title: Esophageal manometry and 24-hour pH testing in the management of gastroesophageal reflux patients.
abstract: BACKGROUND
  With rising interest in gastroesophageal reflux disease, an evaluation of the importance of manometry (M) and 24-hour pH testing (pH) for decisions regarding these patients is appropriate.
  
  
  METHODS
  Two gastroenterologists and two surgeons were presented with history and physical examination, endoscopy, histology, and esophagram data ("DATA") from 100 patients and asked to make a treatment decision. After some time, either pH or M was added to DATA, and a further decision requested. Finally, DATA plus pH plus M was presented, and a decision was requested. Decisions were evaluated for changes in medical therapy, changes between medical and surgical therapy, and changes in type of surgery offered.
  
  
  RESULTS
  Overall, 43% (173 of 400) of decisions were altered by the addition of both M and pH to DATA, with 28.5% (114 of 400) of decisions changed from medical therapy to surgery or vice versa by the addition of both tests to DATA. The addition of M alone changed decisions more often than pH alone especially with regard to the type of surgery offered (P <0.05).
  
  
  CONCLUSIONS
  Together, M and pH alter clinical decisions and often alter the decision regarding surgery. Both tests appear important, but M more frequently alters overall management decisions and the type of surgery offered. Despite the need for cost containment, these clinical tools are essential to important decisions regarding the care of patients with gastroesophageal reflux disease.
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska, USA.
authors.forename: G
authors.initials: G
authors.lastname: Perdikis
authors.forename: R J
authors.initials: RJ
authors.lastname: Lund
authors.forename: R A
authors.initials: RA
authors.lastname: Hinder
authors.forename: T R
authors.initials: TR
authors.lastname: McGinn
authors.forename: C J
authors.initials: CJ
authors.lastname: Filipi
authors.forename: N
authors.initials: N
authors.lastname: Katada
authors.forename: R
authors.initials: R
authors.lastname: Cina
authors.forename: P R
authors.initials: PR
authors.lastname: Hinder
authors.forename: S J
authors.initials: SJ
authors.lastname: Lanspa
mesh_terms: D003657:Decision Making; D004724:Endoscopy; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008365:Manometry; D010808:Physical Examination; D011446:Prospective Studies