Preoperative evaluation in patients with overlapping symptoms of gastroesophageal reflux disease and achalasia – the role of high-resolution esophageal manometry
DOI:
https://doi.org/10.67572/0d8dm247Keywords:
gastroesophageal reflux disease, achalasia, high-resolution manometry, Chicago Classification, preoperative evaluationAbstract
Gastroesophageal reflux disease (GERD) and achalasia are two distinct clinical entities characterized by different pathophysiological mechanisms but with considerable overlap in their clinical presentation. Symptoms such as heartburn, retrosternal chest pain, regurgitation, and dysphagia may occur in both patients with GERD and those with early-stage achalasia, thereby complicating the differential diagnosis and increasing the risk of selecting an inappropriate therapeutic approach. Accurate differentiation between these two conditions is of paramount importance during the preoperative evaluation of patients considered for antireflux surgery, as unrecognized achalasia constitutes a contraindication to conventional fundoplication and necessitates a fundamentally different surgical strategy.
High-resolution esophageal manometry (HRM) has become the gold standard for the diagnosis of esophageal motility disorders. The introduction of the Chicago Classification version 4.0 has substantially improved diagnostic accuracy by standardizing manometric criteria and enabling precise differentiation between the various subtypes of achalasia and other esophageal motility disorders. Current diagnostic algorithms recommend integrating HRM with upper gastrointestinal endoscopy, contrast esophagography, and, when indicated, functional lumen imaging probe (FLIP) to provide a comprehensive assessment of both structural and functional abnormalities of the esophagus.
This review summarizes the clinical overlap between GERD and achalasia, discusses current diagnostic approaches, and highlights the pivotal role of HRM in preoperative assessment and surgical decision-making.
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