Utility of esophageal manometry and pH-metry in gastroesophageal reflux disease before surgery (original) (raw)
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The Turkish Journal of Gastroenterology the Official Journal of Turkish Society of Gastroenterology, 2009
Gastroözofageal reflü hastalar›nda fundoplikasyon ameliyat› öncesinde manometrik de¤erlendirmenin gereklili¤i hala tart›flmal›d›r. Ancak, ameliyat sonras› problemlerden yan-l›fl tan› sorumlu olabilir. Bu çal›flmada cerrahi sonras› problemleri engellemek için fundoplikasyon öncesinde manometri ve 24 saatlik pH analizinin gereklili¤inin de¤erlendirilmesi amaç-lanm›flt›r. Yöntem: 1997-2004 y›llar› aras›nda gastroözofageal reflü nedeni ile ameliyat planlanan ve manometrik inceleme için laboratuar›m›za yönlendirilen 259 hasta retrospektif olarak de¤erlendirildi. Hastalar›n hepsine manometrik inceleme, 91'ine de 24 saatlik pH analizi yap›lm›flt›. Bulgular: Hastala-r›n ortalama yafl› 42.6±13 y›l ve %51'i kad›nd›. Hastalar›n 102'sinde (%39.4) özofagus motilitesi normal iken, 122'sinde (%47.1) reflü ile iliflkili dismotilite saptand› (%2 inefektif özofageal motilite, %25.1 hipotansif alt özofagus sfinkteri). Yirmidokuz hastada (%11.2) primer özofageal motilite bozuklu¤u oldu-¤u tespit edilirken (4 akalazya, 24 ankoordine kontraksiyonlar ve 1 nutcracker özofagus), 6 hastada sklerodermaya ba¤l› sekonder dismotilite bulundu. 24 saatlik pH analizi yap›lan has-talar›n 54'ünde (59.3%) patolojik reflü saptand›. Sonuç: So-nuçlar›m›z gastroözofageal reflü cerrahisi öncesinde manometri ve 24 saatlik pH analizi yap›lmas› gereklili¤ini desteklemektedir. Anahtar kelimeler: Gastroözofageal reflü hastal›¤›, pH metre, motilite, anti-reflü cerrahi Background/aims: 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.
Revista da Associação Médica Brasileira, 2021
OBJECTIVE: To demonstrate the need of performing esophageal pH monitoring and manometry in patients with clinical suspicion of Gastroesophageal reflux disease, as more accurate and practical complementary exams in the indication of surgical treatment. METHODS: A systematic review was carried out in the PubMed/Medline database, based on the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, selecting studies in humans, published in Portuguese,
Türk Pediatri Arşivi, 2015
Aim: In this study, we aimed to compare the superiorities of esophageal manometry, vector volume analysis and 24-hour pH meter studies in showing gastroesophageal reflux disease. Material and Methods: The files of the patients who presented to pediatric surgery and pediatric gastroenterology outpatient clinics of our hospital with suspicious gastroesophageal reflux disease between 2011 and 2012 and who were investigated were examined and 21 patients whose investigations had been completed were included in the study. The patients were evaluated by treatment method and were divided into three groups as Group 1 who were followed up with medical treatment, Group 2 in whom surgical intervention was performed and Group 3 who were not treated. Chi-square test was used in evaluation of the categorical variables, Kruskal Wallis test was used in comparison of the mean values between the groups and Dunn test was used in subgroup analyses when Kruskal Wallis test was found to be significant. A p value of <0.05 was considered statistically significant. Results: Thirteen of 21 patients included in the study were female and eight were male. The mean age of the patients was 5.71 years (one-16 years). In the 24-hour pH monitoring study, the mean reflux index was found to be 48.7% in Group 1, 42.4% in Group 2 and 28.3% in Group 3. In esophageal manometry studies, the pressure difference at lower esophageal sphincter (LES) was found to be 13,4 cm H 2 O in Group 1, 31.8 cm H 2 O in Group 2 and 4.3 cmH 2 O in Group 3. In vector volume analyses, the mean vector volume was calculated to be 96.01 cm 3 in Group 1, 2 398.9 cm 3 in Group 2 and 196.3 cm 3 in Group 3. In the 24-hour pH monitoring study, a statistically significant difference (p<0.05) was found in terms of showing reflux, whereas statistical significance could not be shown in terms of need for surgical treatment or need for medical treatment in any other method (p>0.05). Conclusions: Twenty-four-hour pH monitoring was found to be efficient in making a diagnosis of gastroesophageal reflux disease, whereas esophageal manometry and vector volume analyses were not found to be efficient.
