Preoperative evaluation of patients with gastroesophageal reflux disease.
All patients who are candidates for laparoscopic fundoplication for the treatment of gastroesophageal reflux disease (GERD) should have a symptom review, barium swallow imaging, endoscopy, esophageal manometry, and ambulatory pH monitoring. The presence of a typical primary symptom, an abnormal 24-hour pH score, and a good response to acid-suppression therapy are predictive of a successful surgical outcome. The surgeon should be particularly wary of the following types of patients who may be referred for fundoplication but not have GERD: those who do not respond to proton pump inhibitors, those without esophagitis, those with only atypical symptoms, those in whom pH monitoring was done without previous manometry, and those with a borderline reflux score, severe vomiting, severe dysphagia and heartburn, unusual symptoms, severe depression, or morbid obesity.
Patti
M G
MG
Department of Surgery and Swallowing Center, University of California-San Francisco, 94143-0788, USA. pattim@surgery.ucsf.edu
Fisichella
P M
PM
Perretta
S
S
D003680:Deglutition Disorders / Q000209:etiology; D004947:Esophagus / Q000503:physiopathology; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008365:Manometry; D018670:Monitoring, Ambulatory; D018579:Patient Selection