| Theme |
The Functional Gastrointestinal Disorders -- Clinical Practice Based on the Understanding of Its Basic Mechanisms |
| Title |
Diagnostic Testing for Esophageal Motility Disorders and Gastroesophageal Reflux |
| Author |
Katsuhiko Iwakiri |
Department of Gastroenterology, Nippon Medical School |
| Author |
Yuriko Tanaka |
Department of Gastroenterology, Nippon Medical School |
| Author |
Hirohito Sano |
Department of Gastroenterology, Nippon Medical School |
| Author |
Noriyuki Kawami |
Department of Gastroenterology, Nippon Medical School |
| Author |
Mariko Umezawa |
Department of Gastroenterology, Nippon Medical School |
| Author |
Makoto Kotoyori |
Department of Gastroenterology, Nippon Medical School |
| Author |
Yoshio Hoshihara |
Department of Gastroenterology, Nippon Medical School |
| Author |
Choitsu Sakamoto |
Department of Gastroenterology, Nippon Medical School |
| [ Summary ] |
Esophageal manometry is useful in diagnosing esophageal motility disorders when dysphagia and/or non-cardiac chest pain is present but when abnormal endoscopic findings are not. It is also useful when evaluating esophageal functions in patients with gastroesophageal reflux disease (GERD). The mechanisms of acid reflux are evaluated by measuring esophageal manometry and pH concurrently. Combined esophageal and gastric pH monitoring is useful in the evaluation of esophageal and gastric acid exposure (pH<4) in patients with PPI-resistant GERD. Esophageal pH monitoring is also useful in the evaluation of the relationship between acid reflux and non-typical gastroesophageal reflux (GER) symptoms. In patients with PPI-resistant NERD, it has been reported recently that non-acid reflux is one of the major mechanisms of GER symptoms, however it is not possible for esophageal pH monitoring to detect non-acid reflux. It is essential for esophageal pH and impedance monitoring to evaluate acid reflux and non-acid reflux. Because the diameter of the pH and impedance catheter is almost the same as pH catheter, in the near future, combined esophageal pH and impedance monitoring will be substituted for esophageal pH monitoring. |