World Journal of Surgery, 1992
Lower esophageal sphincter pressure has been assessed pre-operatively, intra-operatively, and more than 6 months postoperatively in 34 patients having antireflux surgery for gastro-esophageal reflux disease. The sphincter pressures associated with the outcome in relation to pH measured reflux and the symptoms of recurrent heartburn, gas bloating, and dysphagia have been determined. There was no significant difference between the intra-operative sphincter pressure or the postoperative sphincter pressure and any of these parameters. It is concluded that intra-operative manometry in its present form is not useful in antireflux surgery for primary gastro-esophageal reflux disease.
Intraoperative Esophageal Manometry and Fundoplications: Prospective Study
World Journal of Surgery, 1996
The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre-and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n ؍ 25) and posterior (partial) fundoplication (n ؍ 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 ؎ 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 ؎ 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.
Journal of Neurogastroenterology and Motility, 2016
Background/Aims The study aimed to determine pre-and post-fundoplication esophagogastric junction (EGJ) pressure and esophageal peristalsis by high-resolution manometry (HRM) in patients with gastroesophageal reflux disease (GERD). Methods Pre-operative and post-operative HRM data from 25 patients with GERD were analyzed using ManoView version 2.0.1. with updated software for Chicago classification and pressure topography. The study involved swallowing water boluses of 10 mL in the upright position. Results Significant increase of mean basal EGJ pressure and minimal basal EGJ pressure was found in post-operative as compared with preoperative patients (P < 0.05 and P < 0.001, respectively). Integrated relaxation pressure (IRP) reached higher values in post-operative patients than in pre-operative patients (P < 0.001). Intra-bolus pressure (IBP) was significantly higher (P < 0.05) and contractile front velocity (CFV) was slower (P < 0.01) in post-operative patients than in pre-operative patients. Moreover significant increase of distal contractile integral (DCI) was found in post-operative patients (P < 0.05). Hiatal hernia was detected by HRM in 11 pre-operative patients. Fifteen out of 25 post-operative patients complained of dysphagia. Conclusions Fundoplication restores the antireflux barrier by reinforcing EGJ basal pressures, repairing hiatal hernias, and enhances peristaltic function of the esophagus by increasing DCI. However slight IRP elevation found in post-fundoplication patients may result in bolus pressurization and motility disorders.
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2016
Patients with esophageal symptoms potentially associated to esophageal motor disorders such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal manometry in clinical practice is: (1) to accurately define esophageal motor function, (2) to identify abnormal motor function, and (3) to establish a treatment plan based on motor abnormalities. With this in mind, in the last decade, investigations and technical advances, with the introduction of high-resolution esophageal manometry, have enhanced our understanding and management of esophageal motility disorders. The following recommendations were developed to assist physicians in the appropriate use of esophageal manometry in modern patient care. They were discussed and approved after a comprehensive review of the medical literature pertaining to manometric techniques and their recent application. This position statement ...
The American Journal of Surgery, 2021
Background: The aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM). Methods: This is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded. Results: Forty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI: 5%e35%), specificity of 72% (95% CI: 52%e86%), PPV of 30% (95% CI: 11%e60%), and NPV of 50% (95% CI: 35%e66%). The accuracy was 46%, while a McNemar test showed p ¼ 0.028. Conclusion: Traditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.