Preoperative Manometry for Antireflux Surgery

Gastroesophageal reflux has to be taken seriously as soon as symptoms like heartburn, dysphagia, or regurgitation occur and/or when it leads to morphological damage of the esophageal epithelium, i.e., reflux esophagitis. It is not necessary that subjective symptoms correlate with morphological epithelial lesions, while on the other hand advanced organic damage may exist without any clinical signs. Prolonged contact of acid or alkaline gastroesophageal regurgitate with the epithelial lining of the esophagus is generally accepted today as the main etiological factor in the pathogenesis of reflux esophagitis. Four major factors in this concept can be differentiated [1]: 1. Degree of insufficiency of the antireflux barrier (reflux quantity) 2. Affected esophageal clearance 3. Reflux quality 4. Insufficient protection of esophageal epithelium