Skip to main content
SpringerLink
Log in
Book cover

Hiatal Hernia Surgery pp 29–50Cite as

Utility of Ambulatory Esophageal pH and High-Resolution Manometry in the Diagnosis of Gastro-Esophageal Reflux Disease and Hiatal Hernia

  • Chapter
  • First Online:

  • 1061 Accesses

Abstract

The esophago-gastric junction (EGJ) allows esophageal clearance and venting of air (belching) while, at the same time, restricting gastroesophageal reflux. Pathology or disruption of the EGJ can impair the passage of food and fluid from the esophagus into the stomach or increase the risk of gastroesophageal reflux disease (GERD). In this article, we review the structure and function of the EGJ in health and disease. The contribution of esophageal high-resolution manometry (HRM) and ambulatory pH-impedance monitoring to GERD diagnosis is considered. Throughout there is an emphasis on how the results of investigation in patients with suspected GERD impacts on management. Additionally, the role of physiological investigation in patients with esophageal symptoms after anti-reflux surgery is considered.

This is a preview of subscription content, log in via an institution.

Notes

  1. 1.

    In these studies hiatus hernia is defined by a negative intra-abdominal LES length

  2. 2.

    PSPW is an impedance-detected antegrade bolus propagation that passes through the esophagus within 30 seconds of a reflux event. The PSPW index is the proportion of reflux events followed by PSPW compared to all reflux events, and can be lower in erosive and nonerosive GERD compared to controls. Further, this index may distinguish hypersensitive esophagus from functional heartburn.

References

  1. Fox M, Forgacs I. Gastroesophageal reflux disease. BMJ. 2006;332:88–93.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med. 1997;336(13):924–32.

    Article  CAS  PubMed  Google Scholar 

  3. Lee J, Anggiansah A, Anggiansah R, Young A, Wong T, Fox M. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterol Hepatol. 2007;5(12):1392–8.

    Article  PubMed  Google Scholar 

  4. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130(3):639–49.

    Article  PubMed  Google Scholar 

  5. Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132(3):883–9.

    Article  PubMed  Google Scholar 

  6. Anggiansah R, Sweis R, Anggiansah A, Wong T, Cooper M, Fox M. The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013;37(5):555–63.

    Article  CAS  PubMed  Google Scholar 

  7. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120(7):1599–060.

    Article  CAS  PubMed  Google Scholar 

  8. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55(10):1398–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Thor K, Lamm M, et al. Long-term management of gastro-oesophageal reflux disease with omeprazole or open antireflux surgery: results of a prospective, randomized clinical trial. The Nordic GORD Study Group. Eur J Gastroenterol Hepatol. 2000;12(8):879–87.

    Article  CAS  PubMed  Google Scholar 

  10. Corley DA, Kubo A, Zhao W. Abdominal obesity, ethnicity and gastroesophageal reflux symptoms. Gut. 2007;56:756–62.

    Article  PubMed  Google Scholar 

  11. Brasseur JG, Ulerich R, Dai Q, Patel DK, Soliman AMS, Miller L. Pharmacological dissection of the human gastroesophageal segment into three sphincteric components. J Physiol. 2007;580(3):961–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Mittal RK, Rochester DF, McCallum RW. Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans. Am J Physiol. 1989;256:G139–44.

    CAS  PubMed  Google Scholar 

  13. Kahrilas PJ, Lin S, Chen J, Manka M. The effect of hiatus hernia on gastroesophageal junction pressure. Gut. 1999;44:476–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Heine KJ, Dent J, Mittal RK. Anatomical relationship between the crural diarphagm and the lower esophageal sphincter: an electrophysiologic study. J Neurogastroenterol Motil. 1993;5:89–95.

    Article  Google Scholar 

  15. Pehlivanov N, Liu J, Kassab G, Puckett J, Mittal RK. Relationship between esophageal muscle thickenss and intraluminal pressure: an ultrasonographic study. Am J Physiol Gastrointest Liver Physiol. 2001;280:G1093–8.

    Article  CAS  PubMed  Google Scholar 

  16. Fletcher J, Wirz A, Young J, Vallance R, McColl KE. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology. 2001;121(4):775–83.

    Article  CAS  PubMed  Google Scholar 

  17. Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major reflux factor for acidic reflux in healthy subjets and patients with GERD. Gut. 2010;49:441–51.

