Gastroesophageal reflux (GE Reflux) scan

The Gastroesophageal Reflux (GE Reflux) Scan, commonly referred to as the Milk Scan, is a non-invasive nuclear medicine test used to evaluate the reflux of stomach contents into the esophagus. It helps assess the functionality and integrity of the lower esophageal sphincter and detects episodes of gastric content regurgitation, which may lead to gastroesophageal reflux disease (GERD). This scan is particularly useful in infants and children, where GERD is suspected but difficult to confirm through conventional testing. However, it is also beneficial for adults with atypical symptoms of reflux or complications such as aspiration, recurrent pneumonia, or upper GI discomfort.

The test involves the ingestion of a small amount of milk or liquid feed mixed with a radioactive tracer (usually Technetium-99m sulfur colloid). A gamma camera captures continuous images over a period to evaluate whether gastric contents are moving abnormally back into the esophagus.

What is a Gastroesophageal Reflux (Milk) Scan?

• A GE Reflux Scan is a functional imaging study used to evaluate reflux activity in the upper digestive tract, especially the esophagus and stomach.
•  It involves the oral administration of a radiolabeled liquid (milk or formula) that allows visualization of gastric transit and any backward flow into the esophagus.
• The scan provides real-time, dynamic images to assess reflux frequency, duration, and the level it reaches in the esophagus.
• It is a safe, painless, and well-tolerated test, making it an excellent choice for neonates, children, and adults with reflux symptoms.

When is a Milk Scan Recommended?

This test is advised when a patient, especially an infant or child, presents symptoms or conditions that suggest possible gastroesophageal reflux, including:

• Persistent vomiting or regurgitation
• Feeding difficulties in infants
• Irritability or crying after feeding
• Suspected aspiration pneumonia or recurrent respiratory infections
• Chronic cough, wheezing, or stridor
• Failure to thrive or poor weight gain
• Suspected GERD in adults with atypical symptoms
• Evaluation of post-surgical reflux or gastric anatomy alterations
• Silent reflux (no overt vomiting but respiratory or digestive symptoms)

Clinical Conditions Where GE Reflux Scan is Helpful

• Gastroesophageal reflux disease (GERD)
• Laryngopharyngeal reflux
• Aspiration syndromes
• Recurrent pneumonia
• Tracheoesophageal fistula (TEF) follow-up
• Fundoplication evaluation (post-surgery)
• Neurological conditions with poor esophageal motility
• Post-operative assessment in esophageal atresia cases

How is the GE Reflux (Milk) Scan Performed?

Preparation

• No specific fasting is generally required unless advised by the nuclear medicine department.
• For infants and children, ensure the child is calm and comfortable before the scan.
• Breast milk, formula, or cow’s milk may be used depending on the patient’s age and dietary routine.
• Medications affecting GI motility may need to be stopped temporarily, as advised by the physician.

Procedure Steps

• The patient is asked to ingest a radiolabeled liquid—typically milk or formula mixed with Technetium-99m sulfur colloid.
• The patient is then placed under a gamma camera, usually in a supine position.
• Continuous imaging begins immediately and is acquired for 20–30 minutes, sometimes up to 1 hour, to observe for any reflux activity.
• Images are monitored in real-time to detect the onset, frequency, and severity of reflux.
• Delayed images may be obtained in certain cases to evaluate delayed gastric emptying or aspiration.
• After the scan, the patient can return to normal activities unless otherwise advised.

What Does the Scan Show?

The Milk Scan provides the following information:

• Presence or absence of reflux
• Frequency of reflux episodes during the scan
• Height or level refluxed material reaches in the esophagus
• Clearance time of refluxate from the esophagus
• Detection of aspiration into the trachea or lungs
• Assessment of gastric emptying rate
• Functional status of the gastroesophageal junction and lower esophageal sphincter

Advantages of the Gastroesophageal Reflux Scan

• Provides a real-time evaluation of reflux and esophageal motility
• Useful in both symptomatic and silent GERD detection
• Ideal for pediatric patients—non-invasive and painless
• Detects aspiration risk, especially in neurologically compromised patients
• Can be performed with routine feeding formula or milk, increasing patient comfort
• No need for sedation or anesthesia
• Safe with minimal radiation exposure
• Helps guide treatment decisions, including the need for medical management or surgery

Limitations of the Test

• It does not provide anatomical detail—may need to be followed by endoscopy or barium swallow
• May miss very brief or infrequent reflux episodes not occurring during imaging
• Less effective in detecting acidic vs. non-acidic reflux, compared to pH monitoring
• Interpretation may be influenced by positioning or feeding volume

Who Interprets the Results?

The scan is reviewed and interpreted by a nuclear medicine physician or radiologist with experience in gastrointestinal imaging. The findings are then shared with the referring pediatrician, gastroenterologist, or primary physician for further evaluation and treatment planning.

Conclusion

The Gastroesophageal Reflux Scan, or Milk Scan, is a sensitive and safe diagnostic test designed to evaluate abnormal reflux of stomach contents into the esophagus. It plays an essential role in diagnosing GERD, particularly in infants, children, and neurologically compromised patients where other diagnostic modalities may be limited. By tracking radiolabeled milk or formula through the upper digestive tract, this test helps identify reflux frequency, height, and clearance, and may even detect aspiration into the lungs, providing a comprehensive functional assessment. The non-invasive nature, real-time visualization, and ease of use make it a reliable and preferred choice for clinicians when evaluating suspected reflux conditions.

In clinical practice, the Milk Scan offers vital information that helps tailor treatment plans, decide on the need for medications or surgery, and monitor the effectiveness of therapy. For patients and parents, it provides peace of mind through early detection and intervention.