Paszkowski A, Jones M. Two point, timesaving method for measurement of gastric emptying with diagnostic accuracy comparable to that of the conventional method. Radiology. 1999;213:599–602.

    CAS  PubMed  Google Scholar 

  100. Lin E, Connolly LP, Drubach L, et al. Effect of early emptying on quantitation and interpretation of liquid gastric emptying studies of infants and young children. J Nucl Med. 2000;41:596–9.

    CAS  PubMed  Google Scholar 

  101. Signer E. Gastric emptying in newborns and young infants. Measurement of the rate of emptying using indium-113m-microcolloid. Acta Paediatr Scand. 1975;64:525–30.

    CAS  PubMed  Google Scholar 

  102. Seibert JJ, Byrne WJ, Euler AR. Gastric emptying in children: unusual patterns detected by scintigraphy. Am J Roentgenol. 1983;141:49–51.

    CAS  Google Scholar 

  103. Knight LC. Radiopharmacy aspects of gastrointestinal imaging. In: Henkin RE, Boles MA, Dillehay GL, et al., editors. Nuclear medicine, vol. 2. St. Louis: Mosby; 1996. p. 922–32.

    Google Scholar 

  104. Sagar S, Grime JS, Little W, et al. 99mTc labelled bran: a new agent for measuring gastric emptying. Clin Radiol. 1983;34:275–8.

    CAS  PubMed  Google Scholar 

  105. Malagelada JR, Carter SE, Brown ML, Carlson GL. Radiolabeled fiber: a physiologic marker for gastric emptying and intestinal transit of solids. Dig Dis Sci. 1980;25:81–7.

    CAS  PubMed  Google Scholar 

  106. Singh SJ, Gibbons NJ, Blackshaw PE, Vincent M, Wakefield J, Perkins AC. Gastric emptying of solids in normal children–a preliminary report. J Pediatr Surg. 2006;41:413–7.

    PubMed  Google Scholar 

  107. Drubach LA, Kourmouzi V, Fahey FH. Cheese is a reliable alternative meal for solid-phase gastric emptying study. Nucl Med Commun. 2010;31:430–3.

    PubMed  Google Scholar 

  108. Montgomery M, Escobar-Billing R, Hellstrom PM, Karlsson KA, Frenckner B. Impaired gastric emptying in children with repaired esophageal atresia: a controlled study. J Pediatr Surg. 1998;33:476–80.

    CAS  PubMed  Google Scholar 

  109. Malmud LS, Fisher RS, Knight LC, Rock E. Scintigraphic evaluation of gastric emptying. Semin Nucl Med. 1982;12:116–25.

    CAS  PubMed  Google Scholar 

  110. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol. 2008;36:44–54.

    PubMed  Google Scholar 

  111. Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–62.

    CAS  PubMed  Google Scholar 

  112. Urbain JLC, Van Custem E, Sirgel JA, et al. Visualization and characterization of gastric contractions using a radionuclide technique. Am J Physiol. 1990;259:G1062–7.

    CAS  PubMed  Google Scholar 

  113. Ham HR, Muls V, Cadiere G-B, et al. Radionuclide study of regional gastric motility. Nucl Med Commun. 1995;16:827–33.

    CAS  PubMed  Google Scholar 

  114. Urbain JLC, Vekemans MC, Bouillon R, et al. Characterization of gastric antral motility disturbances in diabetes using the scintigraphic technique. J Nucl Med. 1993;34:576–81.

    CAS  PubMed  Google Scholar 

  115. Urbain JLC, Vekemans MC, Parkman H, et al. Dynamic antral scintigraphy to characterize antral motility in functional dyspepsia. J Nucl Med. 1995;36:1579–86.

    CAS  PubMed  Google Scholar 

  116. Kuiken SD, Samson M, Camilleri M, et al. Development of a test to measure gastric accommodation in humans. Am J Physiol. 1999;277:G1217–21.

