Diagnostic Tests and Interpretations Before Anti-reflux Surgery

Abstract

Gastroesophageal reflux disease (GERD) is a common and chronic disease. The prevalence of the GERD was 17.1%, 15.4%, and 10.0% in Europe, North America, and Asia, respectively. Although its prevalence has been relatively low in Asia, the increasing trend has been remarkable recently. GERD patients usually use proton pump inhibitors (PPIs) for symptoms control through reducing acid production, which results in increased medical expenditures. However, up to 40% of patients complain persistent symptoms despite PPI therapy. Although most patients are initially treated with acid-suppressive therapy, many require diagnostic testing to objectively assess for the presence and degree of esophageal acid exposure. Furthermore, the recent increase in prevalence of patients with partial response or lack of response to aggressive acid suppression has raised questions about the role of less acidic refluxate in esophageal injury as well as patient symptoms. Esophageal function testing for GERD has evolved greatly to detect esophageal acid reflux and abnormal esophageal movement. Ambulatory esophageal pH monitoring is an essential method in patients with GERD to make an objective diagnosis before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the examination can be better tolerated by patients. Multichannel intraluminal impedance-pH technology has been developed and currently the most sensitive tool to evaluate patients with reflux symptoms. The use of esophageal manometry is suitable for the detection of esophageal movement patterns and motility abnormalities such as achalasia. Therefore, esophageal ambulatory pH monitoring and manometry are often used in assessments prior to laparoscopic anti-reflux surgery and in patients with reflux symptoms refractory to medical treatment. Taking these recent advances into consideration, this chapter focuses primarily on the indications, technique, equipment, and interpretation of esophageal ambulatory reflux monitoring and manometry in the evaluation of esophageal symptoms.