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World Journal of Surgery

, Volume 41, Issue 7, pp 1672–1677 | Cite as

Evaluation of Gastroesophageal Reflux Disease

  • P. Marco FisichellaEmail author
  • Ciro Andolfi
  • George Orthopoulos
Surgical Symposium Contribution

Abstract

Introduction

Gastroesophageal reflux disease (GERD) may present with heartburn, regurgitation, dysphagia, chronic cough, laryngitis, or even asthma. The clinical presentation of GERD is therefore varied and poses certain challenges to the physician, especially given the limitations of the diagnostic testing.

Discussion

The evaluation of patients with suspected GERD might be challenging. It is based on the evaluation of clinical features, objective evidence of reflux on diagnostic testing, correlation of symptoms with episodes of reflux, evaluation of anatomical abnormalities, and excluding other causes that might account for the presence of the patient’s symptoms.

Conclusions

The diagnostic evaluation should include multiple tests, in addition to a thorough clinical examination.

Keywords

Idiopathic Pulmonary Fibrosis Achalasia Chronic Cough Esophageal Motility Idiopathic Pulmonary Fibrosis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to declare

References

  1. 1.
    Vakil N, van Zanten SV, Kahrilas P, Dent K, Jones R, Global Consensus Group (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101(8):1900–1920CrossRefPubMedGoogle Scholar
  2. 2.
    Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108(3):308–328CrossRefPubMedGoogle Scholar
  3. 3.
    Patti MG, Diener U, Tamburini A, Molena D, Way LW (2001) Role of esophageal function tests in the diagnosis of gastroesophageal reflux disease. Dig Dis Sci 46:597–602CrossRefPubMedGoogle Scholar
  4. 4.
    Andolfi C, Bonavina L, Kavitt RT, Konda VJ, Asti E, Patti MG (2016) Importance of esophageal manometry and ph monitoring in the evaluation of patients with refractory gastroesophageal reflux disease: a multicenter study. J Laparoendosc Adv Surg Tech A 26(7):548–550CrossRefPubMedGoogle Scholar
  5. 5.
    Patti MG, Fisichella PM, Perretta S (2001) Preoperative evaluation of patients with gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A 11(6):327–331CrossRefPubMedGoogle Scholar
  6. 6.
    Jobe BA, Richter JE, Hoppo T et al (2013) Preoperative diagnostic work-up before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217(4):586–597CrossRefPubMedGoogle Scholar
  7. 7.
    Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, Johnsson F (2008) The Reflux Disease Questionnaire: a measure for assessment of treatment response in clinical trials. Health Qual Life Outcomes 6:31CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ducrotte P, Zerbib F (2007). ReQuest: a new questionnaire for the simultaneous evaluation of symptoms and well-being in patients with gastro-oesophageal reflux. Digestion, 75Suppl 1:79-86Google Scholar
  9. 9.
    Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG (1999) Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 3:292–300CrossRefPubMedGoogle Scholar
  10. 10.
    Weber C, Davis CS, Fisichella PM (2011) Current applications of evolving methodologies in gastroesophageal reflux disease testing. Dig Liver Dis 43(5):353–357CrossRefPubMedGoogle Scholar
  11. 11.
    Bello B, Zoccali M, Gullo R et al (2013) Gastroesophageal reflux disease and antireflux surgery—What is the proper preoperative work-up? J Gastrointest Surg 17:14–20CrossRefPubMedGoogle Scholar
  12. 12.
    Fisichella PM, Jalilvand A (2014) The role of impaired esophageal and gastric motility in end-stage lung diseases and after lung transplantation. J Surg Res 186(1):201–206CrossRefPubMedGoogle Scholar
  13. 13.
    Andolfi C, Vigneswaran Y, Kavitt RT, Herbella FA, Patti MG (2017) Laparoscopic antireflux surgery: importance of patient’s selection and preoperative workup. J Laparoendosc Adv Surg Tech A 27(2):101–105. doi: 10.1089/lap.2016.0322 CrossRefPubMedGoogle Scholar
  14. 14.
    Sidhwa F, Moore A, Alligood E, Fisichella PM. (2016) Diagnosis and treatment of the extraesophageal manifestations of gastroesophageal reflux disease. Ann Surg. Aug 5. PMID: 27455157Google Scholar
  15. 15.
    Lord RV, Kaminski A, Oberg S et al (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6:3–9CrossRefPubMedGoogle Scholar
  16. 16.
    Herbella FA, Andolfi C, Vigneswaran Y, Patti MG, Pinna BR (2016) Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study. J Gastrointest Surg 20(10):1673–1678CrossRefPubMedGoogle Scholar
  17. 17.
    Lo KW, Mashimo H (2017) Establishing the diagnosis of GERD. In: Fisichella PM (ed) Failed antireflux therapy: analysis of causes and principles of treatment. Springer-Verlag, London (in press)Google Scholar
  18. 18.
    Bredenoord AJ, Weustein BLAM, Smout AJPM (2005) Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut 54(12):1810–1817CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Desjardin M, Luc G, Collet D, Zerbib F (2015) 24-hour pH-impedance monitoring on therapy to select patients with refractory reflux symptoms for antireflux surgery. A single center retrospective study. Neurogastroenterol Motil 28(1):146–152CrossRefPubMedGoogle Scholar
  20. 20.
    Francis DO, Goutte M, Slaughter JC et al (2011) Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux. Laryngoscope 121(9):1902–1909PubMedGoogle Scholar
  21. 21.
