Surgical therapy for atypical symptoms of GERD: patient selection and preoperative evaluation.

Patients are selected for surgery for extraesophageal manifestations of gastroesophageal reflux disease (GERD) after medical therapy failure, medical noncompliance, or because of a desire to change from medical therapy. Preoperative assessment of patients with extraesophageal manifestations of GERD is tailored to the four types of symptoms: noncardiac chest pain, pulmonary, laryngeal, and oropharyngeal. Prior to surgery, all patients should undergo 24-hour pH testing and manometry. Indicators of a good response to surgery are an initial response to medication and positive 24-hour pH test results.