VALUE OF PHYSIOLOGICAL ASSESSMENT OF FOREGUT SYMPTOMS IN A SURGICAL PRACTICE

Background. The aim of this study was to evaluate the reliability of s ymptoms in the diagnosis of gastroesophageal reflux disease and esopha geal motility disorders as assessed by functional tests. Methods. In 3 65 patients referred for suspected esophageal functional disease, symp tomatic assessment was compared with the results of esophageal manomet ry and ambulatory 24-hour pH monitoring of the distal esophagus. Resul ts. Based on the patients' chief complaint, the symptomatic diagnosis was gastroesophageal reflux (44%), esophageal motor disorder (26%), ch est pain of esophageal origin (9%), reflux and aspiration (8%), and ab dominal pathology (12%). The symptomatic diagnosis was considerably al tered by the results of the esophageal function tests: gastroesophagea l reflux and motility disorders were found in all symptomatic diagnost ic groups and a large number of patients in each group tested normal. The sensitivity and specificity of symptom-based diagnoses for functio nal disease were low. Conclusions. The results of this study showed th at symptoms are an unreliable guide of esophageal abnormality, illustr ating the need for objective testing in these patients, particularly t o avoid inappropriate medical or surgical therapy.