Preoperative Evaluation and Testing for GERD

Chapter

Abstract

Diagnostic preoperative testing is necessary to establish the diagnosis of GERD, to understand the disease, to quantify the severity of the disease and to assess the esophageal function, the hiatus, and the lower esophageal sphincter. Appropriate testing also directs the surgeon to the best surgical procedure for the treatment of each individual’s GERD. Diagnostic modalities have improved over recent years, and modern technology has given us a more thorough understanding of the disease.

Radiologic studies are good screening tests that can detect anatomic lesions but are less sensitive for functional esophageal disorders. Endoscopy is necessary to rule out cancer, diagnose and evaluate (biopsy) mucosal lesions such as Barrett’s mucosa, and to evaluate and diagnose a hiatal hernia, all of which are important for the preoperative planning and surgical repair strategy. In patients where the radiologic studies are not normal, manometric testing is indicated to assess the esophageal motility. Recently high-resolution manometry has facilitated the preoperative work-up to rule out motility disorders in the diagnosis of GERD. pH monitoring is routinely used to assess esophageal acid exposure and remains the gold standard in making the diagnosis of GERD as well as determining the severity of the disease. Esophageal impedance studies are used electively in patients that cannot stop anti-acid medication prior to testing or in patients with suspicion of alkaline reflux.

Keywords

Catheter Ischemia Pneumonia Barium Candida 

References

  1. 1.
    Fuller L, Huprich JE, Theisen J, et al. Abnormal esophageal body function: radiographic–manometric correlation. Am Surg. 1999;65(10):911–4.PubMedGoogle Scholar
  2. 2.
    Dodds WJ. 1976 Walter B. Cannon Lecture: current concepts of esophageal motor function: clinical implications for radiology. AJR Am J Roentgenol. 1977;128(4):549–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Hill LD, Kozarek RA, Kraemer SJ, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44(5):541–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Ayazi S, Hagen JA, Zehetner J, et al. The value of high-resolution manometry in the assessment of the resting characteristics of the lower esophageal sphincter. J Gastrointest Surg. 2009;13(12): 2113–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986;8 Suppl 1:52–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Ayazi S, Hagen JA, Zehetner J, et al. Day-to-day discrepancy in Bravo pH monitoring is related to the degree of deterioration of the lower esophageal sphincter and severity of reflux disease. Surg Endosc. 2011;25(7):2219–23.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Ayazi S, Lipham JC, Portale G, et al. Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol. 2009;7(1):60–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103(3):753–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Tougas G, Chen Y, Coates G, Paterson W, Dallaire C, Pare P, et al. Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol. 2000;95(1):78–86.PubMedCrossRefGoogle Scholar
  10. 10.
    Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95(6):1456–62.PubMedCrossRefGoogle Scholar

Copyright information

© Springer New York 2015

Authors and Affiliations

  1. 1.Department of SurgeryKeck Medical Center, Keck School of Medicine of USCLos AngelesUSA
  2. 2.Division of Upper GI and General Surgery, Department of SurgeryKeck Medical Center of USCLos AngelesUSA

Personalised recommendations