Preoperative evaluation of gastroesophageal reflux disease

GERD is a common problem. If prolonged therapy is needed, the patient should have at least an endoscopy to assess for complications of GERD. If a surgical treatment is being considered, a thorough preoperative evaluation should be done to confirm the presence of pathologic GERD. Studies that should be done before a procedure include ambulatory pH testing, esophageal function testing, endoscopy, and esophagram. Nonacid ambulatory studies can be done in those who seem to be suffering from nonacid reflux with careful note of symptom correlation. Gastric emptying studies should be done if gastroparesis or gastric outlet obstruction is suspected. Esophageal motility disorders should be assessed with manometry, especially to evaluate for achalasia, which can mimic reflux.