Twenty-four-hour Distal Esophageal pH Monitoring and the Function of the E-C Junction : The Necessity of Manometric Study

Abstract

Twenty-four-hour distal esophageal pH monitoring (pH monitoring) is one of the most reliable methods for evaluation of gastro esophageal reflux (GER). Thirty nine patients were subjected for a comporative study of pH monitoring and esophageal manometry. The results were scored applying Johnson's scoring method. Thirty nine patients were divided into two groups (normal group and GER group) according to the value of pH score (15.44). The GER group included the patients with gastric outlet obstruction and the patients with tracheoesophageal fistula. So, the GER group was divided into the three subgroups (dys-function of E-C junction, gastric outlet obstruction and tracheoesophageal fistula). Esophageal manometry was compared among these four groups (normal, dysfunction of E-C junction, gastric outlet obstructin and tracheoesophageal fistula). The normal group showed low pH and high manometric score. The group of dysfunction of E-C junction was with high pH and low manometric score. The group of gastric outlet obstruction presented high pH and high manoraetric score. The group of tracheoesophageal fistula was with high pH score because of the esophageal dysmotility, although the number reflux episodes was small. The pH scores in the groups of gastric outlet obstruction and tracheo esophageal fistula did not directry reflect the disturbed function of E-C junction. The pH score in these types of GER is not distinguished from GER due to disfunction of the E-C junction. When an operation for GER is considered, the function of the E-C junction must be evaluated with esophageal manometry and pH monitoring in addition to clinical symptom.