Parameters:
(1) symptoms: pyrosis, regurgitation, dysphagia, odynophagia, atypical, none
(2) changes of esophagitis seen on endoscopy
(3) evidence of reflux on upper GI imaging studies
Manometry is indicated if:
(1) abnormal motility seen on imaging studies, OR
(2) dysphagia or odynophagia present
24-hour pH monitoring is indicated if:
(1) the patient’s symptoms are atypical AND
(2) no changes are seen on endoscopy or imaging studies
Fundoplication is appropriate if one or more of the following are present:
(1) there is none to moderate dysmotility on manometry
(2) the patient has typical symptoms and no clinical evidence of dysmotility
(3) 24 hour pH monitoring shows reflux disease
Further evaluation is indicated to determine the optimum management (do not proceed to fundoplication) if:
(1) there is no evidence of reflux disease
(2) severe dysmotility is present
