Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1751
Peer-review started: January 23, 2021
First decision: February 10, 2021
Revised: February 18, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: April 28, 2021
Processing time: 87 Days and 10.9 Hours
Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.
Core Tip: The goal of this review is to discuss recent technological advancements that have utility for patients with gastroesophageal reflux disease (GERD) as a pre-operative assessment for anti-reflux surgery. Surgical treatment of GERD is centered around improving the integrity of the lower esophageal sphincter, therefore it is crucial to rule out other esophageal pathologies that may present with GERD-like symptoms. Advances in pH-impedance studies allow for assessment of patients with weak acid reflux of non-erosive reflux disease. High resolution manometry with the addition of provocative measures can uncover underlying esophageal motility disorders with GERD-like symptoms.