    CAS  PubMed  Google Scholar 

  117. Bouras EP, Delgado-Aros S, Camilleri M, et al. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography. Gut. 2002;51:781–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  118. Kim D-Y, Delgado-Aros S, Camilleri M, et al. Noninvasive measurement of gastric accommodation in patients with idiopathic nonulcer dyspepsia. Am J Gastroenterol. 2001;96:3099–105.

    CAS  PubMed  Google Scholar 

  119. Simonian HP, Maurer AH, Knight LC, et al. Simultaneous assessment of gastric accommodation and emptying: studies with liquid and solid meals. J Nucl Med. 2004;45:1155–60.

    PubMed  Google Scholar 

  120. Bonapace ES, Parkman HP. Normal esophageal physiology. In: Brandt LJ, editor. Clinical practice of gastroenterology. Philadelphia: Churchill Livingstone; 1999. p. 2–12.

    Google Scholar 

  121. Clouse RE, Richter JE, Heading RC, Janssens J, Wilson JA. Functional esophageal disorders. Gut. 1999;45:31–6.

    Google Scholar 

  122. Dekel R, Fass R. Current perspectives on the diagnosis and treatment of functional esophageal disorders. Curr Gastroenterol Rep. 2003;5:314–22.

    PubMed  Google Scholar 

  123. Hillemeir C, Buchin P, Gryboski J. Esophageal dysfunction in Down’s syndrome. J Pediatr Gastroenterol Nutr. 1983;1:101–4.

    Google Scholar 

  124. Staiano A, Cucchiara S, Del Giudice E, Andreotti MR, Minella R. Disorders of oesophageal motility in children with psychomotor retardation and gastro-oesophageal reflux. Eur J Pediatr. 1991;150:638–41.

    CAS  PubMed  Google Scholar 

  125. Del Giudice E, Staiano A, Capano G, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain Dev. 1999;21:307–11.

    PubMed  Google Scholar 

  126. Gustafsson PM, Tibbling L. Gastroesophageal reflux and esophageal dysfunction in children and adolescents with brain damage. Acta Paediatr. 1994;83:1081–5.

    CAS  PubMed  Google Scholar 

  127. Krausz Y, Maayan C, Faber J, Marciano R, Mogle P, Wynchank S. Scintigraphic evaluation of esophageal transit and gastric emptying in familial dysautonomia. Eur J Radiol. 1994;18(1):52–6.

    CAS  PubMed  Google Scholar 

  128. Genc A, Mutaf O. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children. J Pediatr Surg. 2002;37:1526–8.

    PubMed  Google Scholar 

  129. Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer 3rd LR. Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg. 1995;130:502–8.

    CAS  PubMed  Google Scholar 

  130. Kazem I. A new scintigraphic technique for the study of the esophagus. Am J Roentgenol Radium Ther Nucl Med. 1972;115:681–8.

    CAS  PubMed  Google Scholar 

  131. Guillet J, Wynchank S, Basse-Cathalinat B, Christophe E, Ducassou D, Blanquet P. Pediatric esophageal scintigraphy. Results of 200 studies. Clin Nucl Med. 1983;8:427–33.

    CAS  PubMed  Google Scholar 

  132. Heyman S. Esophageal scintigraphy (milk scans) in infants and children with gastroesophageal reflux. Radiology. 1982;144:891–3.

    CAS  PubMed  Google Scholar 

  133. Svedberg JB. The bolus transport diagram: a functional display method applied to esophageal studies. Clin Phys Physiol Meas. 1982;3:267–72.

    CAS  PubMed  Google Scholar 

  134. Khan SH, Rather TA, ul Rehman B, Gulzar GM, Mir TA, Zargar SA. Radionuclide esophageal transit time in patients of suspected esophageal motility disorders. Indian J Gastroenterol. 2009;28:74–5.

    CAS  PubMed  Google Scholar 

  135. Ham HR, Piepsz A, Georges B, Verelst J, Guillaume M, Cadranel S. Quantitation of esophageal transit by means of 81mKr. Eur J Nucl Med. 1984;9:362–5.

