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To evaluate the mean transit time of a solid bolus in 17 patients with prolonged acid clearing, a scintigraphic non-invasive technique was used. Sticking of the bolus in the middle third of the oesophagus was a common feature in these patients as compared with normals. Thus, the deteriorated transport pattern of a solid bolus in patients with prolonged acid clearing is not acidification-dependent. The catheter-intubated oesophagus showed a significantly (p less than 0.01) lower tendency for sticking as compared with prior intubation, whereas acidification of the oesophagus increased the sticking tendency significantly (p less than 0.01) as compared with the intubated oesophagus without acid. The evaluation of mean transit times was of no value because of the frequency of sticking. The fact that intubation improves the passage must be kept in mind when studies of solid bolus are performed in intubated patients.

Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests. Radiology performed on 14 of the 16 patients showed no evidence of organic lesions. Half the patients had abnormal findings at scintigraphy, with either bolus retention in the upper part of the esophagus or prolonged transit time as compared to a group of 20 asymptomatic subjects. Scintigraphy can be regarded as a valuable complement in the objective documentation of dysphagia when other diagnostic methods fail.

A modified, quantitative cholescintigraphic method for the assessment of enterogastric reflux has been developed. The distribution of the hepatobiliary tracer 99mTc-Hida is continuously recorded by a computer for 1 h after intravenous injection of the substance. With the patient still in a supine position under the gamma camera two administrations were made orally: 1) a gelatin capsule containing a known amount of 99mTc-pertechnetate, which was studied, making possible a determination of the relation between registered counts and known activity; and 2) 99mTc-labelled Albu-Res in water, which identified the gastric region. An intravenous injection of synthetic cholecystokinin (Kinevac) 25 min after Hida administration emptied the biliary system into the duodenum in a controllable manner. The lower limit of reflux detected by this method was about 0.5% of the Hida dose given.

Oesophageal emptying was studied with scintigraphy, radiography, and the acid clearing test (ACT) in 18 patients reporting dysphagia and previously operated on with fundoplication. Radiography with contrast medium, isodense with water, revealed abnormalities in either motility or emptying capacity in 39% (7/18). A A barium meal showed abnormalities--that is, a tight repair, disruption of the fundoplication, or recurrence of the hernia--in 56% (10/18). The ACT was prolonged in 40% (6/15) of the patients. Pathological findings at scintigraphy with a solid bolus were found in 67% (12/18). Even if scintigraphy with a solid bolus is the method that identifies the highest number of patients with impaired oesophageal function among the tests used, it cannot differentiate between functional and anatomical disorders. A barium meal examination is the method of choice when an anatomical disorder is suspected.