[Functional esophageal exploration in the assessment of gastroesophageal reflux]

During the past decade technologic progress has led to the increase use of oesophageal function testing, which is now available in clinical current practice. Ambulatory oesophageal pH monitoring is advocated as one of the best means for assessing the reflux of acid into the oesophagus. This technique can document abnormal gastro-oesophageal reflux (GOR) in patients with atypical symptoms or no endoscopic oesophagitis. The event marker allows to establish the correlation between occurrence of reflux and symptoms. This relationship can be quantified in the form of a symptom index; 24-hours pH monitoring can indicate objective criteria to define success of medical or surgical treatment. Oesophageal manometry analyses the lower oesophageal sphincter pressure and the oesophageal peristaltic function. This technique has a high prognostic value. The lower oesophageal sphincter pressure is not significantly different in patient with GOR but a severe hypotensive value is correlated with the severity of peptic oesophagitis. Peristaltic dysfunction is not specific but also increases with the severity of reflux disease. Pre-operative oesophageal manometry is recommended for identifying patients with oesophageal motility disorders and achalasia in whom anti-reflux surgery may precipitate postoperative dysphagia. The control of postoperative manometric data may be useful in the evaluation of surgery failure or recurrence of reflux symptoms.