    CAS  PubMed  Google Scholar 

  136. Klein HA, Wald A. Computer analysis of radionuclide esophageal transit studies. J Nucl Med. 1984;25:957–64.

    CAS  PubMed  Google Scholar 

  137. Tatsch K. Multiple swallow test for quantitative and qualitative evaluation of esophageal motility disorders. J Nucl Med. 1991;32:1365–70.

    CAS  PubMed  Google Scholar 

  138. Tatsch K, Voderholzer WA, Weiss MJ, Schrottle W, Hahn K. Reappraisal of quantitative esophageal scintigraphy by optimizing results with ROC analyses. J Nucl Med. 1996;37:1799–805.

    CAS  PubMed  Google Scholar 

  139. Lamki L. Radionuclide esophageal transit study: the effect of body posture. Clin Nucl Med. 1985;10:108–10.

    CAS  PubMed  Google Scholar 

  140. Buthpitiya AG, Stroud D, Russell CO. Pharyngeal pump and esophageal transit. Dig Dis Sci. 1987;32:1244–8.

    CAS  PubMed  Google Scholar 

  141. Kjellen G, Svedberg JB, Tibbling L. Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiology. Dig Dis Sci. 1984;29:1–5.

    CAS  PubMed  Google Scholar 

  142. Fisher RS, Malmud LS, Applegate G, Rock E, Lorber SH. Effect of bolus composition on esophageal transit: concise communication. J Nucl Med. 1982;23:878–82.

    CAS  PubMed  Google Scholar 

  143. Mughal MM, Marples M, Bancewicz J. Scintigraphic assessment of esophageal motility: what does it show and how reliable is it? Gut. 1986;27:946–53.

    CAS  PubMed Central  PubMed  Google Scholar 

  144. Russell CO, Hill LD, Holmes 3rd ER, Hull DA, Gannon R, Pope 2nd CE. Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology. 1981;80:887–92.

    CAS  PubMed  Google Scholar 

  145. Odunsi ST, Camilleri M. Selected interventions in nuclear medicine: gastrointestinal motor functions. Semin Nucl Med. 2009;39:186–94.

    PubMed Central  PubMed  Google Scholar 

  146. Lopes MF, Botelho MF. Midterm follow-up of esophageal anastomosis for esophageal atresia repair: long-gap versus non-long-gap. Dis Esophagus. 2007;20:428–35.

    CAS  PubMed  Google Scholar 

  147. Van Zyl JH, Nel MG, Otto AC, et al. Evaluation of reflux oesophagitis with technetium-99m labelled sucralfate. S Afr Med J. 1996;86:1422–4.

    PubMed  Google Scholar 

  148. Mearns AJ, Hart GC, Cox JA. Dynamic radionuclide imaging with 99 m Tc-sucralfate in the detection of oesophageal ulceration. Gut. 1989;30:1256–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  149. Dawson DJ, Khan AN, Nuttall P, Shreeve DR. Technetium 99m-labelled-sucralphate isotope scanning in the detection of peptic ulceration. Nucl Med Commun. 1985;6:319–25.

    CAS  PubMed  Google Scholar 

  150. Millar AJ, Numanoglu A, Mann M, Marven S, Rode H. Detection of caustic oesophageal injury with technetium 99m-labelled sucralfate. J Pediatr Surg. 2001;36:262–5.

    CAS  PubMed  Google Scholar 

  151. Cameron JL, Zuidema GD. Aspiration pneumonia: magnitude and frequency of the problem. JAMA. 1972;219:1194–6.

    CAS  PubMed  Google Scholar 

  152. Trinick R, Johnston N, Dalzell AM, McNamara PS. Reflux aspiration in children with neurodisability-a significant problem, but can we measure it? J Pediatr Surg. 2012;47:291–8.

