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ISSN 1665-2576 (Print)

2008, Number 2

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Rev Mex Cir Endoscop 2008; 9 (2)

Usefulness of diagnosis methods for gastroesophageal reflux disease (GERD). A prospective study

Benítez BJ

Language: Spanish
References: 58
Page: 49-56
PDF size: 154.19 Kb.


ABSTRACT

Background: The Nissen funduplicature is a surgical procedure proven to control the GERD (gastroesophageal reflux disease). We communicate the sensibility and specificity of the selection criteria applied by our group for the antirreflux surgery.
Material and method: During the months from July 2003 and April 2004, we selected 42 patients: 31 female and 11 male with GERD clinical history from 8 to 276 months of evolution. These patients were selected for the laparoscopic Nissen funduplicature with preoperative studies including endoscopy, GI series, manometry and pH-metry. The most frequent symptoms were: 33 pyrosis, 22 night-time reflux cases, 15 regurgitation cases, 12 dysphagia cases, 6 odynophagia cases, 4 digestive tube bleeding cases, among others.
Results: Endoscopy did not show esophagitis in 5 patients and revealed esophagitis Grade I in 9; Grade II in 3, Grade III in 2, Grade IV in 3, Barret 6 and chronic esophagitis in 14. The size of the hernia was between 1 and 8 cm. The GI series showed reflux grade I in 16 patients, grade II in 3, Grade III in 5, Grade IV in 6 and presence of HH type 1 in 37 and without HH in 5. The preoperative manometry resulted in hypotonic Lower Esophageal Sphincter (LES) in 36 patients and normal in 6. The postoperative manometry was made in 42 cases of hypotonic LES in 6 (32%), hypertonic LES in 1(2.3%) and normal LES in 35 (84%). The preoperative pH-metry resulted abnormal in 86%. Improvement in symptom diminishment was of 100% in 36 patients, 95% in 2 patients, 90% in 1 patient and 80% in 3, this alter 6, 24 and 36 months of follow-up. Visick I 100%. Operation time varied from 45 to 240 minutes. Four re-funduplicatures and 8 combined procedures were performed: 2 hernioplasties; 3 cholecystectomies, one biliary tract exploration and 1 gastric tumor.
Conclusions: Sensibility in the endoscopy to detect an hiatus hernia is 95%, for GI series’ sensibility when detecting an hiatus hernia with gastroesophageal reflux is from 90 to 74%, for the manometry in order to prove hypotonia of the LES is 86%. It does not exist a study that by itself can give enough evidence of the GERD. However, when facing the presence and combination of typical and non-typical symptoms, the conscious study of the disease demands a good clinical practice. This must be supported in these 4 diagnosis methods as this will allow us to study associated diseases like the diverse types of gastritis, the presence of ulcerous disease referred to the Helicobacter pylori and the existence and severity of duodenal-gastric reflux that makes more damage to the esophageal mucus even in asymptomatic patients.


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