Re: reflux tests before surgery

Posted By HFHSM.D.-ym on September 19, 1998 at 22:04:33:

In Reply to: reflux tests before surgery posted by Cathy on September 18, 1998 at 13:40:53:






  Could you tell me about 24 hour PH probe what is a good or bad
number, does it hurt? also a gastric emptying, Could you also
tell me about esophagitis? what causes it, it's implications, is
it a pecurssor to Barrets esoph.? Is there a bst time of year for
reflux surgery? What other tests should be done prior to surgery?
    Thank you
     Cathy
Dear Cathy,
24 hour ambulatory pH monitoring is a test where a thin tube is placed in the nose and advanced to the lower esophagus. The tube is connected to a box and kept in place for 24 hours. During this period of time the pH (acidity [below 4] or alkalinity [above 8]) of the lower esophageal contents is measured. An event recorder is also present on this box. When you have symptoms the event recorder button is pressed. This will allow the physician who reads the study to try and correlate episodes of gastroesophageal reflux with your symptoms. The most important number is the number of gastroesophageal reflux episodes (where pH is less than 4). This test is considered the gold standard for confirming the diagnosis of GERD. It is standard to perform this test prior to considering anti-reflux surgery. Another test that is often performed is esophageal manometry. In this test a tube with a pressure transducer is placed in the nose and advanced to the lower esophagus. The pressures along the esophagus are measured. Various patterns have been identified that can suggest certain esophageal motility disorders such as achalasia. It is important to rule out achalasia prior to proceeding with anti-reflux surgery. In some cases a gastric emptying disorders need to be ruled out. This is easily done with a nuclear gastric emptying scan. A meal is ingested and the time is takes for the meal to exit the stomach is calculated using special radioisotopes. A gastric emptying time (t-1/2-the time it takes for half the meal to leave the stomach) of greater than 90 minutes is considered abnormal. However, every hospital has its own normal values.
Esophagitis means inflammation of the esophagus (foodpipe). It usually results from acid being refluxed into the lower esophagus. Chronic damage to the lower esophagus can lead to a change in the lining of the lower esophagus called Barrett's esophagus. Barrett's esophagus is considered a premalignant condition that can lead to the development of adenocarcinoma of the esophagus. Patients who have Barrett's esophagus with intestinal metaplasia should have surveillance endoscopy every 2 years or so to rule out dysplasia (glandular distortion that can be associated with early cancerous change).
The most important factor in considering anti-reflux surgery is choosing a surgeon who has plenty of experience in performing this operation. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call  1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux disease, anti-reflux surgery, pre-operative testing