    PubMed  Google Scholar 

  153. Euler AR, Byrne WJ, Ament ME, et al. Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. Pediatrics. 1979;63:47–51.

    CAS  PubMed  Google Scholar 

  154. Berquist WE, Rachelefsky GS, Kadden M, et al. Gastroesophageal reflux associated recurrent pneumonia and chronic asthma in children. Pediatrics. 1981;68:29–35.

    CAS  PubMed  Google Scholar 

  155. Morton RE, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability. Dev Med Child Neurol. 1999;41:329–34.

    CAS  PubMed  Google Scholar 

  156. Heyman S. Evaluation of gastroesophageal reflux and gastrointestinal bleeding. In: Freeman LM, Weissmann HS, editors. Nuclear medicine annual. New-York: Raven Press; 1985. p. 133–69.

    Google Scholar 

  157. Fawcett HD, Hayden CK, Adams JC, et al. How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration? Pediatr Radiol. 1988;18:311–3.

    CAS  PubMed  Google Scholar 

  158. Berdon WE, Mellins RB, Levy J. Commentary: on the following paper by H.D. Fawcett, C.K. Hayden, J.C. Adams and L.E. Swischuk: How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration? Pediatr Radiol. 1988;18:309–10.

    CAS  PubMed  Google Scholar 

  159. Miller JH. How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration? Letter to the editor. Pediatr Radiol. 1988;19:70.

    CAS  PubMed  Google Scholar 

  160. McVeagh P, Howman-Giles R, Kemp A. Pulmonary aspiration studies by radionuclide milk scanning and barium swallow roentgenography. Am J Dis Child. 1987;141:917–21.

    CAS  PubMed  Google Scholar 

  161. Christie DL, O’Grady LR, Mack DV. Incompetent lower esophageal sphincter and gastroesophageal reflux in recurrent acute pulmonary disease of infancy and childhood. J Pediatr. 1978;93:23–7.

    CAS  PubMed  Google Scholar 

  162. Boonyaprapa S, Alderson PO, Garfinkel DJ, Chipps BE, Wagner Jr HN. Detection of pulmonary aspiration in infants and children with respiratory disease: concise communication. J Nucl Med. 1980;21:314–8.

    CAS  PubMed  Google Scholar 

  163. Bar-Sever Z, Steinberg T, Connolly LP, et al. Scintigraphic and radiographic imaging of aspiration and gastroesophageal reflux in young children. J Nucl Med. 1999;40:13P [abstract].

    Google Scholar 

  164. MacFadyen UM, Hendry GM, Simpson H. Gastro-oesophageal reflux in near-miss sudden infant death syndrome or suspected recurrent aspiration. Arch Dis Child. 1983;58:87–91.

    CAS  PubMed Central  PubMed  Google Scholar 

  165. Berger D, Bischof-Delaloye A, Reinberg O, Roulet M. Esophageal and pulmonary scintiscanning in gastroesophageal reflux in children. Prog Pediatr Surg. 1985;18:68–77.

    CAS  PubMed  Google Scholar 

  166. Levin K, Colon A, DiPalma J, Fitzpatrick S. Using the radionuclide salivagram to detect pulmonary aspiration and esophageal dysmotility. Clin Nucl Med. 1993;18:110–4.

    CAS  PubMed  Google Scholar 

  167. Ravelli AM, Panarotto MB, Verdoni L, Consolati V, Bolognini S. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest. 2006;130:1520–6.

    PubMed  Google Scholar 

  168. Heyman S, Eicher PS, Alavi A. Radionuclide studies of the upper gastrointestinal tract in children with feeding disorders. J Nucl Med. 1995;36:351–4.

    CAS  PubMed  Google Scholar 

  169. Lorber B, Swenson RM. Bacteriology of aspiration pneumonia: a prospective study of community and hospital acquired cases. Ann Intern Med. 1974;81:329–31.

