Reasonability of gastro-oesophageal reflux study requests (contrast swallows and milk scans) for the detection of gastro-oesophageal reflux disease at Red Cross War Memorial Children's Hospital - a retrospective analysis
Master Thesis
2015
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University of Cape Town
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Abstract
Poor weight gain, recurrent vomiting and fussiness, chronic cough and recurrent chest infections are among the wide variety of signs that are often attributed to gastro-oesophageal reflux disease (GORD). The difficulty lies in distinguishing between physiological gastro-oesophageal reflux (GOR) and GORD and none of the tests available can, alone, give conclusive evidence for the latter. Clinicians are often at a loss which investigation to request in order to assess for GOR and assist in a diagnosis of GORD. Our hypothesis was that GORD investigations at Red Cross War Memorial Children's Hospital (RCWMCH) are requested without considering the appropriate modality required and without clear indications for suspecting GORD. This was supported by practical experience and a short preliminary review of request forms. In South Africa no specific guidelines exist regarding the diagnosis of GORD and there is a poor understanding of available tests and their role in aiding the diagnosis. Thus many unnecessary tests are requested. To review how appropriate the requests for GORD investigations were we analysed all requests made to the departments of nuclear medicine and radiology at RCWMCH for the purpose of GORD investigation between January and April 2011. This analysis was based on a review of the folders and the data of tests performed on all included patients. The two examination modalities involved were gastro-oesophageal radionuclide scintigrams (commonly known as milk scans) and contrast swallows. The specific points assessed were reasonability of the request, appropriate timing of the investigation, use of the correct modality for the question investigated and lastly evaluation of prior treatment with antacids. We found that most of the studies performed were requested on appropriate grounds and that the timing of the majority of the investigations was reasonable.
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Bau, S. 2015. Reasonability of gastro-oesophageal reflux study requests (contrast swallows and milk scans) for the detection of gastro-oesophageal reflux disease at Red Cross War Memorial Children's Hospital - a retrospective analysis. University of Cape Town.