    Lai Y-C, Wang P-C, Lin J-C (2008) Laryngopharyngeal reflux in patients with reflux esophagitis. World J Gastroenterol 14(28):4523–4528CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Fisichella PM, Reder NP, Gagermeier J, Kovacs EJ (2014) Usefulness of pH monitoring in predicting the survival status of patients with scleroderma awaiting lung transplantation. J Surg Res 189(2):232–237CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Fisichella PM, Patti MG (2009) Gastroesophageal reflux disease and morbid obesity: is there a relation? World J Surg 33(10):2034–2038. doi:  10.1007/s00268-009-0045-z CrossRefPubMedGoogle Scholar
  24. 24.
    Allaix ME, Fisichella PM, Noth I, Herbella FA, Borraez Segura B, Patti MG (2014) Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment. J Gastrointest Surg 18(1):100–104CrossRefPubMedGoogle Scholar
  25. 25.
    Galindo G, Vassalle J, Marcus SN, Triadafilopoulos G (2013) Multimodality evaluation of patients with gastroesophageal reflux disease symptoms who have failed empiric proton pump inhibitor therapy. Dis Esophagus 26(5):443–450CrossRefPubMedGoogle Scholar
  26. 26.
    Bais JE, Samsom M, Boudesteijn EA, van Rijk PP, Akkermans LM, Gooszen HG (2001) Impact of delayed gastric emptying on the outcome of antireflux surgery. Ann Surg 234:139–146CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Weinstein DH, deRijke S, Chow CC, Foruraghi L, Zhao X, Wright EC, Whatley M, Maass-Moreno R, Chen CC, Wank SA (2013) A new method for determining gastric acid output using a wireless ph-sensing capsule. Aliment Pharmacol Ther 37(12):1198–1209CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Hayat JO, Yazaki E, Moore AT, Hicklin L, Dettmar P, Kang JY, Sifrim D (2014) Objective detection of esophago-pharyngeal reflux in patients with hoarseness and endoscopic signs of laryngeal inflammation. J Clin Gastroenterol 48(4):318–327CrossRefPubMedGoogle Scholar
  29. 29.
    Fisichella PM, Davis CS, Lundberg PW, Lowery E, Burnham EL, Alex CG, Ramirez L, Pelletiere K, Love RB, Kuo PC, Kovacs EJ (2011) The protective role of laparoscopic antireflux surgery against aspiration of pepsin after lung transplantation. Surgery 150(4):598–606CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Fisichella PM, Davis CS, Gagermeier J, Dilling D, Alex CG, Dorfmeister JA, Kovacs EJ, Love RB, Gamelli RL (2011) Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 170(2):e279–e286CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rhagu G, Freudenberger TD, Yang S et al (2006) High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. EurRespir J 27:136Google Scholar
  32. 32.
    Mendez BM, Davis CS, Weber C, Joehl RJ, Fisichella PM (2012) Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis. Am J Surg 204:21CrossRefGoogle Scholar
  33. 33.
    Patti MG, Gasper WJ, Fisichella PM, Nipomnick I, Palazzo F (2008) Gastroesophageal reflux disease and connective tissue disorders: pathophysiology and implications for treatment. J Gastrointest Surg 12:1900. doi: 10.1007/s11605-008-0674-9 Epub 2008 Sep 3 CrossRefPubMedGoogle Scholar
  34. 34.
    Davis CS, Shankaran V, Kovacs EJ, et al. (2010) Gastroesophageal reflux disease after lung transplantation: pathophysiology and implications for treatment. Surgery, 148:737. Discussion 744e5Google Scholar
  35. 35.
    Hartwig MG, Davis RD (2012) Gastroesophageal reflux disease induced aspiration injury following lung transplantation. Curr Opin Organ Transplant 17:474CrossRefPubMedGoogle Scholar
  36. 36.
    Hoppo T, Jarido V, Pennathur A et al (2011) Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg 146:1041CrossRefPubMedGoogle Scholar
  37. 37.
    Basseri B, Conklin JL, Pimentel M et al (2010) Esophageal motor dysfunction and gastroesophageal reflux are prevalent in lung transplant candidates. Ann Thorac Surg 90:1630CrossRefPubMedGoogle Scholar
  38. 38.
    Allaix ME, Fisichella PM, Herbella FA, Patti MG (2014) Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment. J Gastrointest Surg Jan;18(1):100-4; discussion 104-5. doi:  10.1007/s11605-013-2333-z
  39. 39.
    Davis CS, Mendez BD, Flint DV et al (2013) Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation. J Surg Res. doi: 10.1016/j.jss.2013.06.011.:S0022-4804(13)00600-8 PubMedCentralGoogle Scholar
  40. 40.
    Fisichella PM, Davis CS, Shankaran V et al (2012) The prevalence and extent of gastroesophageal reflux disease correlates to the type of lung transplantation. Surg Laparosc Endosc Percutaneous Tech 22:46CrossRefGoogle Scholar
  41. 41.
    Fisichella PM, Davis CS, Gagermeier J et al (2011) Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 170:279CrossRefGoogle Scholar
  42. 42.
    Fisichella PM, Davis CS, Lowery E et al (2012) Pulmonary immune changes early after laparoscopic antireflux surgery in lung transplant patients with gastroesophageal reflux disease. J Surg Res 177:E65CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • P. Marco Fisichella
    • 1
    Email author
  • Ciro Andolfi
    • 2
  • George Orthopoulos
    • 3
  1. 1.Department of Surgery, Brigham and Women’s Hospital and Boston VA Healthcare SystemHarvard Medical SchoolBostonUSA
  2. 2.Department of SurgeryThe University of Chicago Pritzker School of MedicineChicagoUSA
  3. 3.Department of SurgerySt. Elizabeth Medical CenterBrightonUSA

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