    Article  Google Scholar 

  18. Boecxstaens V, Bisschops R, Blondeau K, Vos R, Scarpellini E, De Wulf D, Tack J. Modulation of the postprandial acid and bile pockets at the gastroesophageal junction by drugs that affect gastric motility. Aliment Pharmacol Ther. 2011;33(12):1370–7.

    Article  CAS  PubMed  Google Scholar 

  19. Kahrilas PJ, McColl K, Fox M, O’Rourke L, Sifrim D, Smout AJ, Boeckxstaens G. The acid pocket: a target for treatment in reflux disease? Am J Gastroenterol. 2013;108(7):1058–64.

    Article  CAS  PubMed  Google Scholar 

  20. Curcic J, Roy S, Schwizer A, Kaufman E, Forras-Kaufman Z, Menne D, et al. Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. Am J Gastroenterol. 2014;109(5):658–67.

    Article  PubMed  Google Scholar 

  21. Curcic J, Schwizer A, Kaufman E, Forras-Kaufman Z, Banerjee S, Pal A, et al. Effects of baclofen on the functional anatomy of the oesophago-gastric junction and proximal stomach in healthy volunteers and patients with GERD assessed by magnetic resonance imaging and high-resolution manometry: a randomised controlled double-blind study. Aliment Pharmacol Ther. 2014;40(10):1230–40.

    Article  CAS  PubMed  Google Scholar 

  22. Roy S, Fox M, Curcic J, Schwizer W, Pal A. The gastro-esophageal reflux barrier: biophysical analysis on 3D models of anatomy from magnetic resonance imaging. Neurogastroenterol Motil. 2012;24(7):616–25. e269

    Article  CAS  PubMed  Google Scholar 

  23. Grossi L, Ciccaglione AF, Travaglini N, Marzio L. Swallows, oesophageal and gastric motility in normal subjects and in patients with gastro-oesophageal reflux disease: a 24-h pH-manometric study. Neurogastroenterol Motil. 1998;10(2):115–21.

    Article  CAS  PubMed  Google Scholar 

  24. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease. Am J Surg. 1998;155(1):104–11.

    Article  Google Scholar 

  25. Jones MP, Sloan SS, Jovanovic B, Kahrilas PJ. Impaired egress rather than increased access: an important independent predictor of erosive oesophagitis. Neurogastroenterol Motil. 2002;14(6):625–31.

    Article  CAS  PubMed  Google Scholar 

  26. Daum C, Sweis R, Kaufman E, Fuellemann A, Anggiansah A, Fried M, Fox M. Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease. Neurogastroenterol Motil. 2011;23(6):517–e200.

    Article  CAS  PubMed  Google Scholar 

  27. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65:256–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Dodds WJ, Hogan WJ, Helm JF, Dent J. Pathogenesis of reflux esophagitis. Gastroenterology. 1981;81:376–94.

    CAS  PubMed  Google Scholar 

  29. Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982;307:1547–52.

    Article  CAS  PubMed  Google Scholar 

  30. Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut. 1988;29:1020–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109:601–10.

    Article  CAS  PubMed  Google Scholar 

  32. Holloway RH. The anti-reflux barrier and mechanisms of gastroesophageal reflux. Baillieres Clin Gastroenterol. 2000;14(5):681–99.

    Article  CAS  Google Scholar 

  33. Mittal RK, Fisher MJ. Electrical and mechanical inhibition of the crural diaphragm during transient relaxation of the lower esophageal sphincter. Gastroenterology. 1990;99:1265–8.

    Article  CAS  PubMed  Google Scholar 

  34. Holloway RH, Penagini R, Ireland AC. Criteria for objective definition of transient lower esophageal sphincter relaxation. Am J Physiol. 1995;268:G128–33.

    CAS  PubMed  Google Scholar 

  35. Holloway RH, Boeckxstaens GE, Penagini R, Sifrim D, Smout AJ. Objective definition and detection of transcient lower esophageal sphincter relaxation revisited: is there room for improvement? Neurogastroenterol Motil. 2012;24:54–60.

    Article  CAS  PubMed  Google Scholar 

  36. Roman S, Zerbib F, Belhocine K, des Varannes SB, Mion F. High resolution manometry to detect transient lower oesophageal sphincter relaxations: diagnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria. Aliment Pharmacol Ther. 2011;34(3):384–93.

    Article  CAS  PubMed  Google Scholar 

  37. Roman S, Holloway R, Keller J, Herbella F, Zerbib F, Xiao Y, et al. Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry. Neurogastroenterol Motil. 2016;29(2):1–9.

    Google Scholar 

  38. Pandolfino JE, Shi G, Zhang Q, Ghosh S, Brasseur JG, Kahrilas PJ. Measuring EGJ opening patterns using high resolution intraluminal impedance. Neurogastroenterol Motil. 2005;17:200–6.

    Article  CAS  PubMed  Google Scholar 

  39. Tucker E, Knowles K, Wright J, Fox M. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. Aliment Pharmacol Ther. 2013;37(2):263–74.

    Article  CAS  PubMed  Google Scholar 

  40. Kessing BF, Bredenoord AJ, Smout AJ. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol. 2014;109(1):52–9.

    Article  PubMed  Google Scholar 

  41. Anggiansah A, Taylor G, Bright N, Wang J, Owen WA, Rokkas T, et al. Primary peristalsis is the major acid clearance mechanism in reflux patients. Gut. 1994;35(11):1536–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Lin S, Ke M, Xu J, Kahrilas PJ. Impaired esophageal emptying in reflux disease. Am J Gastroenterol. 1994;89:1003–6.

    CAS  PubMed  Google Scholar 

  43. Bredenoord AJ, Hemmink GJ, Smout AJ. Relationship between gastro-oesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil. 2009;21:807–12.

    Article  CAS  PubMed  Google Scholar 

  44. Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109:46–51.

    Article  CAS  PubMed  Google Scholar 

  45. Savarino E, Gemignani L, Pohl D, Zentilin P, Dulbecco P, Assandri L, et al. Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;34:476–86.

    Article  CAS  PubMed  Google Scholar 

  46. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100:1243–50.

    Article  PubMed  Google Scholar 

  47. Fisher BL, Pennathur A, Mutnick JL, Little AG. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290–4.

    Article  CAS  PubMed  Google Scholar 

  48. Nilsson M, Lundegardh G, Carling L, Ye W, Lagegren J. Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gastroenterol. 2002;37:626–30.

    Article  CAS  PubMed  Google Scholar 

  49. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR 3rd, Rodriguez-Artalejo F. Symptoms of gastroesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther. 2004;19:95–105.

    Article  CAS  PubMed  Google Scholar 

  50. Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC, Song IS. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut. 2008;57(10):1360–5.

    Article  CAS  PubMed  Google Scholar 

  51. Nam SY, Choi IJ, Ryu KH, Park BJ, Kim HB, Nam BH. Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women. Gastroenterology. 2010;139:1902–11.

    Article  PubMed  Google Scholar 

  52. Tilg H, Moschen AR. Visceral adipose tissue attacks beyond the liver: esophagogastric junction as a new target. Gastroenterology. 2010;139:1823–6.

    Article  PubMed  Google Scholar 

  53. Kahrilas PJ, Shi G, Manka M, Joehl RJ. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology. 2000;118(4):688–95.

    Article  CAS  PubMed  Google Scholar 

  54. van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119(6):1439–46.

    Article  PubMed  Google Scholar 

  55. Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: hhiatal hernia, lower esophageal sphincter, or both? Ann Intern Med. 1992;117:977–82.

    Article  CAS  PubMed  Google Scholar 

  56. Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ. High resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102:1056–63.

    Article  PubMed  Google Scholar 

  57. Kaul B, Petersen H, Myrvold HE, Grette K, Roysland P, Halvorsen T. Hiatus hernia in gastroesophageal reflux disease. Scand J Gastroenterol. 1986;21:31–4.

    Article  CAS  PubMed  Google Scholar 

  58. Mittal RK, Lange RC, McCallum RW. Identification and mechanism of delayed esophageal acid clearance in subjects with hiatal hernia. Gastroenterology. 1987;92:130–5.

