Preoperative Workup of GERD

  • Amy ChaEmail author
  • Victoria M. Gershuni


Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Due to the wide range of presentation in GERD patients with esophageal and/or extraesophageal syndromes that are common symptoms but often overlapping those of other upper gastrointestinal and cardiopulmonary disorders, a systematic approach to the preoperative workup of these patients must be undertaken to identify objective evidence of esophageal reflux prior to surgery. The workup should include upper endoscopy, barium esophagram, manometry and pH study with very few exceptions. Only after successful objective identification of pathologic acid exposure should surgery be pursued for select patients.


Gastroesophageal reflux disease GERD Esophageal symptoms Extraesophageal symptoms Mucosal injury Esophagitis Barrett’s esophagus Adenocarcinoma Upper endoscopy Barium esophagram pH testing Manometry 


  1. 1.
    Wayman J, Myers JC, Jamieson GG. Preoperative gastric emptying and patterns of reflux as predictors of outcome after laparoscopic fundoplication. Br J Surg. 2007;94:592–8.CrossRefGoogle Scholar
  2. 2.
    Mikami DJ, Murayama KM. Physiology and Pathogenesis of Gastroesophageal Reflux Disease. Surg Clin N Am. 2015:515–25.Google Scholar
  3. 3.
    Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.CrossRefGoogle Scholar
  4. 4.
    El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871–80.CrossRefGoogle Scholar
  5. 5.
    Jobe BA, Richter JE, Hoppo T, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97.CrossRefGoogle Scholar
  6. 6.
    Richter JE, Pandolfino JE, Vela MF, et al. Utilization of wireless pH monitoring technologies: a summary of the proceedings from the Esophageal Diagnostic Working Group. Dis Esophagus. 2012;26:755–65.CrossRefGoogle Scholar
  7. 7.
    Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:2647–69.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations