Role of Esopaghageal Manometry and 24 hr pH Impedance in Treatment for GERD/Acid Reflux and Other Chronic Digestive Problems

Table of Content:

• Need for Esophageal Manometry and 24-hr pH Impedance Before GERD/Hiatus Hernia Surgery
• Role of Esophageal Manometry and pH Impedance in Chronic GERD/Digestive Issues
• Benefits of Esophageal Manometry and pH Impedance in Chronic GI Problems
• Core Message

While chronic GERD and other upper GI motility problems are very common, the awareness and acceptance of esophageal manometry with 24 hr pH study in Ahmedabad, Gujarat, remain low. To the extent that people who are planning to get Surgery for Hiatus hernia and GERD are willing to get the Surgery done without thorough evaluation.

This article highlights the importance of esophageal manometry and 24-hr pH Impedance study, not only for the candidates of laparoscopic fundoplication surgery, but for all patients having long-term upper GI symptoms. These diagnostic evaluation tests go beyond confirming or disconfirming the diagnosis of common motility problems like GERD and Achalasia; these tests provide a deeper understanding of symptom origins and causes, which is essential for guiding non-surgical treatment strategies.

Necessity of esophageal manometry and 24-hr pH Impedance study before GERD/Hiatus hernia surgery, even if endoscopy clearly shows Hiatus Hernia and Reflux Esophagitis

The first question that comes to our mind is, why can’t we proceed with Surgery if the endoscopy shows hiatus hernia and reflux esophagitis? Why is it necessary to get these tests before Surgery? We need to understand these few points to get answers to these questions.

• Without a 24-hour pH impedance test, we cannot accurately confirm a GERD diagnosis or determine its severity.
• A 24-hour pH study is essential to determine whether your symptoms are caused by acid reflux or not. If you have 4-5/ multiple symptoms, some may be due to reflux, while others could be related to functional issues. This test helps us predict well which symptoms are likely to improve with Surgery and which may persist. Based on the results, we can plan post-surgery medication to manage any remaining symptoms effectively.
• Manometry helps us assess the function of your food pipe, guiding us to make necessary adjustments to the Surgery (such as the type of wrap) if needed. It also helps rule out conditions like Achalasia cardia, which are contraindications(where Surgery surely is not to be done) for fundoplication surgery.

• When we evaluate patients prior to Surgery, we change the decision regarding Surgery in an average of 3 patients out of 10. These three patients in whom we decided not to do Surgery would not have gotten good results if we had performed the Surgery. Because we arrive at an accurate diagnosis in these three patients, we can effectively treat them by changing their medications instead of performing Surgery. This also avoids unnecessary Surgery.
• Surgery alters the anatomy and physiology of the esophagus and its valve. Pre-operative tests provide important baseline documentation of your condition before Surgery. These tests are good primary documentation of your problems and would guide us in any situation where you face small or big problems in the future after surgery. This can be invaluable for understanding and managing any future problems.

Need of Esophageal Manometry and 24 hr pH Impedance Study in patients with Chronic GERD or Chronic Digestive problems with no clear need for Surgery

A lot of patients suffer from chronic GERD or GERD-like digestive and throat problems for years without proper relief. Many of these patients have undergone reports like Upper GI Endoscopy, Colonoscopy, Biopsy for H pylori, USG, and Fibroscan for Fatty liver, etc. However, despite these tests, many still find that the usual GERD treatments in Ahmedabad don’t work well for them.

Many of these patients, especially those having upper GI symptoms like heartburn, excessive burping, reflux of water or food, epigastric or chest pain or discomfort, chest heaviness, throat discomfort, Globus sensation (feeling of something stuck in the throat), palpitation and uneasiness, etc. would benefit from an upper GI evaluation in the form of esophageal manometry and 24 hr. pH Impedance study.

Esophageal Manometry and 24 hr pH Impedance Study Help in Chronic GI Problems in the Following Ways:

• Those having symptoms like heartburn and burping, having poor control with medications and near normal endoscopy, can either have severe reflux (which is poorly controlled with medications and would need Surgery for GERD) or can either have functional esophageal problems like functional heartburn or hypersensitive esophagus (which is treated by medications only, but the medications are neuromodulators and not antacid medication). Manometry and pH studies help differentiate between these two conditions, leading to a change in the treatment line. With a more accurate understanding of the problem and a proper diagnosis, very long-standing problems can be treated with excellent outcomes.

• Those patients who have chronic throat discomfort and Globus sensations, many a time, have unresolved symptoms for a long time. At times, they are diagnosed to have these problems due to GERD, on the basis that no other definitive throat problem is diagnosed, and are already treated by multiple courses of antibiotics. Many of them are also taking PPI antacids on and off without a proper understanding of how long they would need them. All such patients should get a manometry and 24-hr pH Impedance to confirm whether they are having GERD or not. If there is GERD, how severe is this GERD? Are their throat problems likely to be because of GERD? We need to understand that there are many overlapping reasons for throat problems, like chronic allergy, repeated viral infections, and the habit of chewing tobacco or smoking. Hence, it is important to confirm the diagnosis and severity of GERD to guide treatment.

• Patients having chronic or recurrent chest pain, palpitation, breathing problems, and uneasiness, and with all cardiac and lung reports to be normal, are also likely to benefit from esophageal evaluation by a manometry and 24 hr pH Impedance study.

Many patients with GERD or with some other esophageal motility disorders are likely to have these symptoms. At times, a reflux event triggers esophageal muscle spasm or a reflex tachycardia and can be confirmed by proper evaluation. A proper treatment plan (medications, with or without surgery and stress management) after a complete evaluation is highly likely to solve such chronic unsolved symptoms of such patients.

The Core Message Conveyed in the Earlier Discussions

Here is some advice for patients experiencing digestive problems:

If you are suffering from long-term upper gastrointestinal (GI) symptoms, it is important to be aware of the availability and importance of esophageal manometry with 24-hour pH and Impedance study. Many chronic digestive issues, including GERD (acid reflux), are common, but the use of these diagnostic tools is often overlooked.

If you are considering Surgery for a Hiatus hernia or GERD, it is highly recommended that you undergo both esophageal manometry and a 24-hour pH Impedance study before proceeding.

To learn why pH with impedance study is done, watch our video:

To learn how pH with impedance study is done, watch our video:

Your health journey is personal. Whether you’re dealing with GERD/Acid reflux and/or IBS, the right medical approach can make all the difference. Dr. Chirag’s approach focuses on patient education, precision, and compassionate care.

If you’re seeking the best GERD/Acid reflux, IBS, or Gastrointestinal doctor in Ahmedabad, look for a specialist who combines medical expertise with a patient-first approach. Your path to recovery starts with understanding your options and working with a trusted medical professional. Get in touch with us.

You can book a video consultation with Dr Chirag Thakkar.

Call +91-8156078064 / +91-8469327630 or contact us to fix an appointment.

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ADROIT is one of the few centers for GERD treatment that offers everything required for GERD treatment under one roof. It provides all the evaluation tests, including Endoscopy, Esophageal manometry, 24-hour pH with impedance study, and the treatment includes not only Surgery but also nutrition and psychological support along with regular follow-up for a long time, resulting in the best long-term results for our patients.

Dr. Chirag Thakkar is a gastrointestinal surgeon. He has been carrying out Gastrointestinal and weight loss surgery in Ahmedabad, Gujarat, India, for the past 18 years. Surgery for GERD, Hiatus hernia, and Obesity are his core areas of interest and expertise. Even in the case of laparoscopic hernia surgery for complex and recurrent hernias, patients recover faster with minimal post-surgery pain and the best functional outcome. He also has vast experience in laparoscopic Surgery for gallstone removal.

Dr Chirag Thakkar
Senior Gastrointestinal and Bariatric surgeon
GERD and Esophageal Motility Expert
Hernia Surgery Specialist
Founder Director of ADROIT Centre for Digestive and Obesity Surgery