Central Surgical Association| Volume 114, ISSUE 4, P780-787, October 1993

Download started.


Value of physiologic assessment of foregut symptoms in a surgical practice

      This paper is only available as a PDF. To read, Please Download here.


      Background. The aim of this study was to evaluate the reliability of symptoms in the diagnosis of gastroesophageal reflux disease and esophageal motility disorders as assessed by functional tests.
      Methods. In 365 patients referred for suspected esophageal functional disease, symptomatic assessment was compared with the results of esophageal manometry and ambulatory 24-hour pH monitoring of the distal esophagus.
      Results. Based on the patients' chief complaint, the symptomatic diagnosis was gastroesophageal reflux (44%), esophageal motor disorder (26%), chest pain of esophageal origin (9%), reflux and aspiration (8%), and abdominal pathology (12%). The symptomatic diagnosis was considerably altered by the results of the esophageal function tests: gastroesophageal reflux and motility disorders were found in all symptomatic diagnostic groups and a large number of patients in each group tested normal. The sensitivity and specificity of symptom-based diagnoses for functional disease were low.
      Conclusions. The results of this study showed that symptoms are an unreliable guide of esophageal abnormality, illustrating the need for objective testing in these patients, particularly to avoid inappropriate medical or surgical therapy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nebel OT
        • Fornes MF
        • Castell DO
        Symptomatic gastroesophageal reflux: incidence and precipitating factors.
        Am J Dig Dis. 1976; 21: 953-956
        • DeMeester TR
        • Bonavina L
        • Iascone C
        • et al.
        Chronic respiratory symptoms and occult gastroesophageal reflux.
        Ann Surg. 1990; 211: 337-345
        • Richter JE
        • Castell DO
        Gastroesophageal reflux. Pathogenesis, diagnosis, and therapy.
        Ann Intern Med. 1982; 97: 93-103
        • Zaninotto G
        • DeMeester TR
        • Schwizer W
        • et al.
        The lower esophageal sphincter in health and disease.
        Am J Surg. 1988; 155: 104-111
        • Stein HJ
        • DeMeester TR
        • Hinder RA
        Outpatient physiologic testing and surgical management of functional foregut disorders.
        Curr Probl Surg. 1992; 24: 418-555
        • DeMeester TR
        • Wang CI
        • Wernly JA
        • et al.
        Technique, indications and clinical use of 24-hour esophageal pH monitoring.
        J Thorac Cardiovasc Surg. 1980; 79: 656-670
        • Vecchio TJ
        Predictive value of a single diagnostic test in unselected populations.
        N Engl J Med. 1966; 274: 1171-1173
        • Hocking MP
        • Ryckman FC
        • Woodward ER
        Achalasia mimicking peptic esophageal stricture.
        Am Surg. 1985; 51: 563-566
        • Fuchs KH
        • DeMeester TR
        • Albertucci M
        Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease.
        Surgery. 1987; 102: 575-580
        • Castell DO
        • Richter JE
        • Dalton CB
        Esophageal motility testing.
        Elsevier Science Publishing Co Inc, New York1987
        • Stein HJ
        • DeMeester TR
        • Eypasch EP
        • Klingman RR
        Ambulatory 24-hour esophageal manometry in the evaluation of esophageal motor disorders and noncardiac chest pain.
        Surgery. 1991; 110: 753-763
        • Richter JE
        • Hackshaw BT
        • Wu WC
        Edrophonium: a useful provocative test for esophageal chest pain.
        Ann Intern Med. 1985; 103: 14-21
        • Costantini M
        • Sturniolo GC
        • Zaninotto G
        • et al.
        Altered esophageal pain threshold in irritable bowel syndrome.
        Dig Dis Sci. 1993; 38: 206-212
        • Meshkinpour H
        • Glick ME
        • Sanchez P
        • Tarvin J
        Esophageal manometry: a benefit and cost analysis.
        Dig Dis Sci. 1982; 27: 772-775
        • Bremner CG
        • Wilson M
        Value of oesophageal motility with attached pH probe in undiagnosed dysphagia. [Abstract].
        S Afr J Surg. 1987; 25: 113
        • Ruth M
        • Mansson I
        • Sandberg N
        The prevalence of symptoms suggestive of esophageal disorders.
        Scand J Gastroenterol. 1991; 26: 73-81
        • Klauser AG
        • Schindlbeck NE
        • Müller-Lissner SA
        Symptoms in gastro-oesophageal reflux disease.
        Lancet. 1990; 335: 205-208
        • Johnsson B
        • Joelsson K
        • Gudmundsson K
        • Greiff L
        Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease.
        Scand J Gastroenterol. 1987; 22: 714-718