Manometric parameters in patients with suspected gastroesophageal reflux disease and normal ph monitoring
Benatti, Camille Diem [UNIFESP]
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Background: The diagnosis of gastroesophageal reflux disease (GERD) may be difficult in some cases. pH monitoring is the gold standard test for the evaluation of GERD but esophageal manometry is classically not indicated for making or confirming a suspected diagnosis of GERD. This study aims to evaluate the manometric findings in patients with suspected GERD and normal pH monitoring. Methods: 100 adult patients that underwent esophageal manometry and ambulatory pH monitoring for suspected GERD were retrospectively studied. Patients were divided in Group A: normal reflux score (n=60, 72% women, mean age 51 years) and Group B: abnormal reflux score (n=40, 70% women, mean age 54 years). Patients were questioned regarding the presence of symptoms. All patients were submitted to upper endoscopy to evaluated the presence of hiatal hernia, esophagitis and Barrett`s esophagus. Esophageal manometry and pH monitoring was performed in all patients. Results: Heartburn was more frequent in group B and epigastric pain was more frequent in the group A, while the prevalence of other symptoms was similar between groups. Abnormal endoscopy, hiatal hernia and esophagitis were more frequent in group B with significant risk for GERD. LES length and pressure were lower in patients from group B. Esophageal motility was similar between groups. Conclusions: Our results show that: (1) symptoms are unreliable to diagnose GERD, (2) abnormal endoscopy is more frequent in patients with GERD, (3) LES length and pressure are decreased in patients with GERD, and (4) patients with clinical predictors for GERD are not more likely to have manometric parameters to suggest GERD.