Utility of esophageal manometry and pH-metry in gastroesophageal reflux disease before surgery.
OBJECTIVE
The necessity of manometric evaluation before fundoplication in patients with gastroesophageal reflux disease is still a matter of debate. However, misdiagnosis can be responsible for postoperative problems. We aimed to evaluate the necessities of manometry and pH-metry before fundoplication in order to prevent possible complications after surgery.


METHODS
Between 1997 and 2004, 259 consecutive patients who referred to our laboratory with a diagnosis of gastroesophageal reflux disease and request for manometric test before surgery were evaluated retrospectively. Manometric analysis was performed in all patients and 24-hour ambulatory pH-metry in 91 of them.


RESULTS
The mean age of the patients was 42.6+/-13 years and 51% were female. While 102 (39.4%) of the patients had normal esophageal motility, 122 (47.1%) had gastroesophageal reflux-related dysmotility (22% with ineffective esophageal motility, 25.1% with hypotensive lower esophageal sphincter). Primary esophageal motility disorders were detected in 29 (11.2%) patients (4 achalasia, 24 uncoordinated contractions and 1 nutcracker esophagus). Six patients had secondary dysmotility caused by scleroderma. Pathologic reflux was detected in 54 (59.3%) patients in whom pH-metry was performed.


CONCLUSIONS
Our results support that manometry and pH-metry must be performed before surgery in gastroesophageal reflux disease.
Akyüz
Filiz
F
Department of Gastroenterohepatology, Istanbul University, Istanbul School of Medicine, Istanbul.
Arici
Serpil
S
Ermiş
Fatih
F
Mungan
Zeynel
Z
D000328:Adult; D002404:Catheterization; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000628:therapy; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D018662:Fundoplication; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies