Frantzides et al developed an algorithm to evaluate patients with evidence of gastroesophageal reflux. This can help determine if the patient is a suitable candidates for Nissan fundoplication or else requires additional evaluation. The authors are from the Medical College of Wisconsin.



(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


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