New insights into the assessment of gastro-oesophageal reflux disease.
Surgeons now have at their disposal various techniques to investigate both function and anatomy of the foregut in patients suspected to have gastro-oesophageal reflux disease (G.O.R.D.). These are the 24-hour intraoesophageal and intragastric pH-monitoring, 24-hour intraoesophageal and intragastric bilimetry conventional oesophageal manometry, vectometry of the lower oesophageal sphincter, gastric scintigraphy scanning, upper digestive tract endoscopy, and Barium swallow study. These investigative tools permit to settle the diagnosis of excessive gastro-oesophageal reflux, to evidence the functional disorder which is at the origin of G.O.R.D., and to detect eventual complication of the latter. They also provide information for making the right choice of the approach to the gastro-oesophageal junction (transabdominal v.s. transthoracic), performing the most relevant antireflux operation (partial v.s. complete fundoplication), and identifying those patients who require a duodenal diversion procedure for concomitant duodenogastric reflux. Recent studies indicate that the concept of reflux of the gastric contents (mixture of gastric secretion, duodenal refluxate and saliva) into the oesophageal lumen should take over from the classic one of gastro-oesophageal acid reflux. Precise evaluation of the lower oesophageal sphincter competence by oesophageal vectometry permits to identify the patients who are liable to experience recurrence of their reflux symptoms when discontinuing medical therapy.
Collard
J M
JM
Louvain Medical School, Brussels, Belgium.
D001466:Barium Sulfate; D003287:Contrast Media; D016145:Endoscopy, Digestive System; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery; D004947:Esophagus / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008365:Manometry; D008991:Monitoring, Physiologic / Q000379:methods
D003287:Contrast Media; D001466:Barium Sulfate