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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2016; 7(1): 72-85
Published online Feb 15, 2016. doi: 10.4291/wjgp.v7.i1.72
Esophageal testing: What we have so far
Nicola de Bortoli, Irene Martinucci, Lorenzo Bertani, Salvatore Russo, Riccardo Franchi, Manuele Furnari, Salvatore Tolone, Giorgia Bodini, Valeria Bolognesi, Massimo Bellini, Vincenzo Savarino, Santino Marchi, Edoardo Vincenzo Savarino
Nicola de Bortoli, Irene Martinucci, Lorenzo Bertani, Salvatore Russo, Riccardo Franchi, Valeria Bolognesi, Massimo Bellini, Santino Marchi, Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 54124 Pisa, Italy
Manuele Furnari, Giorgia Bodini, Vincenzo Savarino, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16146 Genoa, Italy
Salvatore Tolone, Surgery Unit, Department of Surgery, Second University of Naples, 81100 Naples, Italy
Edoardo Vincenzo Savarino, Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
Author contributions: de Bortoli N, Martinucci I, Bertani L, Russo S, Franchi R, Furnari M, Tolone S, Bodini G and Bolognesi V provided data collection and analysis, wrote the manuscript, approved the final version of the manuscript; Bellini M, Savarino V, Marchi S and Savarino EV reviewed the manuscript and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that there is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola de Bortoli, MD, Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Lungarno Antonio Pacinotti, 43, 54124 Pisa, Italy. nick.debortoli@gmail.com
Telephone: +39-050-997448 Fax: +39-050-997395
Received: July 4, 2015
Peer-review started: July 12, 2015
First decision: September 22, 2015
Revised: December 2, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: February 15, 2016
Abstract

Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

Keywords: Gastroesophageal reflux disease, High resolution manometry, Multichannel impedance and pH, BRAVO, EndoFLIP, PEP-test, Restech

Core tip: In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of gastroesophageal reflux disease. High-resolution manometry permits a greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. The Chicago Classification V3.0 could define a hierarchic classification that accurately defines the major and minor disorders of esophageal motility. Esophageal 24-h pH-metry, especially when it is combined with impedance, is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring are able to detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. Recently, up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry, have been suggested to detect laryngopharyngeal reflux disease. Future studies are required for these techniques to evaluate their accuracy and usefulness, although the available data are promising.