ESOPHAGEAL MANOMETRY AND 24-HOUR PH TESTING IN THE MANAGEMENT OF GASTROESOPHAGEAL REFLUX PATIENTS

BACKGROUND: With rising interest in gastroesophageal reflux disease, a n evaluation of the importance of manometry (M) and 24-hour pH testing (pH) for decisions regarding these patients is appropriate. METHODS: TWO gastroenterologists and two surgeons were presented with history a nd physical examination, endoscopy, histology, and esophagram data ('' DATA'') from 100 patients and asked to make a treatment decision. Afte r some time, either pH or M was added to DATA, and a further decision requested, Finally, DATA plus pH plus M was presented, and a decision was requested. Decisions were evaluated for changes in medical therapy , changes between medical and surgical therapy, and changes in type of surgery offered. RESULTS: Overall, 43% (173 of 400) of decisions were altered by the addition of both M and pH to DATA, with 28.5% (114 of 400) of decisions changed from medical therapy to surgery or vice vers a by the addition of both tests to DATA. The addition of M alone chang ed decisions more often than pH alone especially with regard to the ty pe of surgery offered (P < 0.05). CONCLUSIONS: Together, M and pH alte r clinical decisions and often alter the decision regarding surgery. B oth tests appear important, but M more frequently alters overall manag ement decisions and the type of surgery offered, Despite the need for cost containment, these clinical tools are essential to important deci sions regarding the care of patients with gastroesophageal reflux dise ase. (C) 1997 by Excerpta Medica, Inc.