    CAS  PubMed  Google Scholar 

  170. Bartlett JG, Gorbach SL, Finegold SM. The bacteriology of aspiration pneumonia. Am J Med. 1974;56:202–7.

    CAS  PubMed  Google Scholar 

  171. Russin SJ, Adler AG. Pulmonary aspiration: the three syndromes. Postgrad Med. 1989;85:155–61.

    CAS  PubMed  Google Scholar 

  172. Heyman S. The radionuclide salivagram for detecting the pulmonary aspiration of saliva in an infant. Pediatr Radiol. 1989;19:208–9.

    CAS  PubMed  Google Scholar 

  173. Martinez DA, Ginn-Pease ME, Caniano DA. Sequelae of antireflux surgery in profoundly disabled children. J Pediatr Surg. 1992;27:267–71.

    CAS  PubMed  Google Scholar 

  174. Bauer ML, Figueroa-Colon R, Georgeson K, Young DW. Chronic pulmonary aspiration in children. South Med J. 1993;86:789–95.

    CAS  PubMed  Google Scholar 

  175. Bui HD, Dang CV, Chaney RH, Vergara LM. Does gastrostomy and fundoplication prevent aspiration pneumonia in mentally retarded persons? Am J Ment Retard. 1989;94:16–9.

    CAS  PubMed  Google Scholar 

  176. Heyman S, Respondek M. Detection of pulmonary aspiration in children by radionuclide “salivagram”. J Nucl Med. 1989;30:697–9.

    CAS  PubMed  Google Scholar 

  177. Bar-Sever Z, Connolly LP, Treves ST. The radionuclide salivagram in children with pulmonary disease and a high risk of aspiration. Pediatr Radiol. 1995;25 Suppl 1:S180–3.

    PubMed  Google Scholar 

  178. Huxley EJ, Viroslav J, Gray WR, et al. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978;64:565–7.

    Google Scholar 

  179. Green GM. Pulmonary clearance of infectious agents. Annu Rev Med. 1968;19:315–36.

    CAS  PubMed  Google Scholar 

  180. Green GM. Lung defense mechanisms. Med Clin North Am. 1973;57:547–62.

    CAS  PubMed  Google Scholar 

  181. Siegel JA, Wu RK, Knight LC, Zelac RE, Stern HS, Malmud LS. Radiation dose estimates for oral agents used in upper gastrointestinal disease. J Nucl Med. 1983;24:835–7.

    CAS  PubMed  Google Scholar 

  182. Crawley MT, Savage P, Oakley F. Patient and operator dose during fluoroscopic examination of swallow mechanism. Br J Radiol. 2004;77:654–6.

    CAS  PubMed  Google Scholar 

  183. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154:953–63.

    CAS  Google Scholar 

  184. Baikie G, South MJ, Reddihough DS, Cook DJ, Cameron DJ, Olinsky A, et al. Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy. Dev Med Child Neurol. 2005;47:86–93.

    CAS  PubMed  Google Scholar 

  185. Muz J, Mathog RH, Miller PR, Rosen R, Borrero G. Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy. Laryngoscope. 1987;97:1180–5.

    CAS  PubMed  Google Scholar 

  186. Silver KH, Van Nostrand D. The use of scintigraphy in the management of patients with pulmonary aspiration. Dysphagia. 1994;9:107–15.

    CAS  PubMed  Google Scholar 

  187. Shaw DW, Williams RB, Cook IJ, et al. Oropharyngeal scintigraphy: a reliable technique for the quantitative evaluation of oral-pharyngeal swallowing. Dysphagia. 2004;19:36–42.

    CAS  PubMed  Google Scholar 

  188. Miller JH. Upper gastrointestinal tract evaluation with radionuclides in infants. Radiology. 1991;178:326–7.

    CAS  PubMed  Google Scholar 

  189. Heyman S. Volume-dependent pulmonary aspiration of a swallowed radionuclide bolus. J Nucl Med. 1997;38:103–4.

    CAS  PubMed  Google Scholar 

  190. Baikie G, Reddihough DS, South M, Cook DJ. The salivagram in severe cerebral palsy and able-bodied adults. J Paediatr Child Health. 2009;45:342–5.