    Article  CAS  PubMed  Google Scholar 

  59. Sloan S, Kahrilas PJ. Impairment of esophageal emptying with hiatal hernia. Gastroenterology. 1991;100:596–605.

    Article  CAS  PubMed  Google Scholar 

  60. Ott DJ, Gelfand DW, Chen YM, Wu WC, Munitz HA. Predictive relationship of hiatal hernia to reflux esophagitis. Gastrointest Radiol. 1985;10:317–20.

    Article  CAS  PubMed  Google Scholar 

  61. Weijenborg PW, Van Hoeij FB, Smout AJPM, Bredenoord AJ. Accuracy of hiatal hernia detection with esophageal high resolution manometry. Neurogastroenterol Motil. 2015;27:293–9.

    Article  CAS  PubMed  Google Scholar 

  62. Bredenoord AJ, Weusten BLAM, Timmer R, Smout AJM. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology. 2006;130:334–40.

    Article  PubMed  Google Scholar 

  63. Bredenoord AJ, Weusten BL, Carmagnola S, Smout AJ. Double peaked high pressure zone at the esophagogastric junction in controls and in patients with a hiatal hernia. A study using high resolution manometry. Dig Dis Sci. 2004;49:1128–35.

    Article  CAS  PubMed  Google Scholar 

  64. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  PubMed  Google Scholar 

  65. Berstad A, Weberg R, Froyshov Larsen I, Hoel B, Hauer-Jensen M. Relationship of hiatus hernia to reflux esophagitis. A prospective study of coincidence, using endoscopy. Scand J Gastroenterol. 1986;21:55–8.

    Article  CAS  PubMed  Google Scholar 

  66. Kasapidis P, Vassilakis JS, Tzovaras G, Chrysos E, Xynos E. Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease. Dig Dis Sci. 1995;40:2724–30.

    Article  CAS  PubMed  Google Scholar 

  67. DeMeester TR, LaFontaine E, Joelsson BE, Skinner DB, Ryan JW, O’Sullivan GC, et al. Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction. J Thorac Cardiovasc Surg. 1981;82:547–58.

    CAS  PubMed  Google Scholar 

  68. Bredenoord AJ, Weusten BL, Roelofs JM, Smout AJ. The gastroesophageal pressure inversion point revisited. Scand J Gastroenterol. 2003;38:812–8.

    CAS  PubMed  Google Scholar 

  69. Fox M, Hebbard J, Janiak P, Brasseur JG, Ghosh S, Thumshirn M, et al. High resolution manometry predicts the success of esophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil. 2004;16:533–42.

    Article  CAS  PubMed  Google Scholar 

  70. Clouse RE, Staiano A, Alrakawi A. Topographic analysis of esophageal double-peaked waves. Gastroenterology. 2000;118:469–76.

    Article  CAS  PubMed  Google Scholar 

  71. Nicodeme F, Lin Z, Pandolfino JE, Kahrilas PJ. Esophagogastric Junction pressure morphology: comparison between a station pull-through and real-time 3D-HRM representation. Neurogastroenterol Motil. 2013;25:e591–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Nicodeme F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–60.

    Article  CAS  PubMed  Google Scholar 

  73. Gor P, Li Y, Munigala S, Patel A, Bolkhir A, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2016;29:820–8.

    Article  CAS  PubMed  Google Scholar 

  74. Jasper D, Freitas-Queiroz N, Hollenstein M, Misselwitz B, Layer P, Navarro-Rodriquez T, et al. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil. 2017:29(2). https://doi.org/10.1111/nmo12925.

  75. Tolone S, de Cassan C, de Bortoli N, Roman S, Galeazzi F, Salvador R, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27(8):1175–82.

    Article  CAS  PubMed  Google Scholar 

  76. Patti MG, Diener U, Tamburini A, Molena D, Way LW. Role of esophageal function tests in diagnosis of gastroesophageael reflux disease. Dig Dis Sci. 2001;46(3):597–602.

    Article  CAS  PubMed  Google Scholar 

  77. Fass R, Ofman JJ, Gralnek IM, Johnson C, Carmargo E, Sampliner RE, et al. Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease. Arch Intern Med. 1999;159:2161–8.

    Article  CAS  PubMed  Google Scholar 

  78. Herregods TV, Troelstra M, Weijenborg PW, Bredenoord AJ, Smout AJ. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil. 2015;27(9):1267–73.

