The paper contains information about a case study of a patient suspected to having gastroesophageal reflux disease. It is a form of an abnormal medical case, which require the application of nuclear medicine in diagnosis as well as treatment of gastroesophageal reflux disease. In the case study, the information about the patient history, causes as well as the sign of the suspected disease being diagnosed using nuclear medicine is provided, while it also provide information of the nuclear medicine procedure performed on the patient and finally interpretation of the results on the tests performed on the patient.
Section 1—Defining the Disease
The particular disease to be considered in this case study is gastroesophageal reflux disease.
            Causes: gastroesophageal reflux disease is a type disease associated with digestive disorder affecting LES (lower esophageal sphincter), which is usually the ring muscle between the stomach and esophagus.  There are numerous causes of this digestive disorder in patients. The main cause of GERD is mainly the failure of the digestive part of lower esophageal sphincter. One of the factors that contribute to emergence of GERD in patient is obesity, whereby, large body mass index contributes to changes within the level of acidic exposure of esophageal. Also, hiatal hernia is another factor that causes the likelihood of a person having GERD. In addition usage of medication, for instance prednisolone is associated with patient developing GERD. Other causes of GERD include high blood calcium level, increasing production of gastrin leading to high levels of acidity in the body, visceroptosis and scleroderma.
Signs/Symptoms: There are a variety of typical signs/symptoms connected with gastroesophageal reflux disease. The signs/symptoms of GERD depend on the age of the patient. Some of symptoms of the disease among the adults in include heartburn, mouth having an acidic taste, and regurgitation. Other less forms of common symptoms are increased salivation, chest pain, coughing, nausea, as well as pain while swallowing something. GERD leads to the esophagus injuries, which includes esophageal strictures, reflux esophagitis, esophageal adenocarcinoma, and barrett’s esophagus. The symptoms of GERD in children are different from the one observed in adults. Some of symptoms of GERD in children include repeated vomiting, coughing, refusing food, unforced spitting up, bad breath, burping as well as failure of gaining sufficient weight. It is critical to note that no single form of a symptom is found in all children universally.
            Treatment methods: GERD is treated using a variety of methods that have been tested over the years. One of the methods commonly used in treatment of patients is lifestyle change. The method of lifestyle change involves stopping eating certain types of food and engaging in lifestyles that are deemed to play a role in promoting gastroesophageal reflux. Nonetheless, dietary interventions used show little evidence on their positive impacts on healing a patient suffering from GERD. Some foods to avoid include chocolate, acidic foods, spicy foods, alcohol, fatty foods, and coffee. In addition ensuring that one engages in activities that leads to weight loss and sleeping when the ensuring the elevation of the head in bed is encouraged. Second, medications are also used in the treatment of GERD. The common forms of medication used include antacids without or with alginic acid, H2 receptor blockers and proton-pump inhibitors. Lastly, surgery is another form of treatment used for GERD (Fock and Poh, 2010). Nissen fundoplication is the standard surgical procedure that is used in the treatment of GERD.
            Prognosis: gastroesophageal reflux disease is a medical condition that causes discomfort in patients and makes it difficult to take certain types of food due to heartburn or feeling acidic taste in the mouth. A large number of patients tend to respond to treatment when proton-pump inhibitors are used (Kahrilas, 2008). Also, physicians usually recommends the use of maintenance PPI therapy as means of treatment for patients who have symptoms when the use of PPI is ended, and in case of those individuals with barrett esophagus and erosive esophagitis. It is crucial to note that one of the serious cases of GERD is known as esophageal adenocarcinoma. The risk of having this condition is 0.1% after having barrett metaplasia or what is referred to as adenocarcinoma. The effectiveness of treatment method used is dependent on whether the patient started receiving early treatment or not. Hence, it is recommendable for the patient with GERD to start earlier treatment to prevent a situation where GERD develops to become a serious condition. The majority of patients who seek treatment early reports the best prognosis.
Section 2—History
Fahad Sar was born in August, 25, 1955. In the past the history Fahad  has had blood transfusion and surgeries associated with total knee, eyes, hysterectomy, neck fusion cholecystectomy , stomach. The patient had problem with medications known as see soaring. In addition, the patient is allergic to NKDA. The Farad’s weight is 117.9 pounds, and height is 69 inches.  The key areas within the patient history which can lead to GERD include weight, height and engaging in unhealthy lifestyles, as well as having past problems with the stomach. Nuclear study in the case of Farad suspected of having GERD would be ordered due to a number of reasons. To start with, according to Cherry, Sorenson and Phelps (2012) nuclear medicine involves medical imaging and applying small amounts of radioactive materials in diagnosing as well as determination the severity of disease under investigation. Additionally, nuclear medicine gives accurate diagnosis of a particular disease, hence applying it gives useful and informative information to a doctor concerning a certain disease a patient is suspected of having, such as GERD (Cherry, Sorenson and Phelps, 2012). The nuclear medicine test on the patient was ordered by physician Newton Muthunayagam, whereby he ordered for gastric emptying quantification test.
One of the tests that can be undertaken on the patient is gastric emptying quantification. The goal of this test would be to find out signs and symptoms related to a patient having GERD, such as inflammation of the esophagus and insufficiency in gastric emptying. Additionally, lab tests are supposed to be undertaken on the patient to determine the levels acidity. Also, barium esophacogram can also be carried out with an aim of demonstrating anatomy as well as possible complication of structures (Rosemurgy et al, 2011). Also, it is possible to demonstrate inadequate gastric emptying as well as reflux.
The expected findings from the ordered nuclear medicine test would shows that  Fahad has problem when it comes to gastric emptying from the stomach. The inability of the patient’s stomach and esophagus to empty gastric leads to high levels of acidity in the body, which causes heartburn and a feeling of mouth tasting acid.
Section 3—Procedure
The nuclear medicine test that was carried out on the patient was gastric emptying quantification.  Gastric emptying test is a form of gastric imaging test aimed at determining whether a patient is able to have adequate gastric empting in the esophagus. In the case of the patient, the gastric emptying quantification nuclear medicine procedure involved giving him an oral radiolabel solid phase meal utilizing 0.6 mCi of Tc-99 sulfur colloid in cooked egg. Sequential anterior and posterior images of the abdomen were then acquired over a period of four hours that followed. Computer quantification of the gastric emptying making use of geometric mean activity was carried.
There are different findings obtained by the undertaking the gastric emptying quantification test on the patient. One of the results shows poor transit of activity from the gastric region into the small bowel. The computer quantification demonstrates gastric retention as follows; 97% at 1 hour, 81% at two hours, 69% at three hours and 56% at four hours. The findings are an indication that the patient has challenges when it comes to emptying of gastric materials from the esophagus and this could be the reason why the patient is having heartburn and inflammation of the esophagus leading to nausea and chest pain.
Section 4 – Interpretation
At first, after the Farad early diagnosis, it was clear that he could be suffering from GERD, as he was showing some symptoms associated with the disease. As a result, there was need of undertaking a nuclear medicine test with an objective of ruling out the suspicion or confirming the suspicion of the possible medical condition the patient was suffering.   The use of nuclear medical tests is effective compared to use of other forms of testing on patients suffering from possible severe GERD. For this reason, the gastric emptying quantification was ordered on 10/7/2017. Gastric emptying quantification as ordered following the patient showing signs of GERD, such as heartburn, chest pain, nausea, and swallowing challenges. Also, the imaging test ordered also on the basis of the patients past medical history, where has had stomach complications, overweight and engagement in unhealthy lifestyles, such as eating acidic food and smoking. Therefore, the test aimed at ascertaining that heartburn and chest pain were caused by GERD.  The test shows poor transit of activity from the gastric region into the small bowel. The computer quantification demonstrates gastric retention as follows; 97% at 1 hour, 81% at two hours, 69% at three hours and 56% at four hours. This is an indication that the patient has problem with emptying of significant amount of gastric solids from the body. The most appropriate treatment approaches for managing the condition would be medication and requiring the patient to change lifestyle, especially focusing on weight control. Possible medications that can be used include antacids without or with alginic acid, H2 receptor blockers and proton-pump inhibitors.
Application of nuclear medicine techniques is an effective way of diagnosing the disease in the patient. Overweight and chest pain could be causes of other diseases impacting negatively on the outcome of the test. On the basis of the results of the nuclear medicine tests carried out on the patient, the most appropriate treatment approach would be the patient changing lifestyle of preventing from GERD becoming severe in the future. The results obtained from the test shows challenges in emptying of gastric solids from the body and something urgent needs to be done on the patient to save his life and preventing the condition from becoming worse in the future.
Cherry, S. R., Sorenson, J. A., & Phelps, M. E. (2012). Physics in Nuclear Medicine E-Book. Elsevier Health Sciences.
Fock, K. M., & Poh, C. H. (2010). Gastroesophageal reflux disease. Journal of gastroenterology45(8), 808-815.
Kahrilas, P. J. (2008). Gastroesophageal reflux disease. New england journal of medicine359(16), 1700-1707.
Rosemurgy, A. S., Donn, N., Paul, H., Luberice, K., & Ross, S. B. (2011). Gastroesophageal reflux disease. Surgical Clinics of North America91(5),

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