    PubMed  Google Scholar 

  191. Bauer ML, Lyrene RK. Chronic aspiration in children: evaluation of the lipid-laden macrophage index. Pediatr Pulmonol. 1999;28:94–100.

    CAS  PubMed  Google Scholar 

  192. Ahrens P, Noll C, Kitz R, Willigens P, Zielen S, Hofmann D. Lipid-laden alveolar macrophages (LLAM): a useful marker of silent aspiration in children. Pediatr Pulmonol. 1999;28:83–8.

    CAS  PubMed  Google Scholar 

  193. Nussbaum E, Maggi JC, Mathis R, Galant SP. Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children. J Pediatr. 1987;110:190–4.

    CAS  PubMed  Google Scholar 

  194. Colombo JL, Hallberg TK. Recurrent aspiration in children: lipid-laden alveolar macrophage quantitation. Pediatr Pulmonol. 1987;3:86–9.

    CAS  PubMed  Google Scholar 

  195. Knauer-Fischer S, Ratjen F. Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration. Pediatr Pulmonol. 1999;27:419–22.

    CAS  PubMed  Google Scholar 

  196. Krishnan U, Mitchell JD, Tobias V, Day AS, Bohane TD. Fat laden macrophages in tracheal aspirates as a marker of reflux aspiration: a negative report. J Pediatr Gastroenterol Nutr. 2002;35:309–13.

    CAS  PubMed  Google Scholar 

  197. Krishnan U, Mitchell JD, Messina I, et al. Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr. 2002;35:303–8.

    CAS  PubMed  Google Scholar 

  198. McNally P, Ervine E, Shields MD, Dimitrov BD, El Nazir B, Taggart CC, et al. High concentrations of pepsin in bronchoalveolar lavage fluid from children with cystic fibrosis are associated with high interleukin-8 concentrations. Thorax. 2011;66:140–3.

    CAS  PubMed  Google Scholar 

  199. Cook SP, Lawless ST, Kettrick R. Patient selection for primary laryngotracheal separation as treatment of chronic aspiration in the impaired child. Int J Pediatr Otorhinolaryngol. 1996;38:103–13.

    CAS  PubMed  Google Scholar 

  200. Cook SP, Lawless S, Mandell GA, Reilly JS. The use of the salivagram in the evaluation of severe and chronic aspiration. Int J Pediatr Otorhinolaryngol. 1997;41:353–61.

    CAS  PubMed  Google Scholar 

  201. De Vito MA, Wetmore RF, Pransky SM. Laryngeal diversion in the treatment of chronic aspiration in children. Int J Pediatr Otorhinolaryngol. 1989;18:139–45.

    PubMed  Google Scholar 

  202. Gerber ME, Gaugler MD, Myer 3rd CM, Cotton RT. Chronic aspiration in children. When are bilateral submandibular gland excision and parotid duct ligation indicated? Arch Otolaryngol Head Neck Surg. 1996;122:1368–71.

    CAS  PubMed  Google Scholar 

  203. Klem C, Mair EA. Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhea. Arch Otolaryngol Head Neck Surg. 1999;125:796–800.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Zvi Bar-Sever MD

  2. Department of Nuclear Medicine, Schneider Children’s Medical Center, Petach Tikvah, Israel

    Zvi Bar-Sever MD

Authors
  1. Zvi Bar-Sever MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zvi Bar-Sever MD .

Editor information

Editors and Affiliations

  1. Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA

    S.Ted. Treves

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bar-Sever, Z. (2014). Gastroesophageal Reflux, Gastric Emptying, Esophageal Transit, and Pulmonary Aspiration. In: Treves, S. (eds) Pediatric Nuclear Medicine and Molecular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9551-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9551-2_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9550-5

  • Online ISBN: 978-1-4614-9551-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation