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REVIEW  GERD: THE NEVERENDING STORY 

Minerva Gastroenterologica e Dietologica 2017 September;63(3):235-48

DOI: 10.23736/S1121-421X.17.02395-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Is there a role for high resolution manometry in GERD diagnosis?

Salvatore TOLONE 1 , Edoardo SAVARINO 2, Ludovico DOCIMO 1

1 Division of Surgery, Department of Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy; 2 Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy


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Gastroesophageal reflux disease (GERD) is a condition, which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. In patients with alarm symptoms or signs or in those refractory to antiacid therapy, it is indicated to perform instrumental tests to correctly diagnose GERD presence. Esophageal manometry is currently considered the gold standard test for the diagnosis of esophageal dysmotility. However, it has shown limited capability in diagnosing GERD. With the advent of high resolution manometry (HRM), more accurate evaluations of esophageal motility are now possible. Furthermore, new metrics have been developed to investigate esophagogastric junction (EGJ) morphology and function. In particular, the antireflux barrier function of EGJ can now be assessed evaluating the contraction integral of the junction. Also, transient lower esophageal relaxations can be defined more precisely with HRM. Provocative tests with multiple swallows can give additional information on peristaltic reserve. Finally, adding impedance measurement to HRM allows to detect retrograde movements (e.g. reflux) in the esophagus and to measure the baseline impedance, a novel promising metric associated to esophageal mucosal integrity. The present review will discuss the recent progresses made in evaluation of GERD patients with HRM and its potential role in diagnosing pathological reflux presence.


KEY WORDS: Manometry - Gastroesophageal reflux - Esophagogastric junction

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