Abstract
Clinicians typically make the diagnosis of gastroesophageal reflux disease (GERD) from the clinical findings and then prescribe acid-suppressing drugs. Endoscopy is usually done for persistent or severe symptoms. Esophageal function tests (EFTs: esophageal manometry and 24-hr pH monitoring) are generally reserved for patients who have the most severe disease, including those being considered for surgery. We hypothesized that EFTs are more accurate than symptoms and endoscopy in the diagnosis of GERD. This was a retrospective study undertaken in a university tertiary care center. Between October 1989 and November 1998, 822 patients with a clinical diagnosis of GERD (based on symptoms and endoscopic findings) were referred for EFTs. The patients were divided into two groups depending on whether the 24-hr pH monitoring score showed GERD (group A, GERD−; group B, GERD+). The groups were compared with respect to the incidence and severity of symptoms, presence of a hiatal hernia on barium x-rays, presence and severity of esophagitis on endoscopy, and esophageal motility. In all, 247 patients (30%) had normal reflux scores (group A, GERD−), and 575 patients (70%) had abnormal scores (Group B, GERD+). Eighty percent of group A and 88% of group B had been treated with acid-suppressing medications. The incidence of heartburn and regurgitation was similar in the two groups. Grade I–II esophagitis was diagnosed by endoscopy in 25% of group A and 35% of group B, and grade III esophagitis in 4% of group A and 11% of group B. Esophageal manometry showed that group B more often had esophageal dysmotility, consisting of a hypotensive lower esophageal sphincter and abnormal esophageal peristalsis. These data show that: (1) symptoms were unreliable for diagnosing GERD; (2) endoscopic evidence of grade I–II esophagitis was diagnostically nonspecific, and grade III was much less certain than claimed in other reports; and (3) pH monitoring identified patients with GERD and stratified them according to the severity of the disease. We conclude that esophageal manometry and pH monitoring are important in diagnosing GERD accurately. More liberal use of these tests early in patient management would avoid much improper and costly medical therapy and would help single out for special attention the patients with GERD who have the most severe disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFRENCES
Fennerty MB, Castell D, Fendrick AM, Halpern M, Johnson D, Kahrilas PJ, Leiberman D, Richter JE, Sampliner RE: The diagnosis and treatment of gastroesophageal reflux disease in a managed care environment. Suggested disease management guidelines. Arch Intern Med 156:477–484, 1996
Sonnenberg A, Delco F, El-Serag HB: Empirical therapy versus diagnostic tests in gastroesophageal reflux disease. A medical decision analysis. Dig Dis Sci 43:1001–1008, 1998
Armstrong D, Monnier P, Nicolet M, Blum Al, Savary M: The “MUSE” system. In The Esophageal Mucosa. R Giuli, GNJ Tygat, TR DeMeester, JP Galmiche (eds). New York, Elsevier, 1994
Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, Albertucci M: Ambulatory 24-H esophageal pH monitoring: Normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol 87:1102–1111, 1992
Costantini M, Crookes PF, Bremner RM, Hoeft SF, Ehsan A, Peters JH, Bremner CG, DeMeester TR: Value of physiologic assessment of foregut symptoms in a surgical practice. Surgery 114:780–786, 1993
Klauser AG, Schindlbeck NE, Müller-Lissner SA: Symptoms in gastro-oesophageal reflux disease. Lancet 335:205–208, 1990
Johnsson F, Joelsson B, Gudmundsson K, Greiff L: Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 22:714–718, 1987
Fuchs KH, DeMeester TR, Albertucci M: Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease. Surgery 102:575–580, 1987
Richter JE: Typical and atypical presentations of gastroesophageal reflux disease. The role of esophageal testing in diagnosis and management. Gastroenterol Clin North Am 25:75–102, 1996
Bytzer P, Havelund T, Møller Hansen J: Interobserver variation in the endoscopic diagnosis of reflux esophagitis. Scand J Gastroenterol 28:119–125, 1993
Tefera L, Fein M, Ritter MP, Bremner CG, Crookes PF, Peters JH, Hagen JA, DeMeester TR: Can the combination of symptoms and endoscopy confirm the presence of gastroesophageal reflux disease? Am Surg 63:933–936, 1997
Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, Richter JE: Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci 33:1127–1133, 1988
Richter JE, Castell DO: Gastroesophageal reflux. Pathogenesis, diagnosis, and therapy. Ann Intern Med 97:93–103, 1982
Patti MG, Debas HT, Pellegrini CA: Clinical and functional characterization of high gastroesophageal reflux. Am J Surg 165:163–168, 1993
Harding SM, Guzzo MR, Richter JE: 24-h esophageal pH testing in asthmatics. Respiratory symptom correlation with esophageal acid events. Chest 115:654–659, 1999
Patti MG, Arcerito M, Tamburini A, Feo CV, Safadi B, Way LW: Effect of laparoscopic fundoplication on GERD-induced respiratory symptoms. J Gastrointest Surg 4:143–149, 2000
Fouad YM, Katz PO, Hatlebakk JG, Castell DO: Ineffective esophageal motility: The most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol 94:1464–1467, 1999
Monnier P, Ollyo J-B, Fontolliet C, Savary M: Epidemiology and natural history of reflux esophagitis. Sem Lap Surg 2:2–9, 1995
Crookes PF, DeMeester TR: The diagnosis and treatment of gastroesophageal reflux disease in a managed care environment. A surgeon's response. Arch Surg 131:1021–1023, 1996
Patti MG, Arcerito M, Feo CV, Worth S, De Pinto M, Gibbs VC, Gantert W, Tyrrell D, Ferrell LF, Way LW: Barrett's esophagus: A surgical disease. J Gastrointest Surg 3:397–404, 1999
Ortiz A, Martinez de Haro LF, Parrilla P, Morales G, Molina J, Bermejo J, Liron R, Aguilar J: Conservative treatment versus antireflux surgery in Barrett's oesophagus: Long-term results of a prospective study. Br J Surg 83:274–278, 1996
Rights and permissions
About this article
Cite this article
Patti, M.G., Diener, U., Tamburini, A. et al. Role of Esophageal Function Tests in Diagnosis of Gastroesophageal Reflux Disease. Dig Dis Sci 46, 597–602 (2001). https://doi.org/10.1023/A:1005611602100
Issue Date:
DOI: https://doi.org/10.1023/A:1005611602100