Role of manometry and pH-metry in patients with symptoms and signs of gastroesophageal reflux disease.

To assess the correlation between esophageal manometry and 24-h pH-metry and the clinical, endoscopic and radiological picture, we carried out a retrospective analysis of the data of 175 patients in 2001-2002 with symptoms of gastroesophageal reflux disease and/or the established presence of esophagitis. The data were analyzed on the basis of the mean, standard deviation (SD) and percentage (%). Student's "t"-test was used to calculate statistical significance (P < 0.05). pH-metry was positive in 112 cases (64% R+) and negative in 63 (36% R-). Manometry revealed a significant sphincter hypotonia and a greater involvement of peristalsis in R+ patients. There was no significant relationship between symptoms and response to medical treatment compared to a positive pH-metry. Ninety-three (53%) patients presented esophagitis, while 58 (33%) had a hiatal hernia. Esophagitis was more frequent in R+ patients, while hiatal hernia was equivalent in both groups. In the diagnosis and treatment of gastroesophageal reflux disease, the first step is empirical medical therapy. If symptoms persist, esophagogastroduodenoscopy and barium radiology are performed to evaluate the presence of esophagitis and/or gastroesophageal reflux and any related diseases. Manometry and pH-metry (the gold standard for the diagnosis of gastroesophageal reflux disease) are therefore always performed in patients with atypical symptoms of patients to be subjected to surgical treatment.