THE ROLE OF 24-HOUR AMBULATORY PH-METRY AND MANOMETRY IN THE DIAGNOSIS OF NON-EROSIVE GASTROESOPHAGEAL REFLUX DISEASE
Considered to be the pathology of the 21st century, gastro-esophageal reflux disease (GERD) still poses problems of diagnosis and treatment, especially in patients with atypical symptoms. The use of esophageal manometry and 24-hour pH monitoring, especially in the case of candidates for surgical treatment, allows the identification of patients who actually benefit from this type of therapy. We analyzed a group of 65 patients investigated for typical and atypical symptoms of reflux, in which endoscopy was normal and did not respond to treatment with PPIs (proton pump inhibitors) at the maximum dose. The patients were investigated by esophageal manometry and 24-hour pH metry and the characteristics of the batch and the results of the investigations were analyzed descriptively and statistically. Most patients were in the 51-60 age group, with a slight predominance of females. During the 24 hours monitoring, there were 14 patients who showed no symptoms, and of those who reported symptoms, only 37% actually had pathological acid reflux, as demonstrated by a DeMeester score >14.7. Another 3 patients had a symptom-reflux correlation >50%, but a DeMeester score <14.7, being included in the subtype of patients with hypersensitive esophagus. 24-hour Ambulatory Ph-metry in our group showed that only one third (34%) of patients with negative endoscopy and no response to PPI treatment have reflux disease. These patients may benefit from surgery as a therapeutic option.
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