title: Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a very prevalent disorder. Medical therapy improves symptoms in some but not all patients. Antireflux surgery is an excellent option for patients with persistent symptoms such as regurgitation, as well as for those with complete symptomatic resolution on acid-suppressive therapy. However, proper patient selection is critical to achieve excellent outcomes.
  
  
  METHODS
  A panel of experts was assembled to review data and personal experience with regard to appropriate preoperative evaluation for antireflux surgery and to construct an evidence and experience-based consensus that has practical application.
  
  
  RESULTS
  The presence of reflux symptoms alone is not sufficient to support a diagnosis of GERD before antireflux surgery. Esophageal objective testing is required to physiologically and anatomically evaluate the presence and severity of GERD in all patients being considered for surgical intervention. It is critical to document the presence of abnormal distal esophageal acid exposure, especially when antireflux surgery is considered, and reflux-related symptoms should be severe enough to outweigh the potential side effects of fundoplication. Each testing modality has a specific role in the diagnosis and workup of GERD, and no single test alone can provide the entire clinical picture. Results of testing are combined to document the presence and extent of the disease and assist in planning the operative approach.
  
  
  CONCLUSIONS
  Currently, upper endoscopy, barium esophagram, pH testing, and manometry are required for preoperative workup for antireflux surgery. Additional studies with long-term follow-up are required to evaluate the diagnostic and therapeutic benefit of new technologies, such as oropharyngeal pH testing, multichannel intraluminal impedance, and hypopharyngeal multichannel intraluminal impedance, in the context of patient selection for antireflux surgery.
authors: Department of Surgery, The Western Pennsylvania Hospital, West Penn Allegheny Health System, Pittsburgh, PA. Electronic address: bjobe1@wpahs.org.
authors: Blair A
authors: BA
authors: Jobe
authors: Joel E
authors: JE
authors: Richter
authors: Toshitaka
authors: T
authors: Hoppo
authors: Jeffrey H
authors: JH
authors: Peters
authors: Reginald
authors: R
authors: Bell
authors: William C
authors: WC
authors: Dengler
authors: Kenneth
authors: K
authors: DeVault
authors: Ronnie
authors: R
authors: Fass
authors: C Prakash
authors: CP
authors: Gyawali
authors: Peter J
authors: PJ
authors: Kahrilas
authors: Brian E
authors: BE
authors: Lacy
authors: John E
authors: JE
authors: Pandolfino
authors: Marco G
authors: MG
authors: Patti
authors: Lee L
authors: LL
authors: Swanstrom
authors: Ashwin A
authors: AA
authors: Kurian
authors: Marcelo F
authors: MF
authors: Vela
authors: Michael
authors: M
authors: Vaezi
authors: Tom R
authors: TR
authors: DeMeester
mesh_terms: D004724:Endoscopy; D050782:Esophageal pH Monitoring; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008365:Manometry; D018579:Patient Selection; D011300:Preoperative Care; D011856:Radiographic Image Enhancement
keywords: BE; Barrett esophagus; GERD; HMII; LA; LES; LPR; Los Angeles; MII; PPI; SAP; SI; gastroesophageal reflux disease; hypopharyngeal multichannel intraluminal impedance; laryngopharyngeal reflux; lower esophageal sphincter; multichannel intraluminal impedance; proton pump inhibitor; symptom association probability; symptom index