    Article  CAS  PubMed  Google Scholar 

  79. Bello B, Zoccali M, Gullo R, Allaix ME, Herbella FA, Gasparaitis A, et al. Gastroesophageal reflux disease and antireflux surgery-What is the proper preoperative workup? J Gastrointest Surg. 2013;17:14–20.

    Article  PubMed  Google Scholar 

  80. Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98(4):740–9.

    Article  PubMed  Google Scholar 

  81. Sweis R, Fox M, Anggiansah A, Wong T. Prolonged, wireless pH-studies have a high diagnostic yield in patients with reflux symptoms and negative 24-h catheter-based pH-studies. Neurogastroenterol Motil. 2011;23(5):419–26.

    Article  CAS  PubMed  Google Scholar 

  82. Penagini R, Sweis R, Mauro A, Dominques G, Vales A, Sifrim D. Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless pH monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease. J Neurogastroenterol Motil. 2015;21:265–72.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Sweis R, Fox M, Anggiansah R, Anggiansah A, Basavaraju K, Canavan R, et al. Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies. Aliment Pharmacol Ther. 2009;29(6):669–76.

    Article  CAS  PubMed  Google Scholar 

  84. Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, et al. Ambulatory 24h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity and reproducibility. Am J Gastroenterol. 1992;87:1102–11.

    CAS  PubMed  Google Scholar 

  85. Roman S, Gyawali CP, Savarino E, Yadlapati R, Zerbib F, Wu J, et al. Ambulatory reflux monitoring for the diagnosis of gastroesophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017. https://doi.org/10.1111/nmo.13067.

  86. Yadlapati R, Pandolfino JE, Lidder AK, Shabeeb N, Jaiyeola DM, Adkins C, et al. Oropharyngeal pH testing does not predict response to proton pump inhibitor therapy in patients with laryngeal symptoms. Am J Gastroenterol. 2016;111:1517–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Dulery C, Lechot A, Roman S, Bastier PL, Stoll D, de Gabory L, et al. A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors. Neurogastroenterol Motil. 2017;29(1). https://doi.org/10.1111/nmo12909.

  88. Shay S, Richter J. Direct comparison of impedance, manometry and pH probe in detecting reflux before and after a meal. Dig Dis Sci. 2005;50:1584–90.

    Article  PubMed  Google Scholar 

  89. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastroesophageal reflux monitoring: Review and consensus report on detection and definitions of acid, non-acid and gas reflux. Gut. 2004;53:1024–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Bredenoord AJ. Impedance-pH monitoring: new standard for measuring gastro-oesophageal reflux. Neurogastroenterol Motil. 2008;20:4343–9.

    Article  Google Scholar 

  91. Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;13:884–91.

    Article  PubMed  Google Scholar 

  92. Frazzoni M, Savarino E, de Bortoli N, Martinucci I, Furnari M, Frazzoni L, et al. Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 2016;14(1):40–6.

    Article  PubMed  Google Scholar 

  93. Boeckxstaens GE, Smout A. Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastroesophageal reflux disease. Aliment Pharmacol Ther. 2010;32:334–43.

    Article  CAS  PubMed  Google Scholar 

  94. Kushnir VM, Sayuk GS, Gyawali CP. Abnormal GERD parameters on ambulatory pH monitoring predict therapeutic success in noncardiac chest pain. Am J Gastroenterol. 2010;105:1032–8.

    Article  PubMed  Google Scholar 

  95. Gyawali CP, Roman S, Bredenoord AJ, Fox M, Keller J, Pandolfino JE, et al. Classification of esophageal motor findings in gastro-esophageal reflux disease: conclusions from an international consensus group Neurogastroenterol Motil. 2017. https://doi.org/10.1111/nmo13104.

  96. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20. quiz 1943

    Article  PubMed  Google Scholar 

  97. Patel A, Sayuk GS, Kushnir VM, Chan WW, Gyawali CP. GERD phenotypes from pH-impedance monitoring predict symptomatic outcomes on prospective evaluation. Neurogastroenterol Motil. 2016;28:513–21.

    Article  CAS  PubMed  Google Scholar 

  98. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61:1340–54.

    Article  CAS  PubMed  Google Scholar 

  99. Broeders JA, Draaisma WA, Bredenoord AJ, de Vries DR, Rijnhart-de Jong HG, Smout AJ, et al. Oesophageal acid hypersensitivity is not a contraindication to Nissen fundoplication. Br J Surg. 2009;96(9):1023–30.

    Article  CAS  PubMed  Google Scholar 

  100. Garros A, Mion F, Marjoux S, Damon H, Roman S. Factors associated with nonresponse to proton pump inhibitors therapy in patients referred for esophageal pH-impedance monitoring. Dis Esophagus. 2016;29(7):787–93.

    Article  CAS  PubMed  Google Scholar 

  101. Patel A, Sayuk GS, Gyawali CP. Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil. 2016;28(9):1382–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Bredenoord AJ, Draaisma WA, Weusten BLAM, Gooszen HG, Smout AJ. Mechanisms of acid, weakly acidic and gas reflux after anti-reflux surgery. Gut. 2008;57(2):161–6.

    Article  CAS  PubMed  Google Scholar 

  103. Pandolfino JE, Curry J, Shi G, Joehl RJ, Brasseur JG, Kahrilas PJ. Restoration of normal distensive characteristics of the esophagogastric junction after fundoplication. Ann Surg. 2005;242(1):43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Kwiatek MA, Kahrilas K, Soper NJ, Bulsiewicz WJ, McMahon BP, Gregersen H, et al. Esophaogastric junction distensibility after fundoplication assessed with a novel functional luminal imaging probe. J Gastrointest Surg. 2010;14(2):268–76.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Boudewijn KF, Bredenoord AJ, Schijven MP, van der Peet DL, van Berge HM, Smout AJ. Long-term effects of anti-reflux surgery on the physiology of the esophagogastric junction. Surg Endosc. 2015;29:3726–32.

    Article  Google Scholar 

  106. Wang YT, Tai LF, Yazaki E, Jafari J, Sweis R, Tucker K, et al. Investigation of dysphagia after antireflux surgery by high-resolution manometry: impact of multiple water swallows and a solid test meal on diagnosis, management, and clinical outcome. Clin Gastroenterol Hepatol. 2015;13(9):1575–83.

    Article  PubMed  Google Scholar 

  107. Ang D, Misselwitz B, Hollenstein M, Knowles K, Wright J, Tucker E, et al. High resolution manometry with a solid test meal increases diagnostic sensitivity for clinically relevant, symptomatic esophageal motility disorders: results from a large case series. Lancet Gastroenterol Hepatol. 2017;2(9):654–61.

    Google Scholar 

  108. Kahrilas PJ, Lin S, Spiess A, Brasseur J, Joehl R, Manka M. Impact of fundoplication on bolus transit across esophagogastric junction. Am J Physiol. 1998;275(6Part 1):G1386–93.

    CAS  PubMed  Google Scholar 

  109. Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010;72:272–8.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Tucker E, Sweis R, Anggiansah A, Wong T, Telakis E, Knowles K, et al. Measurement of esophago-gastric junction cross-sectional area and distensibility by an endoluminal functional lumen imaging probe for the diagnosis of gastroesophageal reflux disease. Neurogastroenterol Motil. 2013;25(11):1–7.

    Article  Google Scholar 

  111. Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA institute. Clin Gastroenterol Hepatol. 2017;15:325–44.

    Article  PubMed  Google Scholar 

  112. Ilczyszyn A, Botha AJ. Feasibility of esophagogastric junction distensibility measurement during Nissen fundoplication. Dis Esophagus. 2014;27(7):637–44.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Changi General Hospital, Singapore, Singapore

    Daphne Ang

  2. Department of Gastroenterology, Abdominal Center, St. Claraspital, Kleinriehenstrasse 30, Basel, Switzerland

    Mark Fox

  3. Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland

    Mark Fox

Authors
  1. Daphne Ang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Fox .

Editor information

Editors and Affiliations

  1. Faculty of Health Sciences and Medicine, University of Southern Queensland Faculty of Health Sciences and Medicine, Toowoomba, Queensland, Australia

    Muhammed Ashraf Memon

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Ang, D., Fox, M. (2018). Utility of Ambulatory Esophageal pH and High-Resolution Manometry in the Diagnosis of Gastro-Esophageal Reflux Disease and Hiatal Hernia. In: Memon, M. (eds) Hiatal Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-64003-7_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64003-7_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64002-0

  • Online ISBN: 978-3-319-64003-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation