Gastroesophageal Reflux Disease and Antireflux Surgery—What Is the Proper Preoperative Work-up?

Abstract

The results of this study showed that (a) symptoms were unreliable in diagnosing GERD, (b) the presence of reflux or hiatal hernia on esophagogram did not correlate with reflux on pH monitoring, (c) esophagitis on endoscopy had low sensitivity and specificity, and (d) manometry was mostly useful for positioning the pH probe and rule out achalasia. Ambulatory 24-h pH monitoring should be routinely performed in the preoperative work-up of patients suspected of having GERD in order to avoid unnecessary ARS.

Gastroesophageal reflux disease in the obese: Pathophysiology and treatment

“…First, GERD is usually defined by symptoms that have a low diagnostic accuracy. 124 A higher incidence of GERD is, in fact, found in studies that defined GERD by pH monitoring. Second, GERD may be masked by a change in diet after the operation or underevaluated owing to satisfaction with weight loss.…”

Analysis of the Causes of Failed Antireflux Surgery and the Principles of Treatment

“…This is particularly essential if the patient experienced preoperatively severe dysphagia in addition to heartburn to rule out achalasia. 15 Finally, an achalasia-type picture can be caused by a tootight or long fundoplication. 32 …”

“…14 These patients are frequently labeled as having refractory GERD and they are treated for a long time with PPIs or they might undergo an antireflux operation if esophageal function tests are not performed. Bello et al 15 analyzed the sensitivity and specificity of symptoms, endoscopy, barium esophagography, and manometry as compared with ambulatory 24-hour pH monitoring in 138 patients referred for LARS. Four patients were excluded as they were found to have achalasia.…”

“…This study clearly indicated that 24-hour pH monitoring should be routinely performed as part of the preoperative workup of patients suspected of having GERD. 15 In addition, the preoperative identification of abnormal reflux by pH monitoring is predictive of a successful fundoplication. 9 Campos and colleagues 9 demonstrated that the 3 most important predictors of successful outcome of antireflux surgery are the presence of typical symptoms (heartburn and regurgitation), a good relief of symptoms with PPI therapy, and the presence of a pathologic amount of reflux as determined by pH monitoring.…”

Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease

“…The prevalence of GERD symptoms increased approximately 50% until the mid-1990s, when it plateaued. This increase in GERD is not exactly clear, but has been attributed to the increasing prevalence of obesity, changing diet, and perhaps the decreasing prevalence of Helicobacter pylori (H. pylori) infection [3,4] . Recent publications sustained earlier observations of age-related decline in the number of cholinergic neurons in the enteric nervous system.…”