Role of oesophageal manometry and pH studies in the diagnosis of endoscopy negative upper gastrointestinal disorders

Abstract

Dysphagia and symptoms of gastro-oesophageal reflux disease (GOPD) are common upper gastrointestinal (Gl) symptoms. However a significant proportion of these patients do not have any endoscopic or radiological abnormalities. Therefore, they are most often labeled as having a "motility disorder" or sometimes as "functional", without any objective assessment OBJECTIVES: To assess the oesophageal motility and the pH in symptomatic patients with normal upper Gl endoscopy results. METHODS: Twelve patients with dysphagia and four patients with symptoms of GORD were assessed (n=16) over a period of 20 months {1.1.97 to 30.8.98). Measurements were recorded using a computerized oesophageal pressure/pH transducer (Synectics, UK). RESULTS: Male:Femaie = 7:9. Median age was 52 (range 42-75) years. MotiNty studies indicated oesophageal hypomotility in 3 (19%), early achalasia 2 (13%), and normal motility in 7 (43%) patients. Twenty four hour pH monitoring revealed marked GO reflux in 2 (13%) patients and normal values in 2 (13%) patients.CONCLUSIONS: Since a significant proportion (44%) of our patients showed a positive result, we conclude that manometry and pH studies of the oesophagus are mandatory in the diagnosis of patients with persistent dysphagia and reflux symptoms as most motility disorders cannot be diagnosed only on endoscopy or radiology alone.