Preoperative Evaluation and Testing for GERD

Abstract

Diagnostic preoperative testing is necessary to establish the diagnosis of GERD, to understand the disease, to quantify the severity of the disease and to assess the esophageal function, the hiatus, and the lower esophageal sphincter. Appropriate testing also directs the surgeon to the best surgical procedure for the treatment of each individual’s GERD. Diagnostic modalities have improved over recent years, and modern technology has given us a more thorough understanding of the disease.

Radiologic studies are good screening tests that can detect anatomic lesions but are less sensitive for functional esophageal disorders. Endoscopy is necessary to rule out cancer, diagnose and evaluate (biopsy) mucosal lesions such as Barrett’s mucosa, and to evaluate and diagnose a hiatal hernia, all of which are important for the preoperative planning and surgical repair strategy. In patients where the radiologic studies are not normal, manometric testing is indicated to assess the esophageal motility. Recently high-resolution manometry has facilitated the preoperative work-up to rule out motility disorders in the diagnosis of GERD. pH monitoring is routinely used to assess esophageal acid exposure and remains the gold standard in making the diagnosis of GERD as well as determining the severity of the disease. Esophageal impedance studies are used electively in patients that cannot stop anti-acid medication prior to testing or in patients with suspicion